20010727 Ver 1_Complete File_20010514

OF W ATFR Michael F. Easley -
?O? pG Governor
Vj 7 William G. Ross, Jr., Secretary
>_ Department of Environment and Natural Resources
Kerr T. Stevens
Division of Water Quality
May 15, 2001
Surry County
DWQ Project No. 010727
SR 2034 (Rock Hill Church Road)
APPROVAL of 401 Water Quality Certification
Mr. Heath Slaughter, Division Environmental Officer
NCDOT Division 11
P.O. Box 250
North Wilkesboro, NC 28659
Dear Mr. Slaughter:
You have our approval, in accordance with the attached conditions and those listed below, to impact 132
linear feet (including 30 linear feet of miscellaneous rip-rap impacts) of unnamed tributaries to Bull Creek
for the purpose of upgrading SR 2034 (Rock Hill Church Road) in Surry County. The project should be
constructed in accordance with your application dated 9 May 2001 (received 14 May 2001). After
reviewing your application, we have decided that this fill is covered by General Water Quality
Certification No. 3289 corresponding to the U.S. Army Corps of Engineers Nationwide Permit Number
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 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 be valid, you must follow the conditions listed in the attached certification.
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.
North Carolina Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
919-733-1786 (phone), 919-733-6893 (fax), http://h2o.enr.state.nc.us/ncwetlands/
Page 2 of 2
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water
Act. If you have any questions, please telephone John Dorney at 919.733.1786.
Sincerely,
Attachment
Steven
cc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
NCDWQ Winston-Salem Regional Office
Central Files
File Copy
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY P. O. Box 25201, Raleigh, NC 27611-5202 LYNDO TIPPETT
GOVERNOR PHONE: [phone] SECRETARY
May 9, 2001
Mr. Eric Alsmeyer
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls of Neuse Road, Suite 120
Raleigh, NC 27615
Subject: Nationwide Permit #14
SR 2034 (Rock Hill Church Road)
Surry County, North Carolina
Dear Mr. Alsmeyer:
PAYMENT
RECEIVED
The NC Department of Transportation is scheduled to grade, drain, base, and pave primarily
along the existing roadway of SR 2034 (Rock Hill Church Road) in Surry County. This project
will require the extension of one (1) wet cross line, as well as the replacement one (1) bridge and
one (1) other wet cross line as shown below:
1) Replace existing Bridge 4245 at station 39+80 with 60'of 142"x 91" Arch Pipe.
2) Extend existing 48'x 48" CMP at station 60+00 by 6 feet on both sides.
3) Replace the two existing 30'x 24" CMPs at station 68+80 with one 60'x 48" CMP.
Miscellaneous rip-rap impacts will total 30 linear feet or less. New stream impacts = 132 In. feet.
Please note that all of the above noted crossings carry different unnamed tributaries to Bull Creek
(Class C). Since this is an existing roadway, the minor modifications proposed in this application
should not remove or degrade existing water quality uses. By utilizing the erosion control
measures outlined in the attachments to this application, downstream water quality standards will
be protected.
No Threatened or Endangered Species (or their critical habitat) will be impacted by this project.
Any widening of the existing roadway will be directed away from any adjacent creek whenever
possible with minimum fill placed in the buffer area. Pipe sizes used will be the minimum
necessary to create a safe roadway. The total project length is approximately 1.95 miles. Due to
the proposed work, we are requesting a 404 Nationwide Permit #14.
1, -,.-

