20020859 Ver 1_Complete File_20020530

o?o? W A r?9p6r

DWQ Project No.: OZ065 County: C,--aL
Applicant: 4J6107- iyi s to,J /Z-
Project Name: S6 Z 7- 5-4a gc,G-rnd5il rrs
Date of Issuance of 401 Water Quality Certification: \1!uvE /9 Z.UV Z
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer
Rules, and any subsequent modifications, the applicant is required to return this certificate to the
401/Wetlands Unit, North Carolina Division of Water Quality, 1650 Mail Service Center, Raleigh, NC,
27699-1650. This form may be returned to DWQ by the applicant, the applicant's authorized agent, or
the project engineer. It is not necessary to send certificates from all of these.
Applicant's Certification
1, M, L. 14o LnC--2- , hereby state that, to the best of my abilities, due care
and diligence was used in the observation of the construction such that the construction was observed to
be built within substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules, the app ed n s 'fications, and other supporting ma tprials.
Signature:. Date: G7/Vr- 7
Agent's Certification
I, , hereby state that, to the best of my abilities, due care
and diligence was used in the observation of the construction such that the construction was observed to
be built within substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules, the approved plans and specifications, and other supporting materials.
Signature: Date:
If this project was designed by a Certified Professional
I, , as a duly registered Professional (i.e.,
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized
to observe (periodically, weekly, full time) the construction of the project, for the Permitee hereby state
that, to the best of my abilities, due care and diligence was used in the observation of the construction
such that the construction was observed to be built within substantial compliance and intent of the 401
Water Quality Certification and Buffer,Rules, the approved plans and specifications, and other
supporting materials.
Signature Registration No. Date
.,
AU,, y ?%dt??'Bf

