20020154 Ver 1_Complete File_20020201

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Gregory J. Thorpe, Ph.D., Acting Director
•
461 4
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
DWQ Project No.: - OZ 0 15400 County: __ LE E
Applicant: ----11L,E tt osSER DI y OF N l GFt_ ACS ----
P?•ojectName: __REpL?GtrMEtJT o? t3R!?? SS 6N S /
Date of Issuance of 401 Water Quality Certi "cation: nI ARCH 22j 2 00
NOTE: P6RIv?tT nl?-r us,i:o . ?PROJrc.T co MA-CTEa UN fi:R NW19#-3)
Certificate of Completion
Upon completion or 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
40t/Wetlands [Init. North Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC,
27699-162 1. This form may be returned to DWQ by the applicant, the applicant's authorized agent, or the
project en`,incer. It is not necessary to send certificates from all or these.
Applicant's Certification
----- hereby state that, to the best of my abilities, clue care and
dili?nce 11as 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.
Signahtre:
Date:
Agent's Certification
1, -- --- - - -- ---- -- _, hereby state that, to the best of Im 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:
E'ngineer's Certification
Partial Final
as a duly registered Professional Engineer in the State
of North Carolina, having been authorized to observe (periodically, weekly, full time) the construction of
the project.for the Permittee hereby state that, to the best of my abilities, due care and diliggence 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
Wetlands/4111 Unit 1621 Mail Service Center Raleigh. North Carolina 27699-1 62 1
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ALT %.
/ ffl?N;WA 0
Michael F. Easley, Governor NCDENR
William G. Ross, Jr., Secretary NORTH CAROLINA DEPARTMENT OF
Gregory J. Thorpe, Ph.D., Acting Director ENVIRONMENT AND NATURAL RESOURCES
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
March 22. 2002
Lee County
DWQ Project No. 020154
APPROVAL of 401 Water Quality Certification
Mr. William D. Gilmore, P.E., Manager
Planning and Environmental Branch
North Carolina Department of Transportation
1548 Mail Service Center
Raleigh, North Carolina, 27699-1548
Dear Mr. Gilmore:
You have our approval, in accordance with the attached conditions and those listed below, to place till
material in 90 linear feet of streams for the purpose of replacing Bridge Number 55 on SR 1318 in Lee
County. The project shall be constructed in accordance with your application dated January 31, 2002.
After reviewing your application, we have decided that this fill is covered by General Water Quality
Certification Number 3289. This certification corresponds to the General Permit 198200031 issued by the
Corps of Engineers. In addition, you should acquire any other federal, state or local permits before you
proceed with your project including (but not limited to) Sediment and Erosion Control, Non-Discharge and
Water Supply Watershed regulations. This approval will expire with the accompanying 404 permit, unless
otherwise specified in the Water Quality Certification.
This approval is valid solely for the purpose and design described in your application (unless modified
below). Should your project change, you must notify the DWQ and submit a new application. If the
property is sold, the new owner must be given a copy of this Certification and approval letter, and is thereby
responsible for complying with all the conditions. If total wetland fills for this project (now or in the future)
exceed one acre, or of total impacts to streams (now or in the future) exceed 150 linear feet, compensatory
mitigation may be required as described in 15A NCAC 2H .0506 (h) (6) and (7). For this approval to
remain valid, you must adhere to the conditions listed in the attached certification.
1.) Upon completion of the project, the NCDOT shall complete and return the enclosed "Certification of
Completion Form" to notify DWQ when all work included in the 401 Certification has been completed.
The responsible party shall complete the attached form and return it to the 401/Wetlands Unit of the
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, P.O. Box 27447, Raleigh, N.C. 276 1 1-7447. This certification and its conditions
are final and binding unless you ask for a hearing.
Wetlands/401 Unit 1621 Mail Service Center Raleigh. North Carolina 27699-1621
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State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Gregory J. Thorpe, Ph.D., Acting Director
A 1TY?WAj
Nowak
4; lk
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water
Act. If you have any questions, please contact John Hennessy at 919-733-5694.
