20080571 Ver 1_Application_20080328

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STATE of NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPETT
GOVERNOR SECRETARY
March 26, 2008
NCDENR-DWQ
Transportation Permitting Unit
2321 Crabtree Boulevard, Suite 250 ~'j
Raleigh, NC 27604 ~ ~ ®5 / ~.
Attention: Mr. Rob Ridings
NCDOT Coordinator
Subject: Proposed replacement of existing structure on SR 1503 (Lankford Road)
conveying an unnamed tributary to Matthews Creek in Vance County.
WBS Element No. SB.209111
The North Carolina Department of Transportation (NCDOT) proposes to replace the
existing structure on SR 1503 (Lankford Road) conveying an unnamed tributary to
Matthews Creek in Vance County (Figure 1). Note that two unnamed tributaries to
Matthews Creek converge approximately 9 feet upstream of the existing structure and are
within the construction footprint of the pipe replacement project. They are noted as UT 1
and UT 2 in the permit application and on the permit drawing.
The existing structure is a 72 inch metal pipe that is 40 feet long. Avery large blow hole
has formed at the outlet of the structure and the outlet is perched above the ordinary high
water mark. The proposed re l,__p_ acement structure is a 87 inch x 63 inch corrugated metal
pipe arch (CMPA) that is 60 feet long. Please note that -the outlet of the proposed
structure will be located inside the limits of this blowhole making it impractical to bury
the replacement. pipe one foot in the stream bed that now exists at the bottom of_ the_
blow o e. e CDOT will attempt to set e invert o t e pipe one oot below the
"theore ical" streambed elevation taken from projection of the streambed grade from
further down stream back into the blowhole. NCDOT hydraulics unit has indicated that
the increase in diameter of the proposed structure will reduce the water velocity and
cause sediment to accumulate in the blowhole and eventually fill up over time to match
the surrounding stream bed.
Impacts to Waters of the United States
The removal of the existing structure and subsequent installation of the CMPA will result
in impacts to UT 1 to Matthews Creek and UT 2 to Matthews Creek Creek (1viCDENR-
DWQ Index No. 28-79-2, Best Usage Classification C NSW, HUC 03020102) in the Tar-
Pamlico River Basin.
Division 5; 2612 N. Duke Street, Durham, NC 27704
Phone: [phone] Fax: [phone]

2
Permanent Impacts
Installation of the replacement structure will result in impacts to UT 2 to Matthews Creek.
This impact is summarized below: ..
• 21 linear feet of impact (fill in SW).
Bank stabilization activities will result in impacts to UT 1 to Matthews Creek and UT 2 to
Matthews Creek. These impacts are summarized below:
• l O linear feet of bank impact along UT 1 to Matthews Creek.
• bear feet of bank impact along UT 2 to Matthews Creek at inlet of the replacement
structure
• 10 linear feet of bank impact at along UT 2 to Matthews Creek at the outlet of structure.
__----
Temporary Impacts
The NCDOT proposes to temporarily dewater the work zone during construction for
approximately two weeks. This will involve the temporary placement of sand bags or
sheet piling upstream of the existing inlet and downstream of the existing outlet. This
will result in 381inear feet ofnon-concurrent temporary stream impacts at UT 1 and UT 2
to Matthews reek. To maintain-water flow during construction, water upstream of the
sand bags or sheet piling will be temporarily pumped out by a hose and conveyed
downstream of the construction activity where it will be allowed to filter through
vegetation before flowing into the stream. The effluent from the work area will be
pumped into a prefabricated silt bag allowing water to slowly filter out of the bag in a
dispersed manner and the sediment to be captured in the bag. The temporary sand bags
or sheet piling will be removed after construction.
Riparian Buffer
Construction at this site involves the road crossing of a stream that is subject to the
Tar-Pam Riparian Buffer Rules. UT 2 to Matthews Creek is depicted on the most recent
version of the Vicksboro USGS topographic quadrangle (Figure 1). However, both UT 1.
to Matthews Creek and UT 2 to Matthews Creek are depicted on the Soil Survey of
Vance County (USDA-NRCS, 1977). Construction impacts at this site total 4,533 square
feet in Zone 1 and 1,469 square feet in Zone 2 (totaling 97 linear feet of riparian buffer
impacts). Based on the impacts to the riparian buffer at this site, this crossing is
ALLOWABLE. Temporary erosion control measures will be installed. as required within
the permitted buffer footprint.
Waters of the U.S. Mitigation
Avoidance:
Permanent impacts to the tributaries to Matthews Creek cannot be avoided. T'he existing
pipe structure is rusted. The NCDOT hydraulics unit has determined that the proposed
CMPA is a suitable replacement for the existing structures.
Minimization:
The proposed rip rap at the inlet and outlet of the structure has been minimized as much
as possible whileprovidn1g the required .long-term stability.