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W, Klimek, P. E. Director
Division of Water Quality
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), hftp://h2o.enr.state.nc.us/ncwetlands/
F \1V/-1 /'?7 micnao t-. tasrey, uuvemur
O William G. Ross Jr., Secretary
\O? pG North Carolina Department of Environment and Natural Resources
co Alan W. Klimek, P.E. Director
> y Division of Water Quality
O `C
June 19. 2002
Cleveland County
DWQ Project No. 020859
SR 2256, southwest of Kings Mountain
APPROVAL of 401 Water Quality Certification with Additional Conditions
Ms. 'I'rish Simon. Division Environmental Officer
NCDOT Division 12
P.O. Box 47
Shelby, NC 2815 1-0047
Dear Ms. Simon:
You have our approval, in accordance with the attached conditions and those listed below, to incur 160
linear feet of temporary impacts and 70 linear feet of temporary impacts to unnamed tributaries of Beason
Creek in order to replace pipes on SR 2256 in Cleveland County. The project should be constructed in
accordance with your application dated May 24, 2002 (received May 30, 2002). After reviewing your
application. we have decided that this till is covered by General Water Quality Certification No. 3366 and
3375 corresponding to the U.S. Army Corps of Engineers Nationwide Permit Numher 33 and 14. In
addition, you should acquire any other federal, state or local permits before you proceed with your project
including (hut 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 only valid for the purpose and design that you described in your application except as
modified below. If you change your project, you must notify its in writing and send us a new application.
If the property is sold, the new owner must be given a copy of this Certification and approval letter and is
thereby responsible for complying with all conditions. If total wetland fills for this project (now or in the
future) exceed one acre or if stream impacts 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 and any additional conditions listed below.
1. Temporary or permanent herbaceous vegetation must be planted on all bare soil ?rithin 15 clays of
ground-disturbing activities to provide long term erosion control.
2. The structure and rip-rap required for this project shall be installed in such a manner that the original
stream profile is not altered (i.e. the depth of the channel must not be reduced nor the stream channel
widened). Existing stream dimensions are to be maintained above and below locations of the culvert.
3. 1Jse of rip-rap for bank stabilization is to be minimized; rather, native vegetation is to be planted
when practical. If rip-rap is necessary, it must be limited to the stream bank below the high water
mark, and vegetation must be used for stabilization above high water.
4. All work shall be performed during low flow conditions.
5. All mechanized equipment operated near surface waters must be regularly inspected and maintained
to prevent contamination of stream waters from fuels, lubricants, hydraulic fluids, or other toxic
materials. Heavy equipment should be operated from the bank rather than the stream channel. Under
no circumstances must rock, sand or other materials be dredged from the wetted stream channel under
authorization of this permit, except in the immediate vicinity of the culverts.
6. Upon completion of the project, the NCDOT shall complete and return the enclosed
"C'ertifientr of'Cu nnletion" form to nntif?; NCI-)W Q whon ;ill wnrk inr lurlrrl in the y§4011
??A
1061 ,
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 (tax), http://h2o.enr.state.nc.us/ncwetlands/
Certification has been completed. The responsible party shall complete the attached form
and return it to the 401/Wetlands Unit of the NC Division of Water Quality upon
completion of the project.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing.
You must act within 60 days of the date that you receive this letter. To ask for a hearing, send a written
petition that conforms to Chapter 15013 of the North Carolina General Statutes to the Office of
Administrative Hearings, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its
conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water
Act. If you have any questions, please telephone Ms. Cynthia Van Der Wiele at 919-733-9646 or Mr.
Michael Parks r of the Mooresville Regional Office at 704.663.1699.
Sincerely,
Attachment
r
I Klime , P.E.
1
Pc: Wilmington District Corps of Engineers
John Hendrix. USAGE Asheville Field Office
Michael Parker. NCDWQ Mooresville Regional Oflce
Central Files
Pile Copy
Ir'
MAY 0 2002
coPY ?FILE WFT,7R
STATE of NORTH CAROLINA U=1L T-mO ION
--- q
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY P.O. Box 25201, RALEIGH, N.C. 27611-5201 LYNDO TIPPETT
GOVERNOR SECRETARY
P.O. BOX 47, 1710 East Marion Street
Shelby, N. C. 28151-0047
May 24, 2002
Mr. John W. Hendrix - NCDOT Projects
US Army Corp of Engineers, Asheville Regulatory Field Office
151 Patton Avenue, Room 208
Asheville, N. C. 28801-5006
Dear Mr. Hendrix:
020859
cS,? UED
The North Carolina Department of Transportation, Division of Highways, proposes the following
project for your issuance of a Section 404 Permit. We believe this project can be accomplished
under Nationwide #14 Permit, Linear Transportation Crossings and Nationwide #33 Permit,
Temporary Construction, Access, and Dewatering.
COUNTY: Cleveland
LOCATION: Pipe replacements on SR 2256, southwest of Kings Mountain
STREAM: Unnamed tributaries to Beason Creek, Class C Waters (From source to
Buffalo Creek), Broad River Basin
PROJECT DESCRIPTION: The project consists of replacing two deteriorating corrugated metal
pipes on two sites located within 0.25 miles of each other on SR 2256. Site 1- an existing 40-foot
long, 72" CMP is to be replaced with a 50-foot long, 72" CMP with inlet headwall. Site 2 - an
existing 50-foot long 72" CMP is to be replaced with a 50-foot long 84" CMP with inlet headwall.
At Site 2, the new pipe is to be shifted 5 feet downstream of the existing pipe. At the inlet and
outlet of both pipes, five-foot riprap aprons will be placed in the stream channel. A total of twenty
feet of riprap will be placed on the stream bank for structure stabilization at both pipes. Temporary
impervious cofferdams will be used to restrict stream flows and the streams will be piped around
the sites during construction. Upon project completion, the area impacted by the temporary
cofferdams will be restored to pre-construction conditions. Enclosed is a PCN application, a
sketch of planned activities, and location maps relative to the proposed project.