P. O. Box 250, N. WILKESBORO, NC 28659
PHONE [phone] Fnx [phone]
-111?/
Mr. Eric Alsmeyer
SR 2034 (Rock Hill Church Road)
Page 2
May 9, 2001
Attached is a Preconstruction Notification Form, plan sheets with proposed erosion control
measures, pipe crossing information, 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 Commission 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 Cynthia
Van Der Wiele, NCDENR, Division of Water Quality, 401/Wetland Unit, for her review. A
$200.00 check is enclosed for the 401 certification processing fee. It is requested that any
comments related to the 401 certification be forwarded directly to the Corps with a copy sent to
me.
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 greatly appreciated.
Sincerely,
Heath Slaughter
Division Environmental Officer
Enclosures
cc: Ron Linville, Western Piedmont Region Coordinator, NCWRC
Brian Cole, US Fish and Wildlife Service
Renee Gledhill-Earley, Environmental Review Coordinator, NCDCR
Cynthia Van Der Wiele, Division of Water Quality (7 copies)
R. C. McCann, PE, Division Engineer
Charles Reinhardt, PE, District Engineer
Travis Spicer, County Maintenance Engineer
Heath Slaughter, Division Environmental Officer
Neil Trivette, Area Roadside Environmental Engineer
Is.,/
i 4
OF W a TF
O?/
7P
Pre-Construction Notification (PCN) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
littp://ww%v.saw.usace.armv.nii]/wet]ands/Perm app htm.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at littp://wiv?v.saNv.usace.armv.niiI/wetlands/regtour.litm, or contact one of the field
offices listed at the end of this application. The website also lists the responsible project manager for
each county in North Carolina and provides additional information regarding the identification and
regulation of wetlands and waters of the U.S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://h?o.enr.state.nc.us/ncwetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full test of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for some General Certifications is not required,
provided that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet
should contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is also required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on the last page of this application).

11,0?
CAMA Coordination - If the project occurs in any of North Carolina's twenty coastal counties (listed on
the last page of this application) the applicant should also contact the North Carolina Division of Coastal
Management (DCM) at [phone]. DCM will determine whether or not the project involves a
designated Area of Environmental Concern, in which case DCM will act as the lead permitting agency.
In such cases, DCM will require a Coastal Area Management Act (CAMA) Permit and will coordinate
the 404/401 Permits.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office (addresses are listed at the end of this
application). Upon receipt of an application, the USACE will determine if the application is complete as
soon as possible, not to exceed 30 days. This PCN form is designed for the convenience of the applicant
to address information needs for all USACE Nationwide, Regional or General permits, as well as
information required for State authorizations, certifications, and coordination. Fully providing the
information requested on this form will result in a complete application for any of the USACE
Nationwide, Regional or General permits. To review the minimum amount of information that must be
provided for a complete PCN for each USACE Nationwide permit, see Condition 13, 65 Fed. Reg.
12393 (March 9, 2000), available at http://wwiv.saw.usace.army.mil/wetlinds/nwpfinalFedRec?.t)df
Processing times vary by permit and begin once the application has been determined to be complete.
Please contact the appropriate regulatory field office for specific answers to permit processing periods.
101 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at http://h2o.elinr.state.nc.us/ncwetlands/fees.html. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
n___ 11 _r In

Office Use Only: Form Version April 2001
0 0 - r) 7
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
Check all of the approval(s) requested for this project:
® Section 404 Permit
? Section 10 Permit
® 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: 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: ?
H. Applicant Information
1. Owner/Applicant Information
Name: North Carolina Department of Transportation
Mailing Address: P. O. Box 250, North Wilkesboro, NC 28659
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: hslaughter c dot. 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: Heath Slaughter. Division Environmental Officer
Company Affiliation: North Carolina Department of Transportation
Mailing Address: P. O. Box 250, North Wilkesboro. NC 28659
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: hslaughter a dot. state.nc.us
n___ 7 -C 1'1
11,?
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 2034, Rock Hill Church Road
2. T.I.P. Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN):
N/A
4. Location
County: Surrv Nearest Town: Pilot Mountain
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): From Pilot Mountain, travel west
on NC 268. Turn right onto SR 1003. Travel 2.9 miles and turn right onto SR 2034.
5. Site coordinates, if available (UTM or Lat/Long):
(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:
Residential/Farm
7. Property size (acres): Approximately 4.7 acres.
8. Nearest body of water (stream/river/sound/ocean/lake): UTs of Bull Creek (Class: C)
9. River Basin: Yadkin
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://112o.enr.state.ne.us/,idmin/maps/.)

v..
10. Describe the purpose of the proposed work:_ Improvement of SR 2034.
11. List the type of equipment to be used to construct the project: Trackhoe, backhoe, and motor
,Qrader.
12. Describe the land use in the vicinity of this project: Residential/Farm
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: No
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.

