20052238 Ver 1_Complete File_20060103

Certificate of Completion 1??,rf
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DWQ Protect No. D 5- a 2 3 8 County: L nco In Rkl
cy
Applicant: At C- 0O-r
Project Name: '14 Wy I5-0
Date of Issuance of 401 Water Quality Certification: _TO.Y--, uas' y 3 a--o 0
Upon completion of all work approved within the 401 Water Quality Certification and 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, M, C . 1-k1 d e/ , 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
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: - /S -OCR
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
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:
If this project was designed by a Certified Professional
I, , as a duly registered Professional
(i.e., Engineer, Landscape Architect, Surveyor, etc.) 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 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:
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Mr. Mike Holder, P.E.
NCDOT Division 12
P.O. Box 47
Shelby, NC 28151
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
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APPROVAL of 401 Water Quality Certification with Additional Conditions
Dear Mr. Holder:
Alan W. Klimek, P.E. Director
Division of Water Quality
January 3, 2006
DWQ# 05-2238
Lincoln County
You have our approval, in accordance with the attached conditions and those listed below, to permanently
impact 10 linear feet (If) of Lick Run Creek (a-perennial stream) to stabilize a culvert embankment and
construct a rock ladder and floodplain bench as described in your application received by the Division of Water
Quality (DWQ) on December 27, 2005. The location of the project is Highway 150 near Lincolnton in Lincoln
County. After reviewing your application, we have determined that this project is covered by Water Quality
General Certification Number 3404: This certification corresponds to Nationwide Permit 14 issued by the U.S.
Army Corps of Engineers (USACE). Please note that you should get any other federal, state or local permits
before proceeding with your project, including those required by (but not limited to) Sediment and Erosion
Control, Non-Discharge, and Water Supply Watershed regulations.
This approval is valid solely for the purpose and design that you described in your application (unless modified
below) and will expire with the associated USACE permit unless otherwise specified in the Water Quality
certification. Should your project change, you must notify the DWQ in writing and you may be required to
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 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 those listed
below:
1. The floodplain bench should be installed to restore natural channel dimensions. The bench should be
constructed of natural materials for bench stability.
2. The rock ladder shall be installed in such a manner that the original stream profiles are not altered (i.e., the
depth of the channel must not be reduced by a widening of the streambed). A representative from the North
Carolina Department of Transportation (NCDOT) environmental staff shall be present on site during the
construction of the floodplain bench and rock ladder to provide guidance to the NCDOT Maintenance
Personnel and/or selected contractor.
3. Riprap must not interfere with thalweg performance and aquatic life passage during low flow conditions.
North Carolina Division of Water Quality 610 East Center Avenue, Suite 301
Internet: h2o.enr.state.nc.us Mooresville, NC 28115
Phone [phone]
Fax [phone]
Nm
o hCarolina
Naturally
An Equal Opportunity/Affirmative Action Employer - 50% Recycledl10% Post Consumer Paper
Page 2
4. The presence of equipment in the channel must be minimized. Under no circumstances must rock, sand or
other materials be dredged from the wetted stream channel.
5. Heavy equipment must be operated from the banks rather than in the stream channel, when possible, in
order to minimize sedimentation and reduce the likelihood of introducing other pollutants into the stream.
6. Temporary dewatering sites must be restored to pre-existing conditions unless more natural geomorphic
conditions can be provided.
7. No live or fresh concrete shall come into contact with waters of the state until the concrete has hardened.
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. 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.
10. All work shall be performed during low or normal flow conditions.
11. Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or adjacent to
surface waters is prohibited.
12. Erosion and sediment control practices must utilize Best Management Practices (BMPs) and be. in full
compliance with all specifications governing the proper design, installation, and operation and maintenance of
such BMP in order to protect surface water standards:
a. 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 pit sites, and waste pile (spoil) projects, including
contractor-owned or leased borrow pits associated with the project.
b. 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.
C. The reclamation measures and implementation of these measures must be in accordance with the
requirements of the Sedimentation Pollution Control Act.
13. Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or adjacent to
surface waters is prohibited.
14. 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 30 days after the Division of Land Resources has
released the project.
15. The NCDOT and its contractors and/or agents shall not excavate, fill or perform mechanized land clearing at
any time in the construction or maintenance of this project within waters and/or wetlands, except as,
authorized by this Certification, or any modification to this Certification (e.g., no work shall occur outside of
the footprint of the plans provided). In addition, there shall be no excavation from or waste disposal into
jurisdictional wetlands or waters associated with this Certification without appropriate modification. If this
occurs, compensatory mitigation may be required since it is a direct impact from road construction activities.
1
Page 3
16. Upon completion of the project, the applicant shall complete and return the enclosed "Certificate of
Completion" form to notify DWQ when all work included in the 401 Certification has been completed. Please
include photographs upstream and downstream of the structure to document correct installation.
17. Continuing Compliance. NCDOT shall conduct its activities in a manner so as not to contravene any state
water quality standard [including any requirements for compliance with section 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 to include conditions appropriate to assure compliance with such standards and
requirements in accordance with 15 A NCAC 2H.0507(d). Before codifying the certification, DWQ shall notify
NCDOT and the USACE, provide public notice in accordance with 15A NCAC 2H.0503, and provide
opportunity for public hearing in accordance with 15A NCAC 2H.0504. Any new or revised conditions shall
be provided to NCDOT in writing, shall be provided to the USACE for reference in any permit issued pursuant
to Section 404 of the Clean Water Act, and shall also become conditions of the 404 Permit for 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 that
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 Polly Lespinasse in the Mooresville Regional Office at 704-663-
1699.
Sincerely,
for Alan W. Klimek, P. E.
Attachments
cc: Steve Lund, USACE Asheville Field Office
Rob Ridings, DWQ Wetlands Unit
Central Files
File Copy
as ANE°
@Ww`?Y
STATE of NORTH CAROLINA
052238
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY DIVISION OF HIGHWAYS LYNDO TIPPETT
GOVERNOR SECRETARY
December 19, 2005
Mr. John Hennessy
Division of Water Quality
401/Transportation Permitting Unit
1650 Mail Service Center
Raleigh, N. C. 27699-1650
R19@[R0W[2@
DEC 2 7 2005
iNETLANOSAN STORMWAM BRANCH
SUBJECT: Riprap stabilization at culvert wingwall and Rock Ladder construction at perched culvert
outlet, Hwy 150, Lincoln County
Dear Mr. Hennessy:
The North Carolina Department of Transportation requests authorization to repair a sloughing
embankment at a culvert wingwall. Riprap will be placed below average high water for -10 linear feet
downstream of the culvert. Seeding and matting will be utilized on the repaired slope above the average
high water. The existing culvert is perched and there is sheet flow through the culvert. The culvert is in
acceptable condition and there are no immediate plans to replace the culvert. In an attempt to provide
aquatic passage, a `rock ladder' will be constructed at the outlet of the perched pipe. One layer of rock
will be placed vertically against the culvert outlet. The rock will be embedded into the streambed and a
portion will extend slightly above the culvert invert (2-4 inches). The rock will be placed with spaces
between each rock to allow continuous flow, however, we are also attempting to facilitate deposition of
bed material in the culvert behind the rock structure. A second layer of rock will be installed horizontally
immediately downstream of the culvert. This rock will also be embedded into the streambed and will I
served as energy dissipation for flow exiting the culvert as well as a `rock ladder'. The scope of the work
will permanently impact the jurisdictional waters associated with Lick Run Creek, which is classified as
Class C waters by the Division of Water Quality.
This office has conducted a GIS and field survey for this project and is recommending a finding of "no
effect" for T &E species and historical structures. Hwy 150 is a rural/urban arterial; however the proposed
project is not located within %a mile of a critical watershed area, therefore, hazardous spill basins are not
required. Enclosed is the NCDOT hazardous spill basin checklist.