Mr. John W. Hendrix
Pipe replacements, SR 2256
May 24, 2002 - Page 2
Based upon the "Guidelines for the Location and Design of Hazardous Spill Basins", which are
referenced in DOT's Best Management Practices for the Protection of Surface Waters, the
applicable locations for the placement of hazardous spill basins are at stream crossings on highways
functionally classified as rural or urban arterials and where the stream crossing is within 1/2 mile of
the critical area. The proposed project is located in Class C Waters; therefore, hazardous spill
basins are not required. Enclosed is the NCDOT hazardous spill basin checklist for this project.
A review of the Natural Heritage information for the threatened species listed for Cleveland
County, the dwarf-flowered heartleaf (Hexastylis naniflora), did not reveal any known sites in the
immediate vicinity. I have conducted a survey for this species in the project area on May 24, 2002.
None were observed. It was determined that this species was not in the proposed project area.
No significant effect on this species is anticipated. A review of the available information from the
National Register of Historic Places was also conducted. It is anticipated that no historic sites will
be affected by the proposed project.
By copy of this letter, we are asking Neil Trivette, NCDOT Roadside Environmental Field
Engineer to comment on the above project. By copy of this letter, we are also requesting
concurrence from the Wildlife Resources Commission and U.S. Fish & Wildlife Service.
By copy of this letter, I am forwarding seven (7) copies of the application package to John Dorney,
NCDENR, Division of Water Quality, 401/Wetland Unit for review.
Your earliest consideration for this request would be greatly appreciated. Should you have any
questions, please call me at 704-480-9020.
Respectfully yours,
M.L. Holder, P.E.
Division Engineer
Twelfth Division
BY: ?lk(a-L
Trish Simon
Division 12 Environmental Officer
Enclosures
Mr. John W. Hendrix
Pipe replacements, SR 2256
May 24, 2002 - Page 3
cc: Mr. Michael L. Holder, P.E., Division Engineer
Mr. Dan Holderman, P.E. , Division Bridge Engineer
Mr. Neil Trivette, Roadside Environmental Field Engineer
Mr. Ron Linville, WRC
Mr. Brian Cole, USF & WS
Mr. John Dorney, DENR,DWQ,401/Wetlands Unit (7 copies)
File
Office Use Only: Form Version October 2001 02 085
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: Nationwide Permit #14, #33
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: Mike Holder NCDOT
Mailing Address: P.O. Box 47
Shelby, NC 28151
Telephone Number: 704480-9020 Fax Number: 704-480-5401
E-mail Address:
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: Trish Simon
Company Affiliation: NCDOT
Mailing Address: P.O. Box 47
Shelby, NC 28151
Telephone Number: 704480-9044 Fax Number: 704-480-5401
E-mail Address: [e-mail]
Page 5 of 12
M. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Pipe Replacements on SR 2256, Cleveland County
2. T.I.P. Project Number or State Project Number (NCDOT Only): 5.8052
3. Property Identification Number (Tax PIN): NCDOT Right of way
4. Location
County: Cleveland Nearest Town: Kings Mountain
Subdivision name (include phase/lot number): NA
Directions to site (include road numbers, landmarks, etc.): From Kings Mountain, Turn onto
SR 2256 and travel approximately 1.5 miles.
Site coordinates, if available (UTM or Lat/Long):{11 35°13 08'N/81°23'45W; {2} 35°13
16'N/81 °23'40W
(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:
Pipes on a paved secondary road
7. Property size (acres): 0.10 acres NCDOT right of way/site
8. Nearest body of water (stream/river/sound/ocean/lake): Unnamed tributaries to Beason
Creek (From source to Buffalo Creek). Class C waters
9. River Basin:. Broad
(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/.)
Page 6 of 12
10. Describe the purpose of the proposed work: The project consists of replacing deteriorating
corrugated metal pipes with new pipes Site 1- an existing 40-foot long, 72" CN P is to be
replaced with a 50-foot long, 72" CUT with inlet headwall. Site 2 - an existing 50-foot long
72" CMP is to be replaced with a 50-foot long 84" CN4P with inlet headwall. The new pipe
is to be shifted 5 feet downstream of the existing pipe. At the inlet and outlet of both pipes,
five-foot riprap aprons will be placed in the stream channel A total of twenty feet of riprgp
will be placed on the stream bank for structure stabilization at both pipes. Temporary
impervious cofferdams will be used to restrict stream flows and the streams will be piped
around the sites during construction.
11. List the type of equipment to be used to construct the project: A trackhoe will be used
for excavation and placement of riprap.
12. Describe the land use in the vicinity of this project: The surrounding area is pastureland,
woods, and residential.
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 future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application:
No future permit requests anticipated.
VL 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.
Page 7 of 12
I Wetland Imnacts
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***