,l
1. Wetland Impacts
Wetland Impact
Site Number
indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(ycs/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 tloodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http /htiwu tema.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: 0 acres
Total area of wetland impact proposed: 0 acres
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact Length of Average Perennial or
Site Number Type of Impact* Impact Stream Name** Width of Intermittent?
(indicate on map) (linear feet) Stream Before (please specify)
Impact
Replace Bridge

Station No. 39+80 #2.15 with 60' of
142"x 91" Arch
60 feet
UT 41 of Bull Creek
5 feet
Perennial
Pipe
Station No. 60+00 Pipe extension 12 feet UT #2 of Bull Creek 2 feet Perennial
Station No. 68+80 Pipe replacement 30 feet UT #3 of Bull Creek 1 foot Perennial
Miscellaneous 30 feet
All of the above np-rap (10 feet per UTs Bull Creek 1-5 feet Perennial
placement for crossing)
pipe stabilization

" List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated tip-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 Nvall, 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 streatn has no name, list as UT (untamed 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
atiew.us_*s.,ov. Several Internet sites also allow direct download and printing of USGS traps (e.g., www.topozone.com,
N% A%xv.inwouest.coin, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 132 In. ft. of new impacts.
n_.-_ !_ _r In

3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U. S.
Open Water Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Name
(if applicable) Wateplicablle) e) Type of Watcrbody
(lake, pond, estuary, sound,
bay, ocean, etc.
N/A

• List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation
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.
The existing roadway must be widened to achieve an acceptable section width, thus increasing
public safety. The existing pipes must also be upgraded to an acceptable maintenance condition.
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
construct the widened roadway.
n 't .,C In

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
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://li2o.enr.state.nc.us/ncwetlands/strm<(aide.html.
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
N/A

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 http://h2o.cnr.state.nc.us/Nvrp/index.litm. 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
LX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federaVstate/local)
land?
Yes ® No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 213 .0233
(Meuse), 15A NCAC 213 .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:
r%-__n..c 1n

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 Mietigation
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 2B .0242 or.0260.
N/A
YI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Please refer to the attached erosion control plan.
YII. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
N/A
VIII. 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
Tl...... In ..C III

XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).

Applicant/Agent's Signature 6 Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell
US Army Corps of Engineers Avery Clay Jackson Polk
151 Patton Avenue Buncombe Cleveland Lincoln Rowan
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabarrus Graham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Off ice Alamance Durham Jolmston Rockingham
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes
6508 Falls of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bcrtie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pcndcr
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancev
Wilson
Yadkin
*Croatan National Forest Only
n...-.. 1 1 ..C 1'1

