20051706 Ver 1_Complete File_20050914

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DWQ Project No.: 2-00-5-170C
Applicant: _
Project Name:
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
County: He/-f i:or'q
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Date of Issuance of 401 Water Quality Certification:
-1H--o -
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: '??Zj ?t6
Agent's Certification
1, , 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
Date:
Partial Final
1, , 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.
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hCarolina
Transportation Permitting Unit Xturallf
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] /FAX [phone] / Intemet httpl/h2o enr state nc.us/ncwetlands
An Equal Opportunity/Affirmative Action Employer- 50% Recycled110% Post Consumer Paper
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DWQ Project No.: 2oos-Z 1,1-6
Applicant: - N-EnnT
Project Name:
County: Fete ? 1 ?-,
SDO Sa SouC r 9
Date of Issuance of 401 Water Quality Certification: -x,3-06
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
1, 4/1/& 1- , 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: 11A 1/L
Agent's Certification
1, , 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:
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
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
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None Carolina
Transportation Permitting Unit Naturally
1650 Mail Service Center, Ralegh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] FAX [phone] Internet http'//h2o.enr.state.nc.us/ncwetlands
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September 14, 2005
Hertford County
DWQ Project No. 20051706
APPROVAL of 401 Water Quality Certification with Additional Conditions
Mr. Anthony Roper, P.E.
NCDOT, Division 1
113 Airport Drive Suite 100
Edenton, NC 27932
Dear Mr. Roper:
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You have our approval, in accordance with the attached conditions and those listed below, for the following impacts:
Site Number Type of Impact Wetland Impacts
Site 1 Fill 0.095 acres
The project shall be constructed in accordance with your application dated received September 8, 2005 for the
purpose of filling a scour hole around Bridge # 137 on SR 1311 (Boone's Bridge Road) in Hertford County. After
reviewing your application, we have decided that this fill is covered by General Water Quality Certification Number
3402. This certification corresponds to the Nationwide Permit 18 issued by the Corps of Engineers. 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, unless otherwise specified in the Water Quality Certification.
This approval is valid solely for the purpose and design described in your application (unless modified below).
Should your project change, you must notify the DWQ and submit a new application. If the property is sold, the
new owner must be given a copy of this Certification and approval letter, and is thereby responsible for complying
with all the conditions. If total wetland fills for this project (now or in the future) exceed one acre, or of total
impacts to streams (now or in the future) exceed 150 linear feet, compensatory mitigation may be required as
described in 15A NCAC 2H .0506 (h) (6) and (7). For this approval to remain valid, you must adhere to the
conditions listed in the attached certification.
1.) 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 40 ]/Wetlands Unit of the Division of
Water Quality upon completion of the project.
2.) 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.
3.) Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or adjacent to surface
waters is prohibited.
4.) All work shall be performed during low or normal flow conditions.
5.) A copy of this Water Quality Certification shall be posted on the construction site at all times. In addition, the
Water Quality Certification and all subsequent modifications, if any, shall be maintained with the Division
Engineer and the on-site project manager.
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N. C. Division of Water Quality 943 Washington Square Mall Washington, N.C. 27889 Telephone [phone]
FAX [phone]
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
6.) The outside buffer, wetland or water boundary located within the construction corridor approved by this
authorization shall be clearly marked by highly visible fencing prior to any land disturbing activities. Impacts
to areas within the fencing are prohibited unless otherwise authorized by this certification.
7.) Riparian vegetation must be reestablished within the construction limits of the project by the end of the growing
season following completion of construction.
8.) There shall be no excavation from or waste disposal into jurisdictional wetlands or waters associated with this
permit without appropriate modification of this permit. Should waste or borrow sites be located in wetlands or
stream, compensatory mitigation will be required since it is a direct impact from road construction activities.
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, P.O. Box 27447,
Raleigh, N.C. 27611-7447. 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 Garcy Ward at [phone].
Sincerely,
AA ann a W. Khme P. .
Attachment
cc: Wilmington District Corps of Engineers
Mr. Bill Biddlecome, US Army Corps of Engineers, Washington Field Office
MyClay Willis, Division 1 Environmental Officer, NCDOT
V; r. Rob Ridings, NCDWQ, Wetlands/401 Unit
Central Files
File Copy
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STATE OF NORTH CAROLINA °S9??SgTF ??/ij}.
DEPARTMENT OF TRANSPORTATION T??R?;;q<,,f
MICHAEL F. EASLEY LYNDO ETT
GOVERNOR SECRETAR h
August 31, 2005
Division of Water Quality
934 Washington Square Mall
Washington, N.C. 27889-1000
Attention: Garcy Ward