• List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, till,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://www.fema.gov.
sss 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
2_ Stream Imnacts. including all intermittent and perennial streams
Stream
Impact Site Length of Impact ** Average Width Perennial or
Number Type of Impact* (linear feet) Stream Name of Stream Intermittent?
(indicate on Before Impact (please specify)
ma
FILL (Increase in pipe increase =10 ft First unnamed
1 pipe length and Riprap apron at inlet tributary to 2 feet Perennial
riprap aprons in
and outlet = 10 feet
BeasonCreek
stream
)
Placement of riprap 10 feet (inlet)
1 on bank for 10 feet (outlet) "
structure protection Total = 20 feet
I Temporary coffer 80 feet
dam/diversion pipe
Pipe increase = 0 ft Second unnamed
2 FILL L
?pmp Riprap apron at inlet tributary to 5 feet Perennial
stream
in
aprons and outlet = 10 feet I3easonCreek
Placement of riprap 10 feet (inlet)
2 on bank for 10 feet (outlet) "
structure protection Total = 20 feet
2 Temporary coffer 80 feet "
dam/diversion pipe
" 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, ditchh*slraightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.Qov. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.toiozone.com,
www.mapguest.com, etc.).
Page 8 of 12
Cumulative impacts (linear distance in feet) to all streams on site: Total Fill (Increase in
pipe length and riprap aprons) = 30 feet. Total Riprap used on stream bank for structure
protection = 40 feet, Total tem op rary cofferdam and stream diversion impacts = 160 feet.
Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U. S. NO OPEN WATER IMPACTS
Open Water Impact Area of Name of Watetbod
y Type of Waterbody
Site Number Type of Impact* Impact
( applicable) (lake, pond, estuary, sound,
indicate on ma acres bay, ean, etc.

' 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 NO 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.):
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.
NCDOT plans to replace deteriorating pipes with similar size/length pipes; therefore, there will
be only minimal additional impacts. Temporary cofferdams and pipe diversions will be utilized
to allow for construction to be done "in the dry" and to reduce sediment impacts. Blasting will
be necessary to set invert of pipe #1 one foot below streambed elevation.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetiands/strmizide.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.
IMPACTS < 150 FEET: MITIGATION NOT ANTICIPATED
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://h20.enr.state.nc.usiwm/indea.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Page 10 of 12
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 Butlers (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 )?
Identify the
mitigation is
multipliers.
square feet and acreage of impact to each zone of the riparian buffers. If buffer
required calculate the required amount of mitigation by applying the buffer
Zone* mp Impact feet Multiplier Required
1 3
2 1.5
Total
' Zone I extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 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.
Page 11 of 12
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.
No additional impervious surface is proposed in this project.
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.
NA
XIM Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
NA

Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
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3 PIPE
v2

Upstream of l d pipe on SR 2256 on an
unnamed tributary to Beason Creek in
Cleveland County
Inlet of Id pipe on SR 2256 on an unnamed
tributary to Beason Creek in Cleveland County
Outlet of I" pipe on SR 2256
unnamed tributary to Beason
in Cleveland County

T -
Upstream of 2°d pipe on SR 2256 on an
unnamed tributary to Beason Creek in
Cleveland County
GIB( ,?2:._.T;•.;!_I
X-
&
Outlet of 2nd pipe on SR 2256 on an
unnamed tributary to Beason Creek
in Cleveland County
Existing pond -50 feet downstream
of 2nd pipe on SR 2256

Inlet of 2nd pipe on SR 2256 on an unnamed
tributary to Beason Creek in Cleveland County
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fit. 1 J ..?? `\ ?- ? + ?? # _ _ •
a
Name: GROVER Location: 035° 13' 08.6" N 081023'36.4" W
Date: 5/23/2002 Caption: Two pipe replacements on SR 2245 on unnamed tributaries to
Scale: 1 inch equals 1000 feet Beason Creek, Class C Waters, Broad River Basin
Copyright (C) 1997, Meptech, Inc.

