20060402 Ver 1_Complete File_20061016

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0F W H rF9 Michael F. Easley, Governor
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6 William G. Ross Jr., Secretary

North Carolina Department of Environment and Natural Resources

.? Alan W. Klimek, P.E. Director
Division of Water Quality
October 16, 2006
Davie County
DWQ Project No. 06-0402 ver 2
SR 1337 (Moll Hodgson Road)
APPROVAL of 401 Water Quality Certification
Mr. Pat Ivey, P.E.
Division Engineer, Division 9
North Carolina Department of Transportation
375 Silas Creek Parkway
Winston Salem, 27127
Dear Mr. Ivey:
You have our approval, in accordance with the attached conditions and those listed below, to incur, the following impacts
in order widen, pave and improve SR 1337 (Moll Hodgson Road) in Davie County.
• 32 linear feet of new piping impacts to an unnamed tributary to Hunting Creek (20 feet of new pipe and 12 feet of
rip-rap);
• Temporary dewatering impacts.
The project shall be constructed in accordance with your application dated September 6, 2006. After reviewing your
application, we have decided that this fill is covered by General Water Quality Certification Nos. 3404 and 3366,
corresponding to the U.S. Army Corps of Engineers Nationwide Permit Numbers 14 and 33. In addition, you should
acquire any other federal, state or local permits before you proceed with your project including (but not limited to)
Sediment and Erosion Control, Non-Discharge and Water Supply Watershed regulations. This approval will expire with
the accompanying 404 federal permit. This condition supercedes, condition No. 19 in the General Certification 3404 and
condition No. 12 in the General Certification 3366.
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 Division of Water Quality (Division) and submit a new application. If the
property is sold, the new owner must be given a copy of this approval letter and certifications, 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 if
total impacts to streams (now or in the future) exceed 150 linear feet, compensatory mitigation may be required as
described in 15A NCAC 2H .0506 (h) (6) and (7). For this approval to remain valid, you must adhere to the conditions
listed in the attached certification and any additional conditions listed below.
Erosion and sediment control practices must be in full compliance with all specifications governing the proper
design, installation and operation and maintenance of such Best Management Practices in order to protect surface
waters standards:
a. The erosion and sediment control measures for the project must be designed, installed, operated, and
maintained in accordance with the most recent version of the North Carolina Sediment and Erosion Control
Planning and Design Manual.
One
N Caro a
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North Carolina Division of Water Quality 585 Waughtown Street Phone [phone] Customer Service
Internet: www.ncwaterquality.org Winston-Salem, NC 27107 FAX [phone]
An Equal Opportunity/Affirmative Action Employer - 50%a Recycled/10% Post Consumer Paper
October 16, 2006
DWQ# 06-0402 ver2
Page 2
b. The design, installation, operation, and maintenance of the sediment and erosion control measures must be
such that they equal, or exceed, the requirements specified in the most recent version of the North Carolina
Sediment and Erosion Control Manual. The devices shall be maintained on all construction sites, borrow
sites, and waste pile (spoil) projects, including contractor-owned or leased borrow pits associated with the
project.
c. For borrow pit sites, the erosion and sediment control measures must be designed, installed, operated, and
maintained in accordance with the most recent version of the North Carolina Surface Mining Manual.
d. The reclamation measures and implementation must comply with the reclamation in accordance with the
requirements of the Sedimentation Pollution Control Act.
2. There shall be no excavation from, or waste disposal into, jurisdictional wetlands or waters associated with this
permit without appropriate modification. Should waste or borrow sites be located in wetlands or streams,
compensatory mitigation will be required since that is a direct impact from road construction activities.
3. Sediment and erosion control measures shall not be placed in wetlands or waters to, the maximum extent
practicable. If placement of sediment and erosion control devices in wetlands and waters is unavoidable, they
shall be removed and the natural grade restored within six months of the completion of the project.
4. Native riparian vegetation must be reestablished within the construction limits of the project by the end of the
growing season following completion of construction.
5. Stormwater should be directed to vegetated buffer areas, grass lined ditches or other means appropriate to the site
for the purpose of pre-treating stormwater runoff, and must not be routed directly into streams. Mowing of
existing vegetated buffers is strongly discouraged, so that they may be utilized for stormwater sheet flow.