US Fis
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
li and Wildlife Service / National N.'
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
[arine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivcrs Island
Beaufort, NC 28516
Telephone: [phone]
North Carolina State Abencies
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
CANIA and NC Coastal Counties
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
Telephone: [phone]
Fax: [phone]
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertic Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camdcn Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kcmcrsville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clav Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
Tl___ ,'1 ..C 11
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7.
ELDORA TOWNSHIP - SuRRY COUNTY
NOTE: MAP INCLUDES CNLT STATE MAINTAINED ROAOS
CA IMPORTANT NCH-SYSTEM RCAOS.
MILEAGE NOT SHOWN ON FRGNTAGE ROADS.
ROADS SHOWN AS CF SEPT. 1. 1999.
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64
EROSION CONTROL---
DETAILS AND
SPECIFICATIONS
Std. # Description Symbol
1630.03 Temporary Silt Fence
1630.05 Temporary Silt Ditch TSD
1605.01 Temporary Diversion TD
1622.01 Temporary Slope Drain ?-
1630.01 Silt Basin Type-A --
.1630.02 Silt Basin Type-B
1633.01 Temporary Rock Silt Check Type-A
1633.02 Temporary Rock Silt Check Type-B
1634.01 Temporary Rock Sediment Dam Type-A
1634.02 Temporary Rock Sediment Dam Type-B .
1635.01 Rock Pipe Inlet Sediment Trap Type-A AU
1635.02
1636.01 Rock Pipe Inlet Sediment Trap Type-B
Rock Silt Screen B 9
1630.04 Stilling Basin
Rock Inlet Sediment Trap:

A 0-- OR -
1632.01 Type-A
-A]
B -- OR -
32
02
1 B
.
6
Type-B.
1632.03 Type-C C -- OR -- C)