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19
NCDNVO Stream Classification Form
Ptojcci Namsn e f Cen1? 4 River Basin: Q ? j County. GI C ??rd • Lvaluator. ?, 4?? )!?Y/???
I` y V D
DWQ Project Number. 5TV Nesrest Named Stream:6 Q (Asf? Latitude: 3? 1-61081",/
Signature:
Date: C f r't°
I ?. b USGS QUAD: / Longitude: e 1 ?t / Location/Directions: Fr, 6 s -7 L I I I IQ
'PLEASE NOTE: !/rti/rerxandfe.d.- rh rrA
rprre a r/ratsvr u a menwa/r /4cA, rha. uu o/!h4/an. 6 not ntrecru?
Afro. !/f. the OptOre/g110.It)Y/jfmMf 0/I/le rN/W(N. thr/rwn it a man-male /itch and at r.rdl/IrI noun! run w--fhir Q
4 -4 0 (n ?? S a?L5(
rui.r syrtm- rh..//.ot hr geed' r
Primary Field indicators: rc vrro..Hamerrrr.t r)
nay W ate 1-n
1) Is There A Rime-Pool Sequence? 00 01 O 2
Is I no USDA Texture In Sireambed
2
) Ditrerent From Surrounding Terrain? 00 01 02
7) Are Natural Levees Present? 0 01 02 03
4) Is The Channel Sinuous? 00 01 02 (Y7
_ 3) Is There An Active (Or Relic) Flocidplain Present? 00 1 02 03
6) Is The Channel Braided? - Q4 01 02 03
7) Are Recent Alluvial Deposits Present? 00 B 1' 02 03
8) Is There A Bankfull Bench Present? 00 01 (D 2
Is A Continuous Bed & Bank Present?
9) (,Nora.- l/erd d e..ACo.red crouch)-fd.d WrrKOOr SM-4, TA.
Saerv-019 0
01
? 02.
A 2nd Order Or Greater Channel (As Indicated On Tope,
IO) V
ltl Q j
Map And(Or In Field) Present? ro.0
PRILIARYGEOMORPHOLOGYINDICATORPOINTS. Q
I
) #VALUEf
I1. Hydrolotty
i) It There A Groundwater Absent Weak Modern a Strong
Flow/Discharge Present? 00 O 1 2 03
PR/AIARY HYDROLOGY INDICATOR POINTS.
#VAL UEf
111. Biology Absent Weak Moderate Strong
1) Are Fibrous Roots Present In Sireambed? Gr,3- 02 01 00
2) Are Rooted Plants Present in Sireambed? QT O I 01 00
3) Is Periphyton Present? GI-01- de 01 02 03
4) Are Bivalves Present? 01 02 O 2
PRIMARY BIOLOGY INDICA TOR POINTS.
/
/Yes, #VALUEI
SecondarvField Indicators:
ror/.o..+ma.rr.rw)
1. Geomorphology Absent Weak Moderate Strong
1) Is There A Head Cut Present In Channel? 00 00.3 01 (4165

2) Is There A Grade Control Point in Channel?
00
Otis
01 Old"
Does Topography Indicate A
3)
1
00
O OS
0
l'
Ne
1 Drainage Wa . 1 Dil
SECONDARY GEOAIORPHOLOGY INDICATOR POINTS. #VAL UEl
11. Ilvdrolo v A sent Weak Moderate Stron
I) Is This Year's (Or Last's) l.eallitter
O 13
t
0
Present In Streambed? 0.s 00
2) Is Sediment On Plants (Or Debris) Present? 00 0.5 1 01.s
2) Arc Wrack Linn Present? 00 lY'DS 01 01.5
Is Water In Channel And >48 Hrs. Since,
4)
LaftKnorrRain? /'N0/E:I/DlrrAln/Intr/t.MAberSlia7AirLyA.Ifl?.•)
S
Ol
O 1.5
Is There Water In Channel During Dry
00
!'
0
Conditions Or In Growing Seaton)? l!
OS 1 01.5
,
6) Arc Hydric Soils Present in Sides O(Chsnnel (0r i Hc.ucut)1 tY Tes-1.5 O No-0
SECONDAR
I --VLVV I II rU/ l-A I UK
#VAL UEl
Weak

