20021125 Ver 1_Complete File_20020715

?T Michael F. Easley, Governor
F9 William G. Ross Jr., Secretary
O? Q? North Carolina Department of Environment and Natural Resources
\
I VON 71-
Aian W. Klimek, P.E. Director
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Division of Water

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DWQ Project No.: 0??/oZ S County: G 1
Applicant: NCDOT
Project Name s-Z? /307
Date of Issuance of 401 Water Quality Ce cation:- a 3 y
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
I, Joel B. Setzer, P.E., 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 401 Wa Quality Certification and Buffer Rules, the approved plans and
specifications, and o rtSignature: Date: 1.3ol?F?
Agent's Certific ion
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:

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/ncwetiands/
O?O? W A T ?qQG
O
July 23, 2002
Clay County
DWQ Project No. 021125
SR 1307 (Clear Creek Road)
APPROVAL of 401 Water Quality Certification with Additional Conditions
Mr. J. Ralph Cannady, P.E., County Maintenance Engineer
NCDOT Andrews District Office
P.O. Box 1551
Andrews, NC 28901
Dear Mr. Cannady:
You have our approval, in accordance with the attached conditions and those listed below, to impact 80
linear feet of an unnamed tributary to Clear Creek, Stephens Branch and Camp Branch in order to
improve SR 1307 (Clear Creek Road) in Clay County. The project should be constructed in accordance
with your application dated July 11, 2002 (received July 15, 2002). After reviewing your application, we
have decided that this fill is covered by General Water Quality Certification No. 3375 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 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 us, 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 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. NCDOT shall adhere to Best Management Practices for the Protection of Surface Waters (March
1997).
2. In-stream work and land disturbance within the 25-foot wide buffer zone are prohibited during the
trout spawning season of October 15 through April 15, or other conditions as determined by the
North Carolina Wildlife Resources Commission, to protect the egg and fry stages of trout from
sedimentation during construction.
3. Where practicable, storm water should be directed to buffer areas or retention basins and must not be
routed directly into streams. Mowing of existing vegetated buffers is strongly discouraged, so that
they may be utilized for storm water sheet flow.
4. Temporary or permanent herbaceous vegetation shall be planted on all bare soil within 15 days of
ground-disturbing activities to provide long term erosion control.
5. The pipes required for this project shall be installed in such a manner that the original stream profiles
are not altered (i.e. the depth of the channel must not be reduced by a widening of the streambed).
Existing stream dimensions are to be maintained above and below locations of each culvert. The
culvert shall be installed one foot below the stream to allow for fish and other wildlife movement.
All wnrlr chnll hP i erfnrmerl cluing lnui flnw rnnrlitinnc
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/
7. 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.
8. The presence of equipment in the channels must be minimized. Under no circumstances must rock,
sand or other materials be dredged from the wetted stream channel under authorization of this permit,
except in the immediate vicinity of the culverts.
9. Use of rip-rap for bank stabilization is to be minimized; rather, native vegetation is to be planted when
practical. If it is necessary to the project, rip-rap must be limited to the stream bank below the high
water mark, and vegetation must be used for stabilization above high water.
10. Native riparian vegetation must be reestablished within the construction limits of the project by the
end of the growing season following completion of construction.
11. Upon completion of the project, the NCDOT shall complete and return the enclosed
"Certificate of Completion" form to notify NCDWQ when all work included in the §401
Certification has been completed. The responsible party shall complete the attached form
and return it to the 401/Wetlands Unit of the 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 150B of the North Carolina General Statutes to the Office of
Administrative Hearings, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its
conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water
Act. If you have any questions, please telephone Ms. Cynthia Van Der Wiele at 919.733.5715 or Mr.
Mike Parker of the Asheville Regional Office at 828.251.6208.
Attachment
inc rel ,
Klim , P.E.
Pc: Wilmington District Corps of Engineers
John Hendrix, USACE Asheville Field Office
NCDWQ Asheville Regional Office
Central Files
File Copy
Jy .,. 5(AIT
021125
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL. F. EASLEY
GOVERNOR
July 11, 2002
U.S. Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, NC 28801-2714
Attention: Mr. John Hendrix
NCDOT Coordinator
FILE COPY