FgOSTON CONTROL PT,AN SHEET
Silt Basin. Type B's will be constructed to_the.dimension of
six feet.by..three:feet by three feet unless otherwise noted
on the plans.
Generally, the order of installation of the erosion control
measures Vill be as follows:
Temporary silt basins shall be installed.before
clearing and grubbing begins.
Silt fences and temporary silt ditches shall be
installed after clearing and before grading.
Temporary stone ditch checks shall be installed as
soon as ditchline is established.
Pipe outlet and inlet protection will. be done as
soon as the pipe is installed.
Seeding and other permanent erosion control
measures are to be implemented as soon as practical.
RS
Always SUER toward ditch 1 ine 'as a -
temporary measure in this situation!'
Erosion Control
Matting
._? -
Water Level
Rite Rate Liner
Tvzical for use at cross line pipes, culverts'and where
disturbed area is near stream."
Maintain above and below stream conditions at
nre-construction widths and depths.
Native vegetation should be maintained or restored
along stream banks where practical.
-DITCH LINER RE QUIREMENTS*
ROAD NAME: SR 2034 ROCK HILL C HURCH ROAD SURRY COUNTY
STATION STATION RT. / LT. TYPE LINER REQUIRED
14+00 17+00 LT. MAT
14+00 18+75 RT. MAT
18+75 19+25 RT RIP RAP
26+00 28+00 LT MAT
28+00 28+75 LT. RIP RAF'
29+40 31+00 LT. MAT
31+00 32+00 LT. RIP RAP
32+50 33+00 LT. MAT
32+50 33+00 RT MAT
33+00 35+75 LT RIP RAP
33+00 35+75 RT RIP RAP
36+50 39+80 LT RIP RAP
36+50 38+00 RT RIP RAP
39+40 39+80 RT RIP RAP
41+85 46+00 LT RIP RAP
41+85 46+00 RT RIP RAP
46+00 47+00 LT RIP RAP
46+00 47+00 RT RIP RAP
55+30 60+00 LT MAT
55+30 60+00 RT MAT
60+20 61+00 LT RIP RAP
60+20 61+00 RT RIP RAP
61+00 64+00 LT MAT
67+00 71+00 LT RIP RAP
67+00 71+00 RT RIP RAP
71+00 72+00 LT MAT
71+00 72+00 RT MAT
77+85 78+75 LT RIP RAP
77+85 78+75 RT RIP RAP
92+00 94+00 RT RIP RAP
95+25 102+50 RT RIP RAP
97+00 101+00 LT RIP RAP
105+50 112+00 RT MAT
110+00 112+00 LT MAT
1 - i
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*FENCE LINE DATA SHEET*
ROAD NAME: SR 2034 ROCK HILL ROAD -SURRY COUNTY
STATION STATION RT. / LT. FUNC. / TYPE OF FENCE
NONFUNC.
17+75 18+00 LT. FUNC. 2 RAIL (SPLIT RAIL)
19+20 19+40 LT. FUNC. 3 BOARD & 1 STRAND BW
19+20 27+00 LT. FUNC. 4 STRAND BW
25+50 25+94 RT. FUNC. 3 RAIL (SPLIT RAIL)
41+85 45+50 RT. FUNC. 2 STRAND ELECT.
64+90 69+80 RT. FUNC. 4 STRAND BW
70+00 72+00 RT. FUNC. 5 STRAND BW
71+20 71+60 LT. FUNC. SPLIT RAIL
73+50 74+80 LT. FUNC. 4 STRAND BW
83+50 90+00 LT. FUNC. 2 STRAND BW ELECT.
90+00 91+70 LT. FUNC. 4 STRAND BW
98+00 99+00 LT. NON-FUNC. 2 STRAND BW
110+00 113-+-00 LT. FUNC. 5 STRAND BW
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Top: Bridge # 245 on SR 2034, Surry. Replacing with 60' of 142"x 91" Arch Pipe.
Bottom: Stream crossing @ station 68+80 on SR 2034, Surry.
e?.swto
STATE OF NORTH CAROLINA ?
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY P. 0. Box 25201, Raleigh, NC 27611-5202 LYNDO TIPPETT (n
GOVERNOR PHONE: [phone] SECRETARY (n
C
May 9, 2001
Mr. Eric Alsmeyer
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls ofNeuse Road, Suite 120
Raleigh, NC 27615
Subject: Nationwide Permit #14
SR 2034 (Rock Hill Church Road)
Surry County, North Carolina
Dear Mr. Alsmeyer:
The NC Department of Transportation is scheduled to grade, drain, base, and pave primarily
along the existing roadway of SR 2034 (Rock Hill Church Road) in Surry County. This project
will require the extension of one (1) wet cross line, as well as the replacement one (1) bridge and
one (1) other wet cross line as shown below:
1) Replace existing Bridge #245 at station 39+80 with 60'of 142"x 91" Arch Pipe.
2) Extend existing 48'x 48" CMP at station 60+00 by 6 feet on both sides.
3) Replace the two existing 30'x 24" CMPs at station 68+80 with one 60'x 48" CMP.
Miscellaneous rip-rap impacts will total 30 linear feet or less. New stream impacts = 132 In. feet.
Please note that all of the above noted crossings carry different unnamed tributaries to Bull Creek
(Class C). Since this is an existing roadway, the minor modifications proposed in this application
should not remove or degrade existing water quality uses. By utilizing the erosion control
measures outlined in the attachments to this application, downstream water quality standards will
be protected.
No Threatened or Endangered Species (or their critical habitat) will be impacted by this project.