6. Placement of culverts and other structures in waters, streams, and wetlands shall be placed below the elevation of
the streambed by one foot for all culverts with a diameter greater than 48 inches, and 20 percent of the culvert
diameter for culverts having a diameter less than 48 inches, to allow low flow passage of water and aquatic life.
Design and placement of culverts and other structures including temporary erosion control measures shall not be
conducted in a manner that may result in dis-equilibrium of wetlands or streambeds or banks, adjacent to or
upstream and down stream of the above structures. The applicant is required to provide evidence that the
equilibrium is being maintained if requested in writing by DWQ. If this condition is unable to be met due to
bedrock or other limiting features encountered during construction, please contact the NC DWQ for guidance on
how to proceed and to determine whether or not a permit modification will be required.
7. All work in or adjacent to stream waters shall be conducted in a dry work area. Approved BMP measures from
the most current version of NCDOT Construction and Maintenance Activities manual such as sandbags, rock
berms, cofferdams and other diversion structures shall be used to prevent excavation in flowing water.
8. The dimension, pattern and profile of the stream above and below the crossing should not be modified.
Disturbed floodplains and streams should be restored to natural geomorphic conditions.
9. The use of rip-rap above the Normal High Water Mark shall be minimized. Any rip-rap placed for stream
stabilization shall be placed in stream channels in such a manner that it does not impede aquatic life passage.
10. If concrete is used during construction, a dry work area should be maintained to prevent direct contact between
curing concrete and stream water. Water that inadvertently contacts uncured concrete should not be discharged to
surface waters due to the potential for elevated pH and possible aquatic life and fish kills.
11. During the construction of the project, no staging of equipment of any kind is permitted in waters of the U.S., or
protected riparian buffers.
12. Heavy equipment shall be operated from the banks rather than in the stream channel in order to minimize
sedimentation and reduce the introduction of other pollutants into the stream.
13. 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 toxic materials.
14. Under no circumstances must rock, sand or other materials be dredged from the wetted stream channel under
authorization of this permit, except in the immediate vicinity of the culverts.
Nir. rat Ivey, r.n.
October 16, 2006
DWQ# 06-0402 ver2
Page 3
15. Temporary dewatering sites must be restored to preexisting conditions unless more natural geomorphic conditions
can be provided.
16. Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or adjacent to surface
waters is prohibited.
17. The permittee and its authorized agents shall conduct its activities in a manner consistent with State water quality
standards (including any requirements resulting from compliance with §303(d) of the Clean Water Act) and any
other appropriate requirements of State and Federal law. If DWQ determines that such standards or laws are not
being met (including the failure to sustain a designated or achieved use) or that State or federal law is being
violated, or that further conditions are necessary to assure compliance, DWQ may reevaluate and modify this
certification.
18. Upon completion of the project, the NCDOT shall complete and return the enclosed "Certification of Completion
Form" to notify DWQ when all work included in the 401 Certification has been completed. The responsible party
shall complete the attached form and return it to the 401/Wetlands Unit of the Division of Water Quality upon
completion of the project.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must act
within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition, 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 contact Sue Homewood at 336-771-4964 or at [e-mail].
Sincerely,
Alan W. Klimek, P.E.
Attachment
cc: John Thomas, USACE Raleigh Field Office
Diane Hampton, Division 9, Division Environmental Officer
DWQ Wetlands/401 Transportation Unit
DWQ Winston Salem Regional Office
DWQ Central Files
October 16, 2006
DWQ# 06-0402 ver2
Page 4
DWQ Project No.:
Applicant:
Project Name:
Date of Issuance of 401 Water Quality Certification:
County:
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer Rules, and any
subsequent modifications, the applicant is required to return this certificate to the 401/Wetlands Unit, North Carolina
Division of Water Quality, 1621 Mail Service Center, Raleigh, NC, 27699-1621. This form may be returned to DWQ by
the applicant, the applicant's authorized agent, or the project engineer. It is not necessary to send certificates from all of
these.
