20060239 Ver 1_Complete File_20060227

QF VVM /F9 Michael F. Easley, Governor
Q
t
?o William G. Ross Jr., Secretary
?- North Carolina Department of Environment and Natural Resources
>
p .? Alan W. Klimek, P.E. Director
Division of Water Quality
February 27, 2006
Yadkin County
DWQ Project No. 06-0239
SR 1151 (Rudy Rd)
APPROVAL of 401 Water Quality Certification
Mr. Mike Pettyjohn, P.E.
Division Engineer, Division 11
N C Department of Transportation
Post Office Box 250
North Wilkesboro, North Carolina 28659
Dear Mr. Pettyjohn:
You have our approval, in accordance with the attached conditions and those listed below, to impact 24 linear feet of an
unnamed tributary to South Deep Creek (14 feet of new pipe and 10 feet of rip-rap) in order to pave, increase lane width,
and improve traffic safety on SR 1151 (Rudy Rd) in Yadkin County.
The project shall be constructed in accordance with your application dated February 13, 2006. After reviewing your
application, we have decided that this fill is covered by General Water Quality Certification Nos. 3404, corresponding to
the U.S. Army Corps of Engineers Nationwide Permit Numbers 14. 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.
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.
1. 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.
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.
None Caro 'na
a Amu fy
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% Recycled/10% Post Consumer Paper
February 27. 2006
DWQ# 06-0239
Page 2
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 channel or reducing the depth of the stream.
8. Disturbed floodplains 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 necessary, it must be limited to the stream bank below the high water mark, and vegetation must be
used for stabilization 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.
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.
iwar. 1vtmc rCLLyj01111, r.r.
February 27. 2006
DWQ# 06-0239
Page 3
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
Heath Slaughter, Division 11, Division Environmental Officer
DWQ Wetlands/401 Transportation Unit
DWQ Winston Salem Regional Office
DWQ Central Files
r? ?0
?Yt:}\Nl11':i N'
February 27. 2006
DWQ# 06-0239
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, an(
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, an(
other supporting materials.
Signature:
Engineer's Certification
Partial Final
Date:
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 Wate
Quality Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature
Registration No.
Date
w r

STATE OF NORTII CAROLINA
9 a
?0'f"
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY P. 0. Box 25201, Raleigh, NC 27611-5202 LYNDO TIPPETT
GOVERNOR PHONE: [phone] SECRETARY
February 13, 2006
Mr. John Thomas
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls of Neuse Road, Suite 120
Raleigh, NC 27615, ?i
Subject: Nationwide Permit 914
SR 1151 (Rudy Road)
Yadkin County, North Carolina
Project Number: 11C.099039 (DWQ Permit Fee: $200)
Dear Mr. Thomas:
The NC Department of Transportation is scheduled to grade, drain, base and pave SR 1151, Rudy
Road in Yadkin County. Total project length is approximately 1.29 miles. The roadway width
will increase from 18' to 20' and be paved. Impervious surface area will increase by 0.31 acres.
This project will require the replacement of one (1) wet pipe as shown below:

Station Number Existing Structure
Size Proposed Pipe
Size Riprap Impacts
feet Total Impacts at
this Station ft.
17+00 36'x24" 50'x48" 10 24
Total Stream Impacts = 24 feet
Construction of this project will require impacts to waters of the United States in the Yadkin
Basin. The wet pipe located at station 17+00 carries an unnamed tributary to South Deep Creek
(Class: WS:I1I). This project was reviewed for the presence of threatened and endangered species
on February 13, 2006. This project will have no effect on any federally listed endangered plant or
animal species. The State Historic Preservation Office has reviewed this project and did not
request any survey work.
The proposed project should not remove or degrade existing water quality uses. The pipe size
used will be the minimum necessary to create a safe roadway. All pipes with a slope greater than
6% will remain perched and an energy dissipator pad will be installed at the pipe outlet. By
utilizing the erosion control measures outlined in the attachments to this application, downstream
water quality standards will be protected. All appropriate BMPs will be used during construction.