401 LSSUED

LYNDO TIPPETT
SECRETARY
Subject: Proposed Secondary Road Improvement
SR 1307 Clear Creek Road, near Hayesville, NC, Clay County.
State Project No. 5.9223 (DWQ Minor Permit Fee 5200)
Dear Mr. Hendrix:
The North Carolina Department of Transportation (NCDOT) is proposing to improve SR
1307, Clear Creek Road, in Clay County. This proposal entails placing gravel on the
road surface and installing three pipes in the road where streams are currently forded. In
order to accomplish this work, NC T is requesting permission to install three CMP
culverts.
The proposed improvements of SR 1307 have been identified as necessary maintenance
and safety improvements. These improvements also answer vital environmental
concerns. Currently, vehicles must ford three streams allowing silt, motor oil, gasoline,
and other substances to enter the streams and severely damage the water quality. The
installation of the pipes would correct this problem. Funds have been allocated for this
project, and NCDOT would like to perform these activities sometime during 2002.
Andrews District Office
Phone: [phone] P. 0. Box 1551, Andrews, N. C. 28901 Fax: [phone]
I am attaching details of the sites which will propose to be in conflict with the stream. I
am also attaching photographs, a vicinity map, as well as a USGS map with these sites
shown with their coordinates listed. We propose to install the new culverts slightly
below the existing streambed elevations where bedrock is not encountered to minimize
impacts to wildlife habitats and allow the existing stream gradients to remain as
unchanged as is physically possible. No threatened or endangered species are known to
be present in or near the project area; therefore, no significant impacts are anticipated
from project construction. :1 ly
Best management practices will be used to minimize ind control sedimentation and
erosion on this project. The construction foreman will review all erosion control
measures daily to ensure sedimentation and erosion s being effectively controlled. If the
planned devices are not functionintas intended;"Thrill be immediately replaced with
better devices. The rock siltscreens and other erosion control devices will be in place
prior to pipe culvert construction and will rernmr0iace until the project is stabilized.
Impacts to Waters of the United *tates
In order to complete the above-mentioned improvements along SR 1307 in Clay County,
it will be necessary to impact waters of the United States in the Little Tennessee River
Basin. Specifically, NCDOT is requesting to extend/replace one metal culvert each in
Stephens Branch (Class C), UT to Clear Creek (Class C Trout), and Camp Branch (Class
Q. Listed below is a summary of the proposed impacts.
Station Existing Condition Proposed Condition Net Impacts
Site #1 NO PIPE 25' x (36" x 22") CMP Arch 25' extension
Site #2 NO PIPE 25' x (36" x 22") CMP Arch 25' extension
Site #3 NO PIPE 30' x (50" x 31") CMP Arch 30' extension
80 ft. total
Permits Requested
NCDOT is hereby requesting authorization under NWP 14 and Section 404 of the Clean
Water Act to proceed with the construction project outlined above. By copy of this letter,
I am asking Mr. Owen Anderson, North Carolina Wildlife Resources Commission
(NC WRC) Western Mountain Region Coordinator, to comment directly to you
concerning the 404 Nationwide Permit Request.
Also, by copy of this letter, I am requesting authorization to proceed under Section 401 of
the Clean Water Act from the Division of Environmental Management
Again, we would like to proceed with this project during 2002. If you require additional
information, please contact me at 828.321.4105. Your early review and consideration
will be greatly appreciated.
Sincerely, Z 'P
J. Ralph Cannady,
County Maintenance Engineer
Copy: Mr. Richard Phillips, PE, Regional Engineer DEHNR
Mr. R.G. Watson, PE, Division Engineer, NCDOT
Mr. John Dorney, DWQ, DEHNR
Mr. Owen Anderson, Western Mountain Coordinator, NCWRC
Mr. B.C. Burch, PE, District Engineer, NCDOT
Mr. Terry Woody, Transportation Supervisor III, NCDOT
Mr. Mark Davis, Division Environmental Officer, NCDOT
Mr. Reid Whitehead, Roadside Environmental Officer, NCDOT
Topton Quadrangle
Clear Creek Road, SR 1307
Clay County
STREAM IMPACTS
Station Existing Proposed Condition Net Impacts Latitude/ Longitude
Condition
Site #1 NO PIPE 25' x (36" x 22") 25' extension 35-08-56/83-40-13
CMP Arch
Site #2 NO PIPE 25' x (36" x 22") 25' extension 35-08-35/83-40-07
CMP Arch
Site #3 NO PIPE ,x (50" x 31 30' extension 35-08-04/83-40-24
CMP Arch
80 feet total