Applicant's 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:
Agent's Certification
Date:
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:
Engineer's Certification
Date:
Partial Final
I, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodically, weekly, full time) the construction of the project,for the
Permittee hereby state that, to the best of my abilities, due care and diligence was used in the observation of the
construction such that the construction was observed to be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature
Registration No.
Date
1.0AA7ra
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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPET
GOVERNOR SECRETARY
September 6, 2006
SUBJECT: Davie County - SR 1337 Moll Hodgson Road, Second Pipe Replacement
Mr. John Thomas
US Army Corps of Engineers
6508 Falls of the Neuse Road, Suite 120
Raleigh, NC 27615-6814
0 CooL-1UZ 'J . z
Dear Mr. Thomas,
In an effort to obtain the necessary permits for the subject pipe replacement, we are providing a
pre-construction notification application with supporting documentation for the work on Moll Hodgson
Road in Davie County. This is a permit for defined streams with distinct stream banks. This is the second
pipe on this road to be replaced since right of way was not available initially. There will be 20 feet of
permanent stream impacts, which are in addition to the existing pipe to be mitigated through the EEP. We
propose to replace the 42-inch, 40 feet long corrugated metal pipe with a 117-inch by 79-inch corrugated
steel pipe, 60 feet long at the same location. The longer pipe is needed to establish safe side slopes, which
will be stable. No endangered species were found on 8103/06. We believe this project can be
accomplished under Nationwide Permits 14 and 33.
During construction, which is expected to take a few days, an impervious dike will be placed
upstream and downstream of the pipe and the water will be pumped around. The banks near the pipe and
roadway slopes near the pipe will be lined with rip rap for stabilization. All disturbed areas will be re-
vegetated
By copy of this letter, we are also seeking approval from the NC Wildlife Resources Commission,
NC Department of Natural Resources - Water Quality, and the State Historic Preservation Office.
Therefore, we are submitting the enclosed material to them. For DWQ, the WBS number for this project is
9C.030038. If you have any questions, comments or need additional information after reviewing this
material, please contact me at [phone]. Thank you for your cooperation in this matter.
Sincerely,
Diane K. Hampton, P.E.
Division Environmental Engineer
Enclosures
CF: Mr. Pat Ivey, P.E., Division Engineer
Mr. John Rhyne, P.E., Davie County Maintenance Engineer
Mr. Ron Linville, NCWRC
Mr. David Brook, SHPO
Ms. Sue Homewood (1 copy), Mr. John Hennessy (7 copies) DENR - Water Quality
Division of Highways • Division Nine • 375 Silas Creek Parkway, Winston-Salem, NC 27127
Telephone [phone] Fax [phone] • Courier Box 13-12-04
Office Use Only: Form Version April 2WI
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:
® 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, 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: NC Department of Transportation - Division 9
Mailing Address: 375 Silas Creek Parkway
Winston-Salem NC 27127
Telephone Number: 336-703-6500 Fax Number: 3 3 6-703 -6693
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: Diane Hampton PE, DEO
Company Affiliation: NCDOT - Division 9
Mailing Address: 375 Silas Creek Parkway
Winston-Salem NC 27127
Telephone Number: 336-703-6500 Fax Number: 336-703-6693
E-mail Address: dkhampton ,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: SR 1337 Moll Hodgson Road (Second Pipe)
2. T.I.P. Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Davie Nearest Town: Mocksville
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): Take US 64 West from
Mocksville, go 8.5 miles, take NC 901 north, go 0.5 miles, turn right onto County Line Rd.,
go 1.8 miles, turn left onto Moll Hodgson go approx. 0.5 miles to pipe.
5. Site coordinates, if available (UTM or Lat/Long): 35.930° N 80.697° W
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application:
Rural pipe site
7. Property size (acres):
8. Nearest body of water (stream/river/sound/ocean/lake): UT to Hunting Creek
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-.hAh2o.enr.state_nc.us/admin_/maps/.)
Page 4 of 12
10. Describe the purpose of the proposed work: Site 1 - to replace 40-feet 42-inch CHIP
(corrugated metal pipe) with a 60-feet long 117-inch by 79-inch CSP fcorruuated steel pipe)
on same location.
11. List the type of equipment to be used to construct the project: standard pipe construction
equipment including a trackhoe
12. Describe the land use in the vicinity of this project: rural / wooded
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.