3
Com ensato Miti ation:
Compensatory mitigation will be provided at the request of the regulatory agencies.
Protected Species
Plants and animals with federal classifications of Endangered, Threatened, Proposed
Endangered and Proposed Threatened are protected under provisions of Section 7 and
Section 9 of the ESA. As of March 28, 2008, the bald eagle (Haliaeetus leucocephalus)
and dwarf wedgemussel (Alasmidonta heterodon) are listed as federally protected species
in Vance County. Large open water systems that are required for the bald eagle are not
present at the site. The small streams .located at the project do not provide adequate
habitiat for dwarf wedgemussel.
Summary
The NCDOT proposes to replace the existing structure on SR 1503 (Lankford Road).
Application is hereby made for a NCDENR-DWQ Section 401 Water Quality
Certification (WQC) 3687, 3689 and Tar-Pamlico Buffer Authorization. The NCDOT
proposes to use Department of the Army Section 404 Nationwide Permit (NWPs) 3 and
13; however, these permits do not require notification to the USACE. An automated
payment procedure has been implemented between the NCDOT and NCDENR-DWQ.
This procedure will enable the Division to apply for the 401 WQC without submitting a
check for this permit application. This procedure will provide payment to the NCDWQ
by charging the permit application fee directly to the appropriate NCDOT WBS Element
No. SB.209111. Apre-construction notification and permit drawings are attached with
this request. If you have any questions or need additional information, please contact Mr.
Chris Murray at [phone].
Sincerely,
~~~~
~a4 J. .Bowman, P.E.
Deputy Division Engineer
cc: Tim Robbins, NCDOT
Robert Liverman, NCDOT
Vance County Bridge Superintendent, NCDOT

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i_ Re lacement of structure on SR 1503 Lankford Rd. x - -~~ --
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Copyright (C) 1998, Maptech, Inc.

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Scale - 1:2Q4r~

UT I tc> Mi~ttl-~F~w~ Ckn
' Limlt of dewatering
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UT ? to I~~atthews ~ko
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Notee
--~-~ Proposed rip rap ditch
Q Proposed rip rap
~~~~~ Fill in surface water
-------- Existing transportation facilit
-~ Construction limit
Construction Plan
SR 1503 Lankford Road
Vance County
Figure 3
I inch = 30 feet
Llmlt of degatering

Office Use Only: •• Form Version March OS
2ooao57~
USAGE Action ID No. DWQ No.
~-- ---, t'»---••»-••• _•,,__• ,~ ••~~ uYyaa~.a~ic w U115 pIV~GGh pease enter ._i~oT tippllcable" 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 ^ Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 3 and NWP 13
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 Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, 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: ^
II. Applicant Information
1. Owner/Applicant Information
Name:NCDOT Division 5 J. W. Bowmans P.E. (Division En
Mailing Address: 2612 N. Duke St. Durham NC 27704
Telephone Number: [phone] Fax Number: [phone]
E-mail Address:_ Wbowman(a~dot.state nc us
Z. 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:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 1 of 9