Any widening of the existing roadway will be directed away from any adjacent creek whenever
possible with minimum fill placed in the buffer area. Pipe sizes used will be the minimum
necessary to create a safe roadway. The total project length is approximately 1.95 miles. Due to
the proposed work, we are requesting a 404 Nationwide Permit #14.
P. 0. Box 250, N. WILKESBORO, NC 28659
PHONE [phone] FAx [phone]
Mr. Eric Alsmcycr
SR 2034 (Rock Hill Church Road)
Page 2
May 9, 2001
Attached is a Preconstruction Notification Form, plan sheets with proposed erosion control
measures, pipe crossing information, 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 Commission 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 Cynthia
Van Der Wiele, NCDENR, Division of Water Quality, 401/Wetland Unit, for her review. A
$200.00 check is enclosed for the 401 certification processing fee. It is requested that any
comments related to the 401 certification be forwarded directly to the Corps with a copy sent to
me.
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 greatly appreciated.
Sincerely,
el- -kez
Heath Slaughter
Division Environmental Officer
Enclosures
cc: Ron Linville, Western Piedmont Region Coordinator, NCWRC
Brian Cole, US Fish and Wildlife Service
Renee Gledhill-Earley, Environmental Review Coordinator, NCDCR
Cynthia Van Der Wiele, Division of Water Quality (7 copies)
R. C. McCann, PE, Division Engineer
Charles Reinhardt, PE, District Engineer
Travis Spicer, County Maintenance Engineer
Heath Slaughter, Division Environmental Officer
Neil Trivette, Area Roadside Environmental Engineer
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1
Pre-Construction Notification (PCN) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
http://-,v,,vw.saw.usace.armv.mi1/wetlands/Perm app htm.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at http://xvww.saNv.tisace.armv.mil/wetlands/re,,tour.litm, or contact one of the field
offices listed at the end of this application. The website also lists the responsible project manager for
each county in North Carolina and provides additional information regarding the identification and
regulation of wetlands and waters of the U.S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401AWetlands Unit website at
http:;/l12o.eiir.state.nc.tis/newetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for some General Certifications is not required,
provided that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet
should contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is also required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on the last page of this application).
r%--- 1 ..C I I
I-d
CAMA Coordination - If the project occurs in any of North Carolina's twenty coastal counties (listed on
the last page of this application) the applicant should also contact the North Carolina Division of Coastal
Management (DCM) at [phone]. DCM will determine whether or not the project involves a
designated Area of Environmental Concern, in which case DCM will act as the lead permitting agency.
In such cases, DCM will require a Coastal Area Management Act (CAMA) Permit and will coordinate
the 404/401 Permits.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office (addresses are listed at the end of this
application). Upon receipt of an application, the USACE will determine if the application is complete as
soon as possible, not to exceed 30 days. This PCN form is designed for the convenience of the applicant
to address information needs for all USACE Nationwide, Regional or General permits, as well as
information required for State authorizations, certifications, and coordination. Fully providing the
information requested on this form will result in a complete application for any of the USACE
Nationwide, Regional or General permits. To review the minimum amount of information that must be
provided for a complete PCN for each USACE Nationwide permit, see Condition 13, 65 Fed. Reg.
12893 (March 9, 2000), available at http://www.saw.usace.armv.mil/wetlands/nwl2fi nalFedReg. pd f.
Processing times vary by permit and begin once the application has been determined to be complete.
Please contact the appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at litto://h2o.ehnr.state.nc.us/ncwetIands/fees.litnil. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.