1) Are Fish Present?
00.s
01 V
O 13
2) Are Amphibians Present? 00.5 01 01.5
7) Are AquaticTunles Present? 00.5 01 O IS
4) Are Crayfish present? i?t)^ 00.3 01 01.5
S) Ate Macrobenthos Present? 0 00.s 01 01.5
6) Are Iron Oxidizing Bacteria/Fungus Present? 00 qA O 1 01.5
7) Is Filamentous Algae Present? &Il 00.5 01 01.5
e) Are Wetland Plants In Sitcambed?
f'A'OiE: lfTadAara.rr OJAItPi.rr /n Saea.arl AI Nae/
Anew Sly rAi S tp UNL=SIV Prnr.r•). SAV Mostly OBL
02 01 Mostly FACW
00.7s Mostly FAC
00.s Mostly FACU Mostly UPL
00 00
SECONDAR Y BIOLOGY INDICATOR POINTS. 01 t?
TOTAL PWNTS (Prirrrnrl'+Secondary)- #VALUEI #VALUEI
(IfGremerTitan Or Equal To lYPoints vie Stream is At least intermittent)
INTERMITTENT CHANNEL
EVALUATION FORIM
ACTION ID APPLICANT-NAME A Do -t- ? DATE 5442L
PROPOSED CHANNEL WORK i. c.. culvert, n:loc:ttion, etc.) ,21
??Ip'Q(QrYIP ?? 7??1
WATERBODY/RIVER BASIN Cn f-I
COUNTY/CITY r t'evt ?Q rr?
RF.CF.NT WEATHER CONDITIONS
Q?
- SP NP Observation
Comments or Description
Ft>n Snc?? i>IvC u>tut. uns P se,u I
P
Beatific `Iacco Itl?.'Ieb: d[l'Y
A.nohibtti.s Presr..t'Breeding
al tae :\ntl'Or Fungus (t?atc. quality functiun)
Wildlife Channel Usc ti.e. tracks, feces. shells, others)
Federalh P-otectcd Species Present (Discontinue)
Riftlelpooi Structure
Stable SueambanKS
Channel Substrate
(i.e. ?^acel. cobble. rock, coarse sand)
Ripurian Canopy Present (S? _,> 50^,- closure)
Undercut Banks/Instr.-wn Habitat Structure
Fiow In Channel
W--da tds -UjacLat TorContig. With Channel
(Discontinue)
Persistent ?oolsiSaturated Bottom
Hunt th:o?,cit Sect.;
Scepsi&ound%vater Dlschar?C 01ine through Sept.(
Adjacent ; ?oodolam ?.'esent
W-ack Nlaterial or Drift Lines
Hdrnph..:c Vt,eration in,adjacent to channel
Important To Domestic Water Supply? Y N
Does Channel appear On A Quad Or Soils Map°•O/ N Approx. Drainaize.-Lea: Q i
Deter-,inati0r
Pe- ,.vial Channel (stop [In ortant Channel: LF PROJECT NIGR. Initials
nte-nittent Channel 'proe;., nimoortant Char cl: LF
E?hCt^erai Charne! (nujd) (attach map indicating location of imoortanvuntmporiant channel)
Duch Through Upland (no id)
Evaluator's Signature.
(if other than C.O.E. project manager t
P=Prescnt SP=Slongly P,,:sent NP=Not Present 1 1 /98
.. ._ v
irc.rni a,.i.rnarii? .ruyn corm
?
rCProjeet ey-Ne ? 4
??W1t
River Basin: ro U ,l+1
County: C1 e\1d&1yj
Uvaluator.
DIDQ Project Number. Nearest Named Stream: (u6?\ Latitude: 3S o 2 , $ignaturt: (I Q -
Date: USGS QUAD: Lon
'PLE AS . J J /•,h'-
E?T,n Bi • Q I° ?t I.ocanoNDuections: { 'S as ??
S?AN
Lj Q & s ?( a K
E:I/r..lr.rw and rendawwnefrrr deuhr/ar.r. tle,w.n.,..•%aLM rAw /rM4
wro /^+u
nw rare-v-r?. i _
A4o,?InrlfbrlrPra?Ullanl(?YISrlAfnla?//IrrM/Wler,thr?rararrirrrnuwa/r/irthen/norr,ne/llrr/WrurJlrrran.--chi] ?lr? ..Urn r,..? s? ??5?,
r-tins ryrtrn] the.!/nor br wr1•
Primarv Field Indicators: rc?r.onrN.we..rrrL-rl
I. Ceomnrnholnrv Ab.rnt W-Le Alndrr r Strn
1) Is Then A Rime-Pool Sequence? 00 01 0 2 tjif
is The USDA Tcxrum in Stmenibcd
2)
0
Different From Surrounding Tern in? 0 O L 02