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
Page 5 of 12
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***
N/A

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FF,MA) 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://www . fema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: none
Total area of wetland impact proposed: none
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
indicate on ma)
Type of Impact* Length of
Impact
(linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
lease spccif?)
1 Pipe 20 addd UT to Hunting Creek 6 Perennial
1 Rip rap on banks 6 ea. bank UT to Hunting Creek 6 Perennial

" 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 t1T (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs ov. Several internet sites also allow direct download and printing of USGS maps (e.g., mrwtopozonc.coin,
www.mapcfuesl crnn, etc.). - -
Cumulative impacts (linear distance in feet) to all streams on site: _ 20 additional
Page 6 of 12
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 N/A
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g,, livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
The nine's location has a shoulder which is unsafe. The gravel road will be naved. The
NCDOT proposes to replace the 40 feet long pipe with a 60 feet long pipe to add safe shoulders.
The pipe will be buried 1 foot. Rip rap will be placed on the banks at each end of the pipe. All
efforts to insure erosion control and to minimize the placement of rip rap will be made. Natural
materials will be used to stabilize the banks where possible. Construction will be completed in a
timely fashion to not upset the natural and human community.
VIII. Mitigation
Page 7 of 12
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.enr.state.nc.us/ncwetlands/strtn ide.html.
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.
Payment will be made to the EEP for 20 feet of impacts.
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 ligp://li2o.ciir.statc.iic us/wri)/iiidex_fitin. 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):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
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
e feet)
Multiplier
Re [noon
1 3
2 1.5
Total
Acne 1 extends out JO 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
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.
N/A
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.
N/A
XM. 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
Fax: [phone] Cumberland New Hanover Scotland
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 11 of 12
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p Alan W. Klimek, P T?. Director
Division of Water Quality
April 3, 2006
Davie County
DWQ Project No. 06-0402
SR 1337 (Moll Hodgson Road)
APPROVAL of 401 Water Quality Certification
Mr. Pat Ivey, P.E.
Division Engineer, Division 9
North Carolina Department of Transportation
375 Silas Creek Parkway
Winston Salem, 27127
Dear Mr. Ivey:
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WMANDS AND ITMMWAM AWN
You have our approval, in accordance with the attached conditions and those listed below, to incur the following impacts
in order widen, pave and improve SR 137 (Moll Hodgson Road) in Davie County.
• 42 linear feet of new piping impacts to an unnamed tributary to Hunting Creek (30 feet of new pipe and 12 feet of
rip-rap);
80 linear feet stream bank stabilization impact through the placement of rip rap; and
Temporary dewatering impacts.
The project shall be constructed in accordance with your application dated March 13, 2006 and the additional information
dated March 30, 2006. After reviewing your application, we have decided that this fill is covered by General Water
Quality Certification Nos. 3404, 2495, and 3366, corresponding to the U.S. Army Corps of Engineers Nationwide Permit
Numbers 14, 13, and 33. In addition, you should acquire any other federal, state or local permits before you proceed with
your project including (but not limited to) Sediment and Erosion Control, Non-Discharge and Water Supply Watershed
regulations. This approval will expire with the accompanying 404 permit this hereby supercedes condition No. 19 in the
General Certification 3404, condition No. 15 in the General Certification 3495, and condition No. 12 in the General
Certification 3366.
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 Division of Water Quality (Division) and submit a new application. If the
property is sold, the new owner must be given a copy of this approval letter and certifications, 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 if
total impacts to streams (now or in the future) exceed 150 linear feet, compensatory mitigation may be required as
described in 15A NCAC 2H .0506 (h) (6) and (7). For this approval to remain valid, you must adhere to the conditions
listed in the attached certification and any additional conditions listed below.
Erosion and sediment control practices must be in full compliance with all specifications governing the proper
design, installation and operation and maintenance of such Best Management Practices in order to protect surface
waters standards:
a. The erosion and sediment control measures for the project must be designed, installed, operated, and
maintained in accordance with the most recent version of the North Carolina Sediment and Erosion Control
Planning and Design Manual.