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 maybe included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USAGE 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: Proposed replacement of existing structure on SR 1503 (Lankford Road)
conve~g an UT to Matthews Creek in Vance County.
2. T.I.P. Project Number or State Project Number (NCDOT Only):
NCDOT WBS Element No. SB.209111
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Vance Nearest Town: Henderson
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers/names, landmarks, etc.): From Henderson,
travel southeast on NC 39, turn left and travel east and north east on SR 1518, turn ri t and
travel east on SR 1001, turn left and travel north on SR 1503 to project site.
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (G digits minimum):
Site 1 36.3719 °N 78.3020 °W
6. Property size (acres): approximately 0.2 acres
7. Name of nearest receiving body of water: Unnamed tributary to Matthews Creek
8. River Basin: Tar-Pamlico
(Note -this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
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 land uses along SR 1503 are primarily rural and
forested.
Page 2 of 9

10. Describe the overall project in detail, including the type of equipment to be used: The
NCDOT proposes to replace the existing 72 inch metal pipe conveving UT to Matthews
Creek. The replacement structure is a 87 inch x 63 inch corrugated metal wipe arch (CMPA)
that is 60 feet long. Equipment may include excavator, backhoe, bulldozer, grader, and
crane.
11. Explain the purpose of the proposed work: The purpose of the project is to replace the
structurally deficient ape.
IV. Prior Project History
V. 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. None available.
VI. 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.
VII. 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. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should 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 maybe 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.
Provide a written description of the proposed impacts: Construc±ion of the project will result in
the following impacts:
Page 3 of 9

Permanent Impacts
Installation of the replacement structure will result in impacts to UT 2 to Matthews Creek. This impact
is summarized below:
• 21 linear feet of impact (fill in SW).
Bank stabilization activities will result in impacts to UT 1 to Matthews Creek and UT 2 to Matthews
Creek. These impacts are summarized below:
• 10 linear feet of bank impact along UT 1 to Matthews Creek.
• l O linear feet of bank impact along UT 2 to Matthews Creek at inlet of the replacement structure
• l O linear feet of bank impact at along UT 2 to Matthews Creek at the outlet of structure.
Temporary Impacts
The NCDOT proposes to temporarily dewater the work zone during construction for approximately two
weeks. This will involve the temporary placement of sand bags or sheet piling upstream of the existing
inlet and downstream of the existing outlet. This will result in 38 linear feet of non-concurrent
temporary stream impacts at UT 1 and UT 2 to Matthews Creek.
Individually list wetland impacts. Types of 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.
Wetland Impact Type of Wetland Located within Distance to Area of
Site Number Type of Impact (e.g., forested, marsh,
100-year
Nearest
Impact
(indicate on map) herbaceous, bog, etc.) Floodplain Stream (acres}
(yes/no) (linear feet)

Total Wetland Impact (acres)
2. List the total acreage (estimated) of all existing wetlands on the property: 0.0 ac
Page. 4 of 9

3. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, 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. To calculate acreage m„lt;nly lanoth X .:,;.ith rt,P„ ,t;.,;,to t,<, ~z «~
Stream - -------- -., ---- --- - -
Average -~ ...., ., z~,~.,...
Impact
Number
Stream Name
Type of Impact
perennial or Stream Width
Before
Impact Length Area of
(indicate Intermittent?
Im act
p (linear feet) I
r
t

on ma ) ( )
ac
es
Site 1 UT 2 to Fill in SW from pipe 9 ft at inlet
Matthews Ck. installation perennial 15 ft at outlet ~ 21 ft <0.01 ac
Site 1 Matt ews Ck. Bank stabilization Perennial 3 ft 10 ft <0.01 ac
Site 1 UT 2 to
Matthews Ck. Bank Stabilization inlet
( ) Perennial 9 ft at inlet
15 ft at outlet
10 ft
<0.10 ac
Site 1 UT 2 to
Matthews Ck. Bank stabilization outlet
( ) Perennial 9 ft at inlet
15 ft at outlet
10 ft
<0.01 ac
~