Site #1

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W A 7'FR
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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
SR 1307, Clear Creek Road, Clay County
HOlTM C.4
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NCDOT Division 14, District III
Prepared by: Ralph Cannady, PE
County Maintenance Engineer
Macon & Clay County
Office Use Only: Form Version October 2001
USACE Action ID No. DWQ No P 2 1 1 2 5
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit
? Section 10 Permit
® 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: 14
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ? N/A
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ? N/A
II. Applicant Information
Owner/Applicant Information
Name: North Carolina Department of Transportation (NCDOT)
Mailing Address: PO Box 1551
Andrews NC 28901
Telephone Number: 828.321.4105 Fax Number: 828.321.3228
E-mail Address: rcannady a (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: J. Ralph Cannady, PE
Company Affiliation: County Maintenance Engineer
Mailing Address: (same as above)
Telephone Number: Fax Number:
E-mail Address:
111. 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: Clear Creek Road SR 1307
2. T.I.P. Project Number or State Project Number (NCDOT Only): 5.9223
3. Property Identification Number (Tax PIN)
N/A
4. Location
County: Clay Nearest Town: Hayesville
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): Take SR 1307, Tusquitee Road,
north from Main St in Hayesville Left on Tuni Gap Rd at 10 miles. Right on to Clear
Creek Rd at Tuni Gap (Macon Co line). Site 91 is 2.197 mi off Tuni Gap Rd.
5. Site coordinates, if available (UTM or Lat/Long): see attached "Stream Impacts"
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application:
forest pasture light residential
7. Property size (acres): N/A
8. Nearest body of water (stream/river/sound/ocean/lake): Clear Creek (class C Tr)
9. River Basin: Little Tennessee
(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/map-/.)
Describe the purpose of the proposed work: Improve existing paved road.
10. List the type of equipment to be used to construct the project: trackhoe, backhoe, dozer
loader, grader, dump trucks
11. Describe the land use in the vicinity of this project: forest, pasture, 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:
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying. site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Wetland Impacts No wetland impacts
4
Wetland Impact
Site Number
(indicate on map)
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, out are nor umtted to: mechwuccu uiuwmE, ?tauu?g .??,,
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:/hvww.fema.aov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property:
Total area of wetland impact proposed:
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)
Site #1 Culvert 25 ft. Stephens Branch 2 ft. P
Site #2 Culvert 25 ft. UT to Clear Creek 2 ft. P
Site #3 Culvert 30 ft. Camp Branch 3 ft. P

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated np-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
www.usas.Qov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapguest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 80 linear feet
3. 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
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.