NonthCaro ina
Naturally
North Carolina Division of Water Quality 585 Waughtown Street Phone [phone] Customer Service
Internet: h2o.enr.state.nc.us Winston-Salem, NC 27107 FAX [phone]
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
April 3, 2006
DWQ# 06-0402
Page 2
b. The design, installation, operation, and maintenance of the sediment and erosion control measures must be
such that they equal, or exceed, the requirements specified in the most recent version of the North Carolina
Sediment and Erosion Control Manual. The devices shall be maintained on all construction sites, borrow
sites, and waste pile (spoil) projects, including contractor-owned or leased borrow pits associated with the
project.
c. For borrow pit sites, the erosion and sediment control measures must be designed, installed, operated, and
maintained in accordance with the most recent version of the North Carolina Surface Mining Manual.
d. The reclamation measures and implementation must comply with the reclamation in accordance with the
requirements of the Sedimentation Pollution Control Act.
2. No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or riparian areas beyond the footprint of
the impacts depicted in the Preconstruction Notice Application. All construction activities, including the design,
installation, operation, and maintenance of sediment and erosion control Best Management Practices, shall be
performed so that no violations of state water quality standards, statutes, or rules occur.
3. Sediment and erosion control measures shall not be placed in wetlands or waters to the maximum extent
practicable. If placement of sediment and erosion control devices in wetlands and waters is unavoidable, they
shall be removed and the natural grade restored within six months of the completion of the project.
4. Riparian vegetation must be reestablished within the construction limits of the project by the end of the growing
season following completion of construction.
5. Stormwater should be directed to vegetated buffer areas, grass lined ditches or other means appropriate to the site
for the purpose of pre-treating stormwater runoff, and must not be routed directly into streams. Mowing of
existing vegetated buffers is strongly discouraged, so that they may be utilized for stormwater sheet flow.
6. Where practicable, culverts that are less than 48-inch in diameter should be buried to a depth equal to or greater
than 20% of their size to allow for aquatic life passage. Culverts that are 48-inch in diameter or larger should be
buried at least 12 inches below the stream bottom to allow natural stream bottom material to become established
in the culvert following installation and to provide aquatic life passage during periods of low flow. These
measurements must be based on natural thalweg depths. This may require increasing the size of the culvert to
meet flow conveyance requirements. If any of the existing pipes are perched, they shall be removed and replaced,
and re-installed correctly, unless demonstrated that this is topographically unfeasible. All waters must flow
through without freefalling or damming on either end of the culverts during low flow conditions, to maintain
aquatic life and/or fish passage.
7. The dimension, pattern and profile of the stream above and below the crossing should not be modified by
widening the stream hannel or reducing the depth of the stream.
8. Disturbed floodplai s and streams should be restored to natural geomorphic conditions.
9. Use of rip-rap for bank stabilization is to be minimized; rather, native vegetation is to be planted when practical.
If rip-rap is nece sary, it must be limited to the stream bank below the high water mark, and vegetation must be
used for stabilizion above high water. Any rip-rap used must not interfere with aquatic life passage during low
flow conditions.
10. If concrete is used, work must be accomplished so the wet concrete does not contact the stream water. This will
lessen the chance of altering the stream's water chemistry and causing a fish kill.
11. 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.
12. 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 toxic materials.
13. The presence of equipment in the channels must be minimized. Under no circumstances must rock, sand or other
materials be dredged from the wetted stream channel under authorization of this permit, except in the immediate
vicinity of the culverts.
14. Temporary dewatering sites must be restored to preexisting conditions unless more natural geomorphic conditions
can be provided.
;vir. rat Ivey, r.r..
April 3, 2006
DWQ# 06-0402
Page 3
15. All work shall be performed during low flow conditions.
16. Upon completion of the project, the NCDOT shall complete and return the enclosed "Certification of Completion
Form" to notify DWQ when all work included in the 401 Certification has been completed. The responsible party
shall complete the attached form and return it to the 401/Wetlands Unit of the Division of Water Quality upon
completion of the project.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must act
within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition, 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 contact Sue Homewood at 336-771-4964 or at [e-mail].
Sincerely,
f ?
Alan W. Klimek, P.E.