Site 1 UT 1 and 2 to Temp. dewatering Perennial 9 ft at inlet
~ 38 ft (temporary, non-
Matthews Ck. 15 ft at outlet
concurrent) . 0.01 ac
51 feet permanent impact and 38
Total Stream Impact (by length and acreage) feet temporary (non-concurrent) 0.02
impact for dewatering
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water cf the U.S.). Open water impacts include, but are not limited to
fill, excavation, dred~in~. floodin~_ drainage h„1khParlc Pry

Open Water Impact
Site Numb
Name of Waterbody -~ --,
Type of Waterbody
Area of
er
(indicate on ma) (if applicable) Type of Impact (lake, pond, estuary, sound, bay, Impact
ocean, etc.) (acres)

Total Open Water Impact (acres)
5. List the cumulative impact to all Waters ~f the i T ~ rec„ lt;no from the r~r~;Pr+•
Stream Impact (acres): 0.02 ac
Wetland Impact (acres): 0.0
Open Water Impact (acres): NONE
Total Impact to Waters of the U.S. (acres) 0.02 ac
Total Stream Impact (linear feet):

/ T 1 51 linear ft permanent and 38 linear ft
temporary non-concurrent (for
dewaterin )
o. isotatea waters
Do any isolated waters exist on the property? ^ Yes ®No
Describe all impacts to isolated waters, and include the type cf water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters tY!at have specifically been determined to be isolated by the USACE.
Page 5 of 9

N/A
7. 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.): N/A
Current land use in the vicinity of the pond: N/A
Size of watershed draining to pond: N/A Expected pond surface area: N/A
VIII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It maybe 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.
Avoidance•
Construction of the proiect cannot avoid impacts to waters of the United States The NCDOT
hydraulics umt has determined that the CMPA is a suitable replacement for the existing
structure.
Minimization•
The roposed .rip rap at the inlet and outlet of the structure has been minimized as much as
possible while providm~ the reauired long-term stability NCDOT will implement best
management practices for the protection of surface waters in accordance with the most recent
version of the "North Carolina Sediment and Erosion Control Plannin and Desi Manual"
during design and construction phases of the project
IX. 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 ar~d Modification of Nationwide
Permits, published in the Federal Register on January 15, 2002, mitigation will be required when
necessary to ensure that adverse effects to thu_ 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 ar~d practicable
Page 6 of 9

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 NCEEP 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 for the proiect will be provided if requested b the re latory a encies
1. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
(919) 71 ~-0476 to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at http://h2o.enr.state.nc.us/wrp/index htm. If use of the NCEEP is proposed, please
check the appropriate box on page five 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 ofNon-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
X. Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ® No ^
2. 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 (9I9) 733-5083 to review current thresholds for environmental documentation.
Yes ^ No
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3. ,. 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 ^
XI. 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.
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify )? Yes ® No ^
2. If "yes", 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.
Site 1
Zone* Impact
(s uare feet) Multiplier Required
Miti ation
1 4,533 sf 3 (2 for Catawba) N/A
2 1,469 sf 1.5 N/A
Total 6,002 sf
~` Gone t extends out 3U teet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration /Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B .0242 or .0244, or .0260. N/A
XII. Stormwater (required by DWQ)
Describe impervious acreage (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. Iir percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. There is approximately 2,142 square feet
existins? impervious surface within the 0.2 acres proiect site. No additional impervious-surface is
roposed with this project
XIII. Sewage Disposal (required by DWQ}
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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.
This project will not generate wastewater.
XIV. 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 anafter-the-fact permit application? Yes ^ No
XV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ^ No
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
http://h2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description:
This maintenance project will not result in additional development.
XVI. 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).
326/ v ~
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
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