* 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.):
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.
Erosion and siltation control measures and BMP's will be used during construction to avoid
environmental impacts
VIII. Mitigation N/A
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://h2o.enr.state.nc.us/ncwetlands/strm.izide.htmi.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
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.enr.state.nc.us/NvTp/index.litm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information: N/A
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): -
7
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/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 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ? If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
square feet
Multiplier
Required
Miti ation
I 3
2 1.5
Total
L.VIIC I C[LCnUJ VUL.3V IM perpenolcular trom near bank of channel; "Lone 2 extends an
additional 20 feet from the edge of Zone 1.
8
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.
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.
The existing unpaved roadway acts as a pervious surface Applying gravel to the roadway will
not impact the pervious nature of the surface. Stormwater will be treated as it has been
previously. (See 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.
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No ?
Is this an after-the-fact permit application?
Yes ? No ?
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered -and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
C
Applicant/Agent's Signature / v Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
MINIMUM CRITERIA DETERMINATION CHECKLIST
The following questions provide direction in determining when the Department is
required to prepare environmental documents for state-funded construction and
maintenance activities. Answer questions for Parts A through C by checking either yes
or no. Complete Part D of the checklist when Minimum Criteria Rule categories #8 or
# 15 are used.
TIP Project No.: N/A
State Project No.: 5.9223
Project Location: SR 1307, Clear Creek Road, Clay County
Project Description: Unpaved secondary road improvement
Anticipated Permit or Consultation Requirements: 401 and 404
Special Project Information: Project consists of placing gravel on existing roadway
surface and installing new pipes where streams are currently forded.
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PART A: MINIMUM CRITERIA
YES NO
1. Is the proposed project listed as a type and class of activity allowed under X El
the Minimum Criteria Rule in which environmental documentation is not
required?
If the answer to number 1 is "no", then the project does not qualify as a
minimum criteria project. A state environmental assessment is required.
If yes, under which category? Nine (9)
If either category #8 or #15 is used complete Part D of this checklist.
PART B: MINIMUM CRITERIA EXCEPTIONS
?7te; 2:;9alo?ecorriplefed>:b h ' ?t t' a "'. L
2. Could the proposed activity cause significant changes in land use
concentrations that would be expected to create adverse air quality
impacts?
3. Will the proposed activity have secondary impacts or cumulative impacts
that may result in a significant adverse impact to human health or the
environment?
4. Is the proposed activity of such an unusual nature or does the proposed
activity have such widespread implications, that an uncommon concern
for its environmental effects has been expressed to the Department?
5. Does the proposed activity have a significant adverse effect on wetlands;
surface waters such as rivers, streams, and estuaries; parklands; prime or
unique agricultural lands; or areas of recognized scenic, recreational,
archaeological, or historical value?
6. Will the proposed activity endanger the existence of a species on the ? F]
Department of Interior's threatened and endangered species list?
7. Could the proposed activity cause significant changes in land use
concentrations that would be expected to create adverse water quality or
ground water impacts?
07/11/02 2 of 4
YES NO
8. Is the proposed activity expected to have a significant adverse effect on
long-term recreational benefits or shellfish, finfish, wildlife, or their
natural habitats
If any questions 2 through 8 are answered "yes", the proposed project may not qualify as a
Minimum Criteria project. A state environmental assessment (EA) may be required. For
assistance, contact:
Manager, Project Development and Environmental Analysis Branch
P. O. Box 25201
Raleigh, NC 27611
(919) 733 -3141
Fax: [phone]
PART C: COMPLIANCE WITH STATE AND FEDERAL REGULATIONS
teriisJ ?I2• o''bo etsviroy menta YES NO
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9. Is a federally protected threatened or endangered species, or its El habitat, likely to be impacted by the proposed action?
10. Does the action require the placement of temporary or permanent
fill in waters of the United States?
11. Does the project require the placement of a significant amount of 1:1 El
fill in high quality or relatively rare wetland ecosystems, such as
mountain bogs or pine savannahs?
12. Is the proposed action located in an Area of Environmental
Concern, as defined in the coastal Area Management Act?
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13. Does the project require stream relocation or channel changes?
Cultural Resources
13. Will the project have an "effect" on a property or site listed on the
National Register of Historic Places?
14. Will the proposed action require acquisition of additional right of .
way from publicly owned parkland or recreational areas?
Questions in Part "C" are designed to assist the Engineer and the Division Environmental
Officer in determining whether a permit or consultation with a state or federal resource
agency may be required. If any questions in Part "C" are answered "yes", follow the
appropriate permitting procedures prior to beginning project construction.
07/11/02 3 of4
PART D:(To be completed when either category #8 or #15 of the rules are used
' ems I5- 20 0 die complei ?iti 74ivisron ' nvironmenfal Wei
15. Project length:
16. Right of Way width:
17. Project completion date:
18. Total acres of disturbed ground surface:
19. Total acres of wetland impacts:
20. Total linear feet of stream impacts:
21. Project purpose:
If Part D of the checklist is completed, send a copy of the entire checklist document to:
Don G. Lee
State Roadside Environmental Engineer
Mail Service Center 1557
Raleigh, NC 27699-1557
[phone]
Fax [phone]
Email: [e-mail]
Reviewed by:
Date: 7/11/02
Division Environmental Engineer
cc: Don Lee
Date:
07/11/02 4 of4