Office Use Only: Form Version April 2001
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.
I. 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: 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: ?
H. Applicant Information
1. Owner/Applicant Information
Name: North Carolina Department of Transportation
Mailing Address: P. O. Box 250, North Wilkesboro, NC 28659
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: hslaughterndot.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: Heath Slaughter. Division Environmental Officer
Company Affiliation: North Carolina Department of Transportation
Mailing Address: P. O. Box 250, North Wilkesboro, NC 28659
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: hslaughter e dot. state.nc.us

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 2034, Rock Hill Church Road
2. T.I.P. Project Number (NCDOT Only)
N/A
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Surry Nearest Town: Pilot Mountain
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): From Pilot Mountain, travel west
on NC 268. Turn right onto SR 1003. Travel 2.9 miles and turn right onto SR 2034.
Site coordinates, if available (UTM or Lat/Long):
(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:
Residential/Farm
7. Property size (acres): Approximately 4.7 acres.
8. Nearest body of water (stream/river/sound/ocean/lake): UTs of Bull Creek (Class: C)
9. River Basin: Yadkin
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://l12o.enr.st ite.nc.us/adnin/naps/.)

10. Describe the purpose of the proposed work: Improvement of SR 2034.
11. List the type of equipment to be used to construct the project: Trackhoe, backhoe, and motor
grader.
12. Describe the land use in the vicinity of this project: Residential/Farm
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: No
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.
n.,..., z .,c V)
1. Wetland Impacts
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***
N/A

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, gmd ng, 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 1-800-353-9616, or
online at http //u??w. fema. gov.
*** List a wetland type that best describes wetland to be impacted (e.g., fieshwaWr/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: 0 acres
Total area of wetland impact proposed: 0 acres
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)
Replace Bridge
Station No. 39+80 #245 with 60' of 142"x 91" Arch 60 feet UT #1 of Bull Creek 5 feet Perennial
Pipe
Station No. 60+00 Pipe extension 12 feet UT #2 of Bull Creek 2 feet Peremtial
Station No. 68+80 Pipe replacement 30 feet UT #3 of Bull Creek 1 foot Perennial
Miscellaneous 30 feet
All of the above rip-rap (10 feet per UTs Bull Creek 1-5 feet Perennial
placement for
pipe stabilization crossing)

" 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
a WW.us?_,s.¢ov. Several Internet sites also allow direct download and printing of USGS Wraps (e.g., www.topozonc.cont,
ww.mapnlues[.coin, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 132 1n. ft. of new impacts.

Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.
N/A

' List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation
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.
The existinsz roadway must be widened to achieve an acceptable section width, thus increasing
public safety. The existing pipes must also be upgraded to an acceptable maintenance condition.
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
construct the widened roadway.
n..,... -r -C In
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
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://li2o.enr.state.nc.us/ncwetiands/strmf-)ride.html.
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
N/A
n.._- 0 ..rill
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 hun://h2o.cnr.state.nc.us/Nvm/index.htni. 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
LX.
Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federaVstate/local)
land?
Yes ® No ?
X.
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 ?
Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Yes ? No ® If you answered "yes", provide the following information:
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
n..-..n-cis
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* sqImpact uare feet Multiplier Required
1 3
2 1.5
Total
Lone I extends out 3U teet perpendicular trom near bank of channel; Lone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
N/A
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Please refer to the attached erosion control plan.
XH. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
N/A
XHI. 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
n.. _., i n ..c In
YIV. 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).
15-,
Applicant/Agent's Signature 6 Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell
US Army Corps of Engineers Avery Clay Jackson Polk
151 Patton Avenue Buncombe Cleveland Lincoln Rowan
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 23801-5006 Cabarrus Graham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes
6508 Falls of the Neuse Road Ashe Franklin Nash Surrv
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
n...-.. , , -c vi
US Fis
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
h and Wildlife Service / National N
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
larine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivers Island
Beaufort, NC 28516
Telephone: [phone]
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
CANIA and NC Coastal Counties
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Scrvice Center
Raleigh, NC 27699-4617
Telephone: [phone]
Fax: [phone]
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kemcrsville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transvlvania
Fax: [phone] Ha}wood McDowell Yancey
Tl. __ In -r 1 ll
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ELDORA TOWNSHIP - SuRRY COUNTY r'
NOTE: uAP INCLUDES ONLT STATE WAINTAINED ROADS l
Cn IWCRTANT NON-STSTE4 ROADS.
W LEACE NOT SHOWN ON FRONTAGE ROADS.
ROADS SH01M AS OF SEPT. 1. 1999. zt ( S
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--i
EROSION CONTROL---
DETAILS AND
SPECIFICATIONS
Std. # Description Symbol
1630.03 Temporary Silt Fence
1630.05 Temporary Silt Ditch TM
1605.01 Temporary Diversion TD
1622.01 Temporary Slope Drain `-
1630.01 Silt Basin Type-A - D
.1630.02 Silt Basin Type-B
1633.01 Temporary Rock Silt Check Type-A
1633.02 Temporary Rock Silt Check Type-B
1634.01 Temporary Rock Sediment Dam Type-A
1634.02 Temporary Rock Sediment Dam Type-B
1635.01 Rock Pipe Inlet Sediment Trap Type-A A?
1635.02
1636
01 Rock Pipe Inlet Sediment Trap Type-B
S
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1630.04 Stilling Basin
Rock Inlet Sediment Trap:
A OR --A)
1632.01 Type-A
1632.02 Type-B. B -- OR - B
1632.03 Type-C C -- OR -- C
.RORTON CONTROL 'PT,AN SHgET
Silt Basin. Type B's will be constructed to the"dimension^of
six feet,by..three:feet by three feet unless otherwise noted
on the plans.
Generally, the order of installation of the erosion control
measures will be as follows:
Temporary silt basins shall be instal I ed. before
clearing and grubbing begins.
Silt fences and temporary silt ditches shall be
installed after clearing and before grading.
Temporary stone ditch checks shall be installed as
soon as ditchline is established.
Ripe outlet and inlet protection will be done as
soon as the pipe is installed.
Seeding and other permanent erosion control
measures are to be implemented as soon as practical.
RS
Always SUER toward ditch line as a -
temporary measure in this situation'.'
Erosion Control
Matting i -
Water Level
M ,
Rip Rap Liner
Typical nor use at cross line pipes, culverts-and where
disturbed area is near stream.
Maintain above and below stream conditions at-
'Ore-cons-ruction widths and depths.-
Native vegetation should be maintained or restored
along stream banks where practical.
J
*DITCH LINER RE QUIREMENTS*
ROAD NAME: SR 2034 ROCK HILL C HURCH ROAD SURRY COUNTY
STATION STATION RT. / LT. TYPE LINER REQUIRED
14+00 17+00 LT. MAT
14+00 18+75 RT. MAT
18+75 19+25 RT RIP RAP
26+00 28+00 LT MAT
28+00 28+75 LT. RIP RAP
29+40 31+00 LT. MAT
31+00 32+00 LT. RIP RAP
32+50 33+00 LT. MAT
32+50 33+00 RT MAT
33+00 35+75 LT RIP RAP
33+00 35+75 RT RIP RAP
36+50 39+80 LT RIP RAP
36+50 38+00 RT RIP RAP
39+40 39+80 RT RIP RAP
41+85 46+00 LT RIP RAP
41+85 46+00 RT RIP RAP
46+00 47+00 LT RIP RAP
46+00 47+00 RT RIP RAP
55+30 60+00 LT MAT
55+30 60+00 RT MAT
60+20 61+00 LT RIP RAP
60+20 61+00 RT RIP RAP
61+00 64+00 LT MAT
67+00 71+00 LT RIP RAP
67+00 71+00 RT RIP RAP
71+00 72+00 LT MAT
71+00 72+00 RT MAT
77+85 78+75 LT RIP RAP
77+85 78+75 RT RIP RAP
92+00 94+00 RT RIP RAP
95+25 102+50 RT RIP RAP
97+00 101+00 LT RIP RAF'
105+50 112+00 RT MAT
110+00 112+00 LT MAT
*FENCE LINE DATA SHEETS
ROAD NAME: SR 2034 ROCK HILL ROAD -SURRY COUNTY
STATION STATION RT. / LT. FUNC. / TYPE OF FENCE
NONFUNC.
17+75 18+00 LT. FUNC. 2 RAIL (SPLIT RAIL)
19+20 19+40 LT. FUNC. 3 BOARD & 1 STRAND BW
19+20 27+00 LT. FUNC. 4 STRAND BW
25+50 25+94 RT. FUNC. 3 RAIL (SPLIT RAIL)
41+85 45+50 RT. FUNC. 2 STRAND ELECT.
64+90 69+80 RT. FUNC. 4 STRAND BW
70+00 72+00 RT. FUNC. 5 STRAND BW
71+20 71+60 LT. FUNC. SPLIT RAIL
73+50 74+80 LT. FUNC. 4 STRAND BW
83+50 90+00 LT. FUNC. 2 STRAND BW ELECT.
90+00 91+70 LT. FUNC. 4 STRAND BW
98+00 99+00 LT. NON-FUNC. 2 STRAND BW
110+00 113+00 LT. FUNC. 5 STRAND BW
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