3) Are Natural Levees Present?
,
11Y0"
01 Frr,-
02 03
d) Is The Channel Sinuous? 00 01 02
5) Is There An Active (Or Relic) Floodplain Present? 00 01 02
6) Is The Channel Braided? (J,? 01 0 2 03
7) Are Recent Alluvial Deposits Present? 00 01 02 8) Is There A Bsr&&Il Bench Present? 00 01 02
Is A Continuous Bed & Bank Present? ((?'3
9) ("Nord.. (/bd d B--b C-wr,l By Di"Ai.r Ant w"HoUr S-.-nry taa Senn-09 0 01 02
I
V A 2nd Order Or Greater Channel (As Indicated On Topes
10) Map And/Or in Field) Present? 6'res-3 O tro.0
INDICATOR
#VALUEI
II. Hvdrologv k1bsentl Weak Moderate Stron

1) Is There A Groundwater g
FlowtOiacha a Present? 00 0 1 02
PRIMARY HYDROLOGY INDICATOR POINTS.
#VA L UEl
Ill. Biology Absent Weak Moderate Strop
1) Arc Fibrous Roots Present In Streambed7 O-er 02 01 00
2) Are Rooted Plants Present In Streambed? oil- 02 01 0 0
3) Is Periphyron Present? 010 01 02 03
4) Are Bivalves Present? 0 1 02 03
PRIAIAR Y BIOLOGY INDICA TOR POINTS.
Secondarv Field Indicators: (c7w.o.rm-br+Pmu.0 /
l?Yn #VALUEI
_ L Geomorphology Absent Weak Moderate Strong
1) Is There A Head Cut Present In Channel? 00 00.5 01 Q<5
2) Is Then A Grade Control Point In Channel? 00 0 OS 01 Gei?
3) Does Topography Indicate A
Natural Drainage Way?
0 0
0 OS
01
1.5
ocLUNIJARYGEUMORPHOLOGYINDICATORPOINTS.

11. IlvdrologY
I) is This Years (Or Lass's) Lcallilter
Present In Stmambcd?
,1_4?
t
Absent
0-6
#VALUEI

Weak

01

oderate

00.5

trong

00
2) Is Sediment On Plants (Or Debris) Present? 00 00.5 01 0'f,s
3) Are Wrack Linea Present? 00 00.s 01

C Is W titer In Channel And N8 Hrs. Since 0
Last Known Rain? (•NOTr-10`0
, Mdl
dt
f
2

OO'S

?1 S

$
,
e
. al
Above5b, Thi1Srp A
Is There Water in Channel During Dry
5) wfU9
r-J ,
'

Conditions Or In Growing Season)?
00
00.5
01 ^
.
S
6) Are Hydric Soils Present In Sides O(Channel (Or b 14 -kurn es-1.5 0 No-o
SECONDARY HYDROLOGY INDICATOR POINTS.
Q
#VALU
El
_
111. Biology Absent Weak Moderate Strong
1) Are Fish Present? nt
U+'9 00.5 01 01.5
2) Are Amphibians Present?
? ?
00.s
01
01.5
3) Are AquatieTuales Present? ..
04/ 00.s 01 0 IS
/) Are Crayfish Present? 0.4-- 00.5 01 0i.5
5) An Macrobenrhos Present? 00 e10.5 0 1 01.5
6) An Iron Oxidising Bacteria/Fungus Present? 00 00.5 01.5
7) Is Filamentous Algae Present? 00 00.s 01
13
8) Art Wetland Plano In Streambed? SAV
NOTE: rf rent Abrr-er OfArr Pr-„n t. Sue-.bd Al Nad 02 Alostly OBL
01 Mostly FACW
0 Mostly FAC
0 Alos(lY FACU Mostly UPL