Subject: NW 18 request for scour hole repair for Bridge #137 on SR 1311 (Boone's Bridge Road) in
Hertford County.
The North Carolina Department of Transportation is requesting a NW 18 permit for scour hole
repair on SR 1311 (Boone's Bridge Road) in Hertford County. The bridge is located approximately 0.1
miles west of SR 1312. The bridge pilings are 40' in total length. The scour hole is 13' at its deepest point
around the pilings. It is 10' from the bridge caps to the surrounding wetlands. This only leaves 17' of
cover for the affected bridge pilings. NCDOT is concerned these pilings are reaching their critical scour
level. NCDOT would like to use clean fill to bring scour hole to the same elevation as surrounding
wetlands. Fill will be dumped from dump trucks over the side of the bridge. Fill will be graded and spread
over scour hole using a bobcat. The material will be spread in such a way to prevent material from entering
adjacent wetlands.
There are no anticipated wetland impacts with this pipe replacement. The PCN, vicinity maps,
and permit drawings are included with this letter. If you need any additional information or have any
questions concerning this project please call me at 252-482-7977.
Sincerely,
Anthony Roper, PE
Division One Engineer
Clay Willis
Division One Envi nmental beer
Cc: Bill Biddlecome, USACOE
Rob Ridings, DWQ
Scour Hole Location on SR 1311 (Boone's Bridge Road) in Hertford County
located in the Chowan River Basin. 24k Quad Name- Boykins.
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Office Use Only: Form Vcrsion May 2002
20051 700
USACE Action ID No. DWQ No.
(itany particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. 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 18
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: ?
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: ?
IL Applicant Information
1. Owner/Applicant Infonnation
Name: Clay Willis, NC DOT Division 1 Environmental Officer
Mailing Address: 113 Aimort Drive
Suite 100
Edenton, NC 27932
Telephone Number: _(252) 482-7977 Fax Number: [phone]
E-mail Address: tcwiIIisndot.state. ne.us
2. Agent/Consultant 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: N/A
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 12
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: SR 1311 (Boone's Bridge Road) Scour Hole Repair ; Hertford County
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN):
4. Location
1 B.20461 I
County: Hertford County Nearest Town: Murfreesboro
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): From the intersection of US 158
and US 258 in Murfreesboro, take US 258 North for approximately 2.8 miles. Turn left onto
SR 1310 (Statesville Road), and go approximately 2.95 miles. Turn left onto SR 1311
(Boone's Bridge Road). Go approximately 6.3 miles. This is the location of the Bridge.
5. Site coordinates, if available (UTM or Lat/Long): 36.534127 N 77.142805 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):
1.0 acres
7. Nearest body of water (stream/river/sound/ocean/lake): Meherrin River
8. River Basin: Chowan River Basin
(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.ne.us/a(imin/inaps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: woodlands, rural residential, agriculture
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used: A scour
hole has formed under the bridge 13 feet deep in places. The scour hole is 55' x 75'. It is
10' from the bridge caps to the surrounding wetlands and the pilings are 40' in total length.
With the 10' from bridge to wetlands, and 13' deep scour hole, that only leaves 17' to
support the pilings. Therefore NCDOT is concerned about the pilings reaching a critical
scour level and not ensuring safe public travel. NCDOT proposes to fill in the scour hole
with clean fill to the same elevation as the surrounding; wetlands. Fill will be dumped over
the side of the bridge and will be graded by a Bobcat.
11. Explain the purpose of the proposed work: To fill in scour hole under Bridge #137.
IV. Prior Project History
If jurisdictional detenninations 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 pen-nits issued for prior segments of the same T.I.P. project, along with
construction schedules.
There have been no prior permits issued on this project.
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.
None
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to detennine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
1. Provide a written description of the proposed impacts: There will be no impacts.
2. Individually list wetland impacts below: N/A
Wetland Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(yes/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***

* 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 floodplains arc identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local tloodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http:-iwww.fema.!ov.
*** 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: 1.0 acres
Total area of wetland impact proposed:
3. Individually list all intermittent and perennial stream impacts below: NONE
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?
(please secif )
N/A

* List each impact separately and identity 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 atler, 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
www.us?s.eov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.toporone.com,
Nvww.mapgucst.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: None
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact Area of
Name waterbody Type of Waterbody
Site Number Type of Impact* Impact (if

applicable)
(lake, pond, estuary, sound,
(indicate on ma) (acres) bay, ocean, etc.)
Site 1 Fill 0.095 N/A N/A

* 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
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
Filling of scour hole will ensure safe travel for the general public. No heavv machincrv will
be used in wetlands. No impacts to wetlands are expected.
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
Page 9 of 12
aquatic resource will be considered in detennining 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
littp://li2o.enr.state.nc.us/newetlands/strm,gi(ic.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.
Mitigation may also be madr; 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 11ttp://1i2o.enr.state.11c.Lis/w!])/in(iex.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
IX. Environmental Documentation (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 10 of 12
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
(Neuse), 15A NCAC 213 .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* Impact
(square feet) Multiplier Required
Mitigation
1 3
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 213 .0242 or.0260.
N/A
XI. Stormwater (required by DWQ)
Page 11 of 12
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 acreage will remain the same.
XI1. 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.
There is no sewage disposal associated with this project.
XII1. 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).

Applicant/A?ent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
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