I have enclosed a PCN application for the Division of Water Quality's WQC#3404 (NW #14) for
permanent fill impacts associated with linear transportation crossings, sketches of planned activities,
photographs documenting existing conditions, and location maps relative to the project.
Hwy 150
Embankment Stabilization
Page 2
Project information for the 401 Automated Payment Procedure is as follows:
0 Work order number: 150463-55120005-12B.105511-4671
• TIP #: NA
• Project Category $200.00 Fee
If you have any questions or concerns, please feel free to contact me at [phone]. Thank you for
your time and consideration to this matter.
Respectfully yours,
M.L. Holder, P.E.
Division Engineer
Twelfth Division
BY:
Trish Simon
Division 12 Environmental Supervisor
Enclosures
Cc: Polly Lespinasse, DWQ, Mooresville Regional Office
Ron Linville, Wildlife Resources Commission (Courtesy Copy)
Office Use Only: Form Version May 2002
20052238
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. Processing
1. Check all of the approval(s) requested for this project:
? Section 404 Permit ?Riparian or Watershed Buffer Rules
? Section 10 Permit ?Isolated Wetland Permit from DWQ
® 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NW #14 MC#3404)
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 (verify availability with NCWRP prior to submittal of PCN),
complete section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
11 Applicant Information
1. Owner/Applicant Information
Name: Mike Holder, N.C. Department of Transportation
Mailing Address: P.O. Box 47
Shelby, North Carolina 28151
Telephone Number: 704-480-9020 Fax Number: 704-480-5401
E-mail Address:
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: Trish Simon
Company Affiliation: N.C. Department of Transportation
Mailing Address: P.O. Box 47
Shelby, North Carolina 28151
Telephone Number: 704-480-9044 Fax Number: 704-480-5401
E-mail Address: tsimon(a?dot.state.nc.us
Page 1 of 8
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: Bank Stabilization around wingwall & Outlet Rip M Placement {"Rock
ladder) for verched nine condition at Culvert on Hwy 150.
2. T.I.P. Project Number or State Project Number (NCDOT Only): 12B.105511.
3. Property Identification Number (Tax PIN): NA
4. Location
County: Lincoln Nearest Town: Lincolnton
Subdivision name (include phase/lot number): NA
Directions to site (include road numbers, landmarks, etc.): Travel Hwv 150 East from -1.5
miles to culvert.
5. Site coordinates, if available (UTM or Lat/Long): 35'30'00"N/81'11'18"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. Property size (acres): <0.10 (NCDOT right of way).
7. Nearest body of water (stream/river/sound/ocean/lake): Lick Creek, Class C Waters
(from source to Leepers Creek).
8. River Basin: Catawba
(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/mgps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the
project at the time of this application:Existing Conditions --Culvert on paved primary
highway. The road embankment around the culvert wingwall is sloughing and needs
stabilization before full shoulder failure occurs. General Land Use- Wooded, Residential.
Page 2 of 8
10. Describe the overall project in detail, including the type of equipment to be used:
Stabilization of road embankment around wingwall with riprap below average high water
and mattinglseeding above average high water. The existing culvert is perched. A rock
ladder is to be constructed and will be placed in a manner to facilitate deposition of bed
material in the culvert but also allow some aquatic passage. A trackhoe will be used during
construction.
11. Explain the purpose of the proposed work: The purpose of the project is to repair the
embankment at the left wingwall and also to install a "rock ladder" at the perched outlet.
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.
NA
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
No permit requests are anticipated at this site in the immediate future.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Provide a written description of the proposed impacts: Class II 6prap will be used around
the wing-wall for structuretembankment stabilization and will extend approximately 10
linear feet downstream. Seeding and mattin, will be used for stabilization above average
high water. The existing culvert is perched and there is sheet flow through the culvert A
"rock ladder" will be constructed at the outlet of the perched pine. One layer of rock will
Page 3 of 8
be placed vertically against the culvert outlet. The rock will be embedded into the
streambed and a portion will extend slightly above the culvert invert (?24 inches). The
rock will be placed in such a manner to allow aquatic passage, but we are also attempting to
facilitate deposition of bed material in the culvert. A second layer of rock will be installed
horizontally immediately downstream of the culvert. This rock will also be embedded into
the streambed and will served as energy dissipation for flow exiting the culvert as well as a
rock ladder to allow some aquatic passage.