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Wilmington Field Office
DWQ Raleigh Regional Office
File Copy
Central Files
c:\ncdot\SR 1318\wqc\020154wgc.doc
w M
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1621
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Ar t
State of North Carolina
Department of Environment
and Natural Resources
Division of,Water Quality

Michael F. Easley, Governor NC ENR
William G. Ross, Jr., Secretary NORTH CAROLINA DEPARTMENT OF
Gregory J. Thorpe, Ph.D., Acting Director ENVIRONMENT AND NATURAL RESOURCES
ROAD CROSSING CERTIFICATIONGENERAL CERTIFICATION FOR PROJECTS ELIGIBLE
FOR CORPS OF ENGINEERS NATIONWIDE PERMIT NUMBER 14 (ROAD CROSSINGS),
REGIONAL GENERAL PERMIT 198200031 AND NEUSE/TAR-PAMLICO/RANDLEMAN
BUFFER RULES
This General Certification is issued in conformity with the requirements of Section 401, Public Laws 92-
500 and 95-217 of the United States and subject to the North Carolina Division of Water Quality (DWQ)
Regulations in 15A NCAC 2H, Section .0500 and 15A NCAC 2B .0200 for the discharge of fill material to
waters and wetland areas as described in 33 CFR 330 Appendix A (B) (14) of the Corps of Engineers
regulations (i.e., Nationwide Permit No. 14 and Regional General Permit 198200031) and for the Neuse,
Tar-Pamlico and Randleman Buffer Rules (15A NCAC 213 .0233,.0259 and.0250). The category of
activities shall include any fill activity for road crossing and is limited to fill less than one-third of an acre.
This Certification replaces Water Quality Certification Number 2177 issued on November 5, 1987, Water
Quality Certification Number 2666 issued on January 21, 1992, Water Quality Certification Number 2732
issued on May 1, 1992 and Water Quality Certification Number 3103 issued on February 11, 1997. This
WQC is rescinded when the Corps of Engineers re-authorizes Nationwide Permit 14 or Regional General
Permit 198200031 when deemed appropriate by the Director of the DWQ.
The State of North Carolina certifies that the specified category of activity will not violate applicable
portions of Sections 301, 302, 303, 306 and 307 of the Public Laws 92-500 and 95-217 if conducted in
accordance with the conditions hereinafter set forth.
Conditions of Certification:
1. Proposed fill or substantial modification of wetlands or waters (including streams) under this General
Certification requires application to and prior written concurrence from the Division of Water Quality;
2. In accordance with North Carolina General Statute Section 143-215.3D(e), any application for a 401
Water Quality Certification must include the appropriate fee. If a project also requires a CAMA Permit,
one payment to both agencies shall be submitted and will be the higher of the two fees;
3. In accordance with 15A NCAC 2H .0506 (h) compensatory mitigation may be required for impacts to
streams and/or wetlands. In addition, buffer mitigation may be required for any project with Buffer
Rules in effect at the time of application. A determination of buffer, wetland and stream mitigation
requirements shall be made for any Certification for this Nationwide Permit. The most current design
and monitoring protocols from DWQ shall be followed and written plans submitted for DWQ approval
as required in those protocols;
4. For any project involving a stream re-alignment, a stream relocation plan must be included with the 401
application for written DWQ approval. Relocated stream designs should include the same dimensions,
patterns and profiles as the existing channel, to the maximum extent practical. The new channel should
be constructed in the dry and water shall not be turned into the new channel until the banks are
stabilized. Vegetation used for bank stabilization shall be limited to native woody species, and should
include establishment of a 30 foot wide wooded and an adjacent 20 foot wide vegetated buffer on both
sides of the relocated channel to the maximum extent practical. A transitional phase incorporating coir
fiber and seedling establishment is allowable. Also, rip-rap may be allowed if it is necessary to maintain
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post consumer paper
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Gregory J. Thorpe, Ph.D., Acting Director
1 ? •
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
the physical integrity of the stream, but the applicant must provide written justification and any
calculations used to determine the extent of rip-rap coverage requested. If suitable stream mitigation is
not practical on-site, then stream impact will need to be mitigated elsewhere;