Attachment
cc: Wilmington District Corps of Engineers
John Thomas, USACE Raleigh Field Office
Diane Hampton, Division 9, Division Environmental Officer
DWQ Wetlands/401 Transportation Unit
DWQ Winston Salem Regional Office
DWQ Central Files
April 3, 2006
DWQ# 06-0402
Page 4
DWQ Project No.:
County:
Applicant:
Project Name:
Date of Issuance of 401 Water Quality Certification:
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer Rules, and any
subsequent modifications, the applicant is required to return this certificate to the 401/Wetlands Unit, North Carolina
Division of Water Quality, 1621 Mail Service Center, Raleigh, NC, 27699-1621. This form may be returned to DWQ by
the applicant, the applicant's authorized agent, or the project engineer. It is not necessary to send certificates from all of
these.
Applicant's 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:
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
Partial Final
I, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodically, weekly, full time) the construction of the project,for the
Permittee hereby state that, to the best of my abilities, due care and diligence was used in the observation of the
construction such that the construction was observed to be built within substantial compliance and intent of the 401 Water
Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature
Registration No.
Date
6. 10
STATE OF NORTH CAROLINA
9
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPET
GOVERNOR SECRETARY
March 30, 2006
SUBJECT: Davie County - SR 1337 Moll Hodgson Road Pipe Replacement - Additional
Information
Mr. John Thomas
US Army Corps of Engineers
6508 Falls of the Neuse Road, Suite 120
Raleigh, NC 27615-6814
Dear Mr. Thomas,
In an effort to provide additional information for the subject project, and as requested by
Ms. Sue Homewood of DENR on a site visit on March 29`x', we are providing additional
information. We have found it necessary to stabilize the banks of a small stream that meanders
parallel to the road. There are four places where rip rap will be needed on the stream banks. The
rip rap will be approximately 4 feet up the banks by 20 feet in length at each location to prevent
scour on the banks, and none will be placed in the stream bottom. Pictures are attached. We
believe this additional work can be accomplished under Nationwide Permit 13.
For DWQ, the WBS number for this project is 9C.030038. If you have any questions,
please contact me at [phone]. Thank you for your cooperation in this matter.
Sincerely,

Diane K. Hampton, P.E.
Division Environmental Engineer
Attachment
CF: Mr. Pat Ivey, P.E., Division Engineer
Mr. John Rhyne, P.E., Davie County Maintenance Engineer
Mr. Ron Linville, NCWRC
Mr. David Brook, SHPO
Ms. Sue Homewood DENR - Water Quality
Mr. John Hennessy DENR - Water Quality
Division of Highways • Division Nine • 375 Silas Creek Parkway, Winston-Salem, NC 27127
Telephone [phone] • Fax [phone] • Courier Box 13-12-04
Moll Hodgson Road
Division of Highways • Division Nine • 375 Silas Creek Parkway, Winston-Salem, NC 27127
Telephone [phone] • Fax [phone] • Courier Box 13-12-04
Mrn
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STATE OF NORTH CAROLINA
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J,C?2jdtyTF ?t h'
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPET
GOVERNOR SECRETARY
March 13, 2006
SUBJECT: Davie County - SR 1337 Moll Hodgson Road Pipe Replacement
Mr. John Thomas
US Army Corps of Engineers
6508 Falls of the Neuse Road, Suite 120
Raleigh, NC 27615-6814 060402
Dear Mr. Thomas,
In an effort to obtain the necessary permits for the subject pipe replacement, we are providing a
pre-construction notification application with supporting documentation for the work on Moll Hodgson
Road in Davie County. This is a permit for defined streams with distinct stream banks. There will be 30
feet of permanent stream impacts, which are in addition to the existing pipe to be mitigated through the
EEP. We propose to replace the 54-inch, 30 feet long corrugated metal pipe with a 72-incli corrugated steel
pipe, 60 feet long at the same location. The longer pipe is needed to establish safe side slopes, which will t
be stable. No endangered species were found on 12/09/05. We believe this project can be accomplished
under Nationwide Permits 14 and 33.