P. O. Box 250, N. WILKESDORo, NC 28659
PHONE [phone] FAX [phone]
Mr. John Thomas
SR 1151, Rudy Road, Yadkin
Page 2
February 13, 2006
Attached is a Preconstruction Notification Form, plan sheets with proposed erosion control
measures, a marked county map, a marked topography map and photographs.
By copy of this letter, it is requested that Mr. Ron Linville, Mountain Region Coordinator, with
the North Carolina Wildlife Resources Comnussion comment directly to you concerning the 404
Nationwide Permit application with a copy sent to me.
By copy of this letter, I am forwarding seven (7) copies of this application package to John
Hennessy, NCDENR, Division of Water Quality, 401/Wetlands Unit, for his review. It is
requested that any comments related to the 401 certification be forwarded directly to me with a
copy sent to the US Army Corps of Engineers.
We would like to begin construction as soon as possible. If further information is required, please
let me know. Your early review and consideration will be appreciated.
Sinc rely, ,
Staci Hining
Division Environmental Specialist
Enclosures
cc: John Thomas, US Army Corps of Engineers (1 additional copy)
Ron Linville, Western Piedmont Region Coordinator, NCWRC
John Hennessy, Division of Water Quality (7 copies)
Sue Homewood, Division of Water Quality
Mike Pettyjoh n, PE, Division Engineer
Brandon «7nitaker, PE, District Engineer
Scott Gallman, County Maintenance Engineer
Heath Slaughter, Division Environmental Officer
Neil Trivette, Roadside Environmental Field Operations Engineer
Office Use Only: Form Version April 2001
2 0 0 6 0 2 3 9
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit
? Section 10 Permit
® 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: NW # 14
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name: North Carolina Department of Transportation
Mailing Address: P. 0. Box 250, North Wilkesboro, NC 28659
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: sshiningndot.state.nc.us
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: Staci Hinine. Division Environmental Specialist
Company Affiliation: North Carolina Department of Transportation
Mailing Address: P. 0. Box 250, North Wilkesboro, NC 28659
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: sshining(2adot.state.nc.u.s
Page 3 of 1 I
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: SR 1151 Rudy Road
2. T.I.P. Project Number (NCDOT Only): 11C.099039
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Yadkin Nearest Town: Yadkinville
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): See attached SR map.
5. Site coordinates, if available (UTM or Lat/Long): 17+00 DD: 36.0988° N, 80.6802° 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:
Forest/Residential/Farm
7. Property size (acres): Approximately 7.82 acres.
8. Nearest body of water (stream/river/sound/ocean/lake): UT to South Deep Creek
(Class: WS:III).
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 htth://f??o.cnr.statc.nc.us/admin/masi.)
10. Describe the purpose of the proposed work: Grade, drain, base and pave SR 1151.
Page 4 of 1 I

11. List the type of equipment to be used to construct the project: Trackhoe/backhoe, motor
grader and dump trucks.
12. Describe the land use in the vicinity of this project: Forest/Residential/F
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
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
Page 5 of I I
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 (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http //h%?cw fcnm.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:
Total area of wetland impact proposed:
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact Length of Average
Width of Perennial or
Site Number Type of Impact* Impact Stream Name**
Stream Before intermittent?
(indicate on map) (linear feet)
Impact (please specify)
Station No. 17+00 Pipe replacement 14 feet UT South Deep Creek 2.5 feet 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. USGS maps are available through the USGS at 1-800-358-9616, or online at
\k-\% -\\ u< Several Internet sites also allow direct download and printing of USGS maps (e.g., t n : n c n;_.
\\ ', etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 14 In. R. of new permanent impacts.
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact Area of
Name Type of Waterbody
Site Number Type of Impact* Impact applicable)
)
(if (lake, pond, estuary,
indicate on ma acres sound, bay, ocean, etc.
Miscellaneous rip-rap
Station No. 17+00 placement for 0.0007 UT to South Deep Creek Stream
stabilization

* List cacti impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation
Page 6 of I 1
W
v
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
teclmiques to be followed during construction to reduce impacts.
By utilizing the erosion control measures as shown in the attached drawings, adverse impacts to
streams in the area will be minimized. Since this is an existing roadway, the stream impacts
cannot be avoided. However, the replacement pipe lengths will be the minimum needed to
safely construct the paved roadway. All appropriate BMPs will be used during construction.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
Page 7 of 1
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
littp://li2o.enr.state.nc.us/nc%vetlancis/strm,-,ide.litml.
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.
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 //li2o.cnr.s?.??c.nc.ush?ry?/indc?.h?m. 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): To be determined by the COE
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federaUstate/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)
Page 8 of I I
4
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 213 .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 213 .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* Impact
(square feet Multiplier Required
Mitigation
1 3
2 1.5
Total
* Zone I extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone I.
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.
NI
XI. Storniwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Impervious surface area will increase by 0.31 acres. All appropriate best manaeement practices
for sediment and erosion control will be implemented during construction.
XII. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
Page 9 of I
4
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
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).
/c, ,e-
6
Ap'pli ant/Agent's Signature L____j 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 Union
US Army Corps of Engineers Wilkes Clay Jackson Polk Watauga
151 Patton Avenue Buncombe Cleveland Lincoln Rowan Yancey
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 Wilson
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes Yadkin
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
Page 10 of 1 I

Vicinity Map
SR 1151- Rudy Rd
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Start SR 1151
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Name: LONE HICKORY Location: 036.1043565° N 080.6821835° W
Date: 2/9/2006 Caption: SR 1151, Rudy Road
Scale: 1 inch equals 1333 feet
Copyright (C) 1998, Maptech, Inc.
7
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