2. Individually list wetland impacts below: NO WETLAND EMPACTS
Wetland Impact
Site Number
(indicate on map)
Type of Impact* Area of
Impact
(acres) Located within
100 year Floodplain**
es/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized
clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both
structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance
Rate Maps (FIRM), or FEMA-approved local floodplam 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.) Indicate if wetland is isolated (determination of isolation to be made by USACE
only).
List the total acreage (estimated) of all existing wetlands on the property:
Total area of wetland impact proposed: 0
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact Length of Average Width Perennial or
Site Number Type of Impact* Impact Stream Name** of Stream Before Intermittent?
(indicate on map) (linear feet) Impact (please specify)
Class H riprap on
embankment at
10 feet
1 wingwall for (maximum) Lick Run Creek 8 Perennial
stabilization and
rock ladder
* 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/gam), stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation,
ditching/straightening, etc. H stream relocation is proposed, plans and profiles showing the linear footprint for both the
original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to
the nearest downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-
9616, or online at www.usgs.-gov. Several internet sites also allow direct download and printing of USGS maps (e.g.,
www.topozone.com, www.Mgpquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: Permanent Riprap
Impacts =10 feet
Page 4 of 8
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any water of the U. S. below: 0
Open Water Impact Area of Name of Waterbody Type of Waterbody
Site Number Type of Impact* Impact (if applicable) (lake, pond, estuary, sound,
indicate on ma acres bay, ocean, etc.

• List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation,
dredging, flooding, drainage, bulkheads, etc.
5. Pond Creation: NO POND IMPACTS
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 safety of the travelling public must be maintained. The sloughing embankment around the
wnzgvvall could cause bank failure; therefore, reconstruction and structure stabilization is
necessary. The culvert is currently perched and is not due to be replaced at any time in the near
future. The rock ladder is being constructed to allow some aquatic passage until such time.
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.
Page 5 of 8
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/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.
MITIGATION NOT ANTICIPATED.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP
at [phone] to determine availability and to request written approval of mitigation
prior to submittal of a PCN. For additional information regarding the application process
for the NCWRP, check the NCWRP website at http://h2o.enr.state.nc.us/wrp/index.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet):
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 (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ® No ?
Page 6 of 8
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 (required by DWQ)
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:
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* I Impact^.` I Multiplier I *Required
I
1.5
Total I
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement,
Preservation or Payment into the Riparian Buffer Restoration Fund). Please attach all
appropriate information as identified within 15A NCAC 2B .0242 or .0260.
NA
Page 7 of 8
XI. Stormwater (required by DWQ)
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.
No increase in impervious surface is ,proposed.
XU. Sewage Disposal (required by DWQ)
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.
No wastewater is generated from the project.
XUL Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
NA
Applicaut/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 8 of 8

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Name: MAIDEN (NC) Location: 035° 30'00.69" N 081° 11' 18.50" W
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Scale: 1 inch equals 1000 feet C Waters, Catawba River Basin
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NCDOT
HAZARDOUS SPILL BASIN CHECKLIST
Division:/ County: Lih4dr, Project ID: 1Z6,1jQ.56*11
River Basin: 1?42 4mabl Bridge No: eox
Route: Ale _/5Z Stream: 1-1.k& -an 6tee
Water Quality Criteria: Class 'C"
Yes No
Stream Crossing Blue Line On USGS f! R
ORW F R7
WSI F R-
WS H,III OR IV, Crossing Within 0.5mi of W. S. Critical Area r- r---'
Roadway Criteria:
Route Designation-
Yes No
Arterial Urban r F`
Arterial Rural R R!
Additional Site Information:
Yes No
Is a Hazardous Spill Basin Required? R F7
Criteria Based Upon NCDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997).