During construction, which is expected to take a few days, an impervious dike will be placed
upstream and downstream of the pipe and the water will be pumped around. The banks near the pipe and
roadway slopes near the pipe will be lined with rip rap for stabilization. All disturbed areas will be re-
vegetated
By copy of this letter, we are also seeking approval from the NC Wildlife Resources Commission,
NC Department of Natural Resources - Water Quality, and the State Historic Preservation Office.
Therefore, we are submitting the enclosed material to them. For DWQ, the WBS number for this project is
9C.030038. If you have any questions, comments or need additional information after reviewing this
material, please contact me at [phone]. Thank you for your cooperation in this matter.
Respectfully,
Diane K. Hampton, P.E.
Division Environmental Engineer
Enclosures
CF: Mr. Pat Ivey, P.E., Division Fngineu
Mr. John Rhyne, P.P., Davie County Maintenance Engineer
Mr. Ron Linville, NCWRC
Mr. David Brook, SI IPO
Ms. Sue I to newood (t copy), Mr. John Hennessy (6 copies) DENR - Water Quality
Division of Highways • Division Nine • 375 Silas Creek Parkway, Winston-Salem, NC 27127
Telephone [phone] • Fax [phone] • Courier Box 13-12-04
Office Use Only: Form Version April 2001
20060 402
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, 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: ?
II. Applicant Information
Owner/Applicant Information
Name: NC Department of Transportation - Division 9
Mailing Address: 375 Silas Creek Parkway
Winston-Salem, NC 27127
Telephone Number: 336-703-6500 Fax Number: 336-703-6693
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: Diane Hampton, PE, DEO
Company Affiliation: NCDOT - Division 9
Mailing Address: 375 Silas Creek Parkway
Winston-Salem NC 27127
Telephone Number: 336-703-6500 Fax Number: 336-703-6693
E-mail Address: dkhamptonAdot.state.nc.us
Page 3 of 12
III. Project Information
7
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 1337 Moll Hodgson Road
2. T.I.P. Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Davie Nearest Town: Mocksville
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): Take US 64 West from
Mocksville, go 8.5 miles take NC 901 north go 0.5 miles turn right onto County Line Rd
go 1.8 miles, turn left onto Moll Hodgson go approx 0.5 miles to pipe
5. Site coordinates, if available (UTM or Lat/Long): 35.930°N 80.697° W
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application:
Rural pipe site
Property size (acres): N/A
8. Nearest body of water (stream/river/sound/ocean/lake): UT to Hunting Creek
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: Site 1 - to replace 30-feet 54-inch CMP
(corrugated metal pipe) with a 60-feet long 72" CSP (corrugated steel pipe) on same
location.
11. List the type of equipment to be used to construct the project: standard pipe construction
equipment including a trackhoe

12. Describe the land use in the vicinity of this project: rural / wooded
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.
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
Page 5 of 12
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***
N/A

List each impact separately and identity temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year tloodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FF,MA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://www.fcma gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: none
Total area of wetland impact proposed: none
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)
I Pipe 30 addtl UT to Ifunting Creek 6 Perennial
1 Rip rap on banks 6 ea. bank UT to Ifunting Creek 6 Perennial

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. IISGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.to ozonc.com,
www.manquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 30 additional
Page 6 of 12
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 N/A
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
The nine's location has a shoulder which is unsafe. The gravel road will be paved. The
NCDOT proposes to replace the 30 feet long pipe with a 60 feet long pipe to add safe shoulders.
The pipe will be buried 1 foot. Rip rap will be placed on the banks at each end of the pipe. All
efforts to insure erosion control and to minimize the placement of rip rap will be made. Natural
materials will be used to stabilize the banks where possible. Construction will be completed in a
timely fashion to not upset the natural and human community.
VIII. Mitigation
Page 7 of 12
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.enr.state.nc.us/ncwetiands/strmj?,ide.htmi.
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.
Payment will be made to the EEP for 30 feet of impacts
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 hup://112o.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):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
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
(square feet Multiplier Required
Mitigation
1 3
2 1.5
Total
lone 1 extends out 30 feet perpendicular from near bank of channel; Gone 2 extends an
additional 20 feet from the edge of lone 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.
N/A
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.
N/A
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.
N/A
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 / v 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 Beilic Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 1 1 of 12
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