Ab-w SUP This SIrp UNL=SAV P.we.r •). 0.7S 0.5 00 00
SECONDARY BIOLOGY INDICATOR POINTS.
#VALUEI
TOTAL POINTS (Prima •+Secandarv. 1 (I)'Grearrr Than Or Equal To 19 Poin ts The Stream G At Leant Intermittent)

INTERMITTENT C IAYYEL ?`?:,` '
EVALUATION FORlV•I
ACTION ID APPLICAYI' NA,NIE ' C l) ar DATE ? O 2
PROPOSED CHANNEL WORK6.c.. culvert, relocation, etc.) tQI (? of a eh? i>3?' ! < o?aS?o
WaTERSODY/RIVER BASIN ?co D-C?
COUNTY/CITY l ?F eV?e?Q ?1/?'
RF,CFN'r WEATHER CONDITIONS nln/
P SP NP I Observation
t _,,-I Fi,h;She!!t!slit &uhtaccans Present
Comments or Descriouon
Bentn)t. `tacro Invertebrates
a:nphtbixts Present.'Breeding,
Algae and'Or Fungus (water quality function)
Wildlife Channel Use (i.e, tracks, feces, shells. odters)
Federally Protected Species Present (Discontinue)
Riffle,Pool Structure
Stable Streambanks
f Channel Substrate
(i.e. Yacel, cobble rock. coarse sand)
R:oarian Canopy Present (SP =,> SO11, closure)
Undercut Banxs/Instream Habiwt Structure
Flow In C:w.vtel
??glands adjacent To/Conti- with Channel
(Discontinue)
I Persistent PoulsrSatumted Bottom
tJune th o-ich Sept.i
Secps/G,roandwuter Discaar_e (June through Sept.)
Adjacent Foodolam Present
«rack Material or Drift Lines
H;:droph?tic Ve ?:ation in adjacent to channel
Important To Domestic Water Supply? Y / N
Does Channel Appear On A Quad Or Soils Map-? 0 N
Deterninotion-
Perennial Channel
IRlerm:tZent Channel
Ephemeral Charnel
Ditch Throu,h Upland
Approx. Drainage Area:
(stop) Important Channel LF PROJECT `IGR. Initials
(proceed) Unimportant Channcl: LF
(nojdi (attach ;nap indicating location of imoortantiunimportant channel)
(no jdi
Evaluator's Signature:
(if other than C.O.F. project manager)
P=Prescnt SP=Ston,lvPrescnt NP=.NotPresent 11;1/g8
NCDOT
HAZARDOUS SPILL BASIN CHECKLIST
Division: 17- County: Project ID: 58o5Z
River Basin: I L,2 4? Bridge No:

Route: -;57e- ZZS4, Stream:
Water Quality Criteria: CL?455 G ' r'?2?'z S
Yes No
Stream Crossing Blue Line On USGS rZ r
ORW r Fr`
WSI r r„<
WS 11,111 OR IV, Crossing Within 0.5mi of W.S. Critical Area r F?'
Roadway Criteria:
Route Designation-
Additional Site Information:
Yes No
Arterial Urban F P,
Arterial Rural r r?
Yes No
Is a Hazardous Spill Basin Required?
r r?
Criteria Based Upon NCDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997).
df •
STATE of NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPETT
GOVERNOR SECRETARY
020859
MEMO TO: John Dorney, DENR/DWQ/40 I [Wetlands Unit
FROM: Trish Simon, Division 12 Environmental Officer
DATE: May 24, 2002
SUBJECT: Pre-construction Notifications/401 Automated Payment
Enclosed are seven copies of a pre-construction notification permit application for a
bridge project in Cleveland County for your review and comments.
Project information for the 401 Automated Payment Procedure
• Work order number: 4312B-549-5.8052475-SR2256-80999
• TIP #: Not Applicable
• Project Category: $200.00 Fee
is
MAY ,? 0002 °.,•-.,,WA7c,? U,aLI?yS a,
?CTfON t
PAYMENT
RECEIVED
Post Office Box 47 Shelby, North Carolina 28151-0047