Impacts to any stream length in the Neuse, Tar-Pamlico and Randleman River Basins requires written
concurrence from DWQ in accordance with 15A NCAC 213.0233, 15A NCAC 213 .0259 and .0250 and
15A NCAC 2H .0500. New development activities located in the protected 50-foot wide riparian areas
(whether jurisdictional wetlands or not) within the Neuse, Tar-Pamlico and Randleman River Basins
shall be limited to "uses" identified within and constructed in accordance with 15A NCAC 213 .0233,
15A NCAC 213 .0259 and .0250. All new development shall be located, designed, constructed, and
maintained to have minimal disturbance to protect water quality to the maximum extent practicable
through the use of best management practices. Activities listed as "exempt" from these rules do not need
to apply for written concurrence under this Certification;
Placement of culverts and other structures in waters, streams, and wetlands must be placed below the
elevation of the streambed to allow low flow passage of water and aquatic life unless it can be shown to
DWQ that providing passage would be impractical. Design and placement of culverts and other
structures including temporary erosion control measures shall not be conducted in a manner that may
result in dis-equilibrium of wetlands or stream beds or banks, adjacent to or upstream and down stream
of the above structures. The applicant is required to provide evidence that the equilibrium shall be
maintained if requested in writing by DWQ. Additionally, when roadways, causeways or other till
projects are constructed across FEMA-designated floodways or wetlands, openings such as culverts or
bridges must be provided to maintain the natural hydrology of the system as well as prevent constriction
of the floodway that may result in destabilization of streams or wetlands;
7. If this Certification is used to access building sites, all lots owned by the applicant must be buildable
without additional fill beyond that allowed under other General Certifications. Deed restrictions must be
placed on the remaining wetlands and streams on these lots to restrict future wetland and stream till.
DWQ shall be sent copies of all deed restrictions applied to these lots;
8. That appropriate sediment and erosion control practices which equal or exceed those outlined in the
most recent version of the "North Carolina Sediment and Erosion Control Planning and Design Manual"
or the "North Carolina Surface Mining Manual" whichever is more appropriate (available from the
Division of Land Resources (DLR) in the DENR Regional or Central Offices) shall be in full
compliance with all specifications governing the proper design, installation and operation and
maintenance of such Best Management Practices in order to assure compliance with the appropriate
turbidity water quality standard;
9. All sediment and erosion control measures placed in wetlands or waters shall be removed and the natural
grade restored within two months after the Division of Land Resources has released the project;
10. Measures shall be taken to prevent live or fresh concrete from coming into contact with waters of the
state until the concrete has hardened;
a
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50%, recycled/10%, post consumer paper
1W - 1
1 •
Michael F. Easley, Governor NCDENR'
William G. Ross, Jr., Secretary NORTH CAROLINA DEPARTMENT OF
Gregory J. Thorpe, Ph.D., Acting Director ENVIRONMENT AND NATURAL RESOURCES
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
11.This Certification shall be utilized for roads from natural high ground to natural high ground. The
Certification for Nationwide Permit 18 may not be used in conjunction with this Certification to create
high ground for road access;
12. If an environmental document is required, this Certification is not valid until a Finding of No Significant
Impact (FONSI) or Record of Decision (ROD) is issued by the State Clearinghouse. All water quality-
related conditions of the FONSI or ROD shall become conditions of this Certification;
13.That additional site-specific conditions may be added to projects proposed under this Certification in
order to ensure compliance with all applicable water quality and effluent standards;
14. When written concurrence is required, the applicant is required to use the enclosed "Certification of
Completion Form" to notify DWQ when all work included in the 401 Certification has been completed;
15.Concurrence from DWQ that this Certification applies to an individual project shall expire three years
from the date of the cover letter from DWQ or on the same day as the expiration date of the
corresponding Nationwide Permit 14 and Regional General Permit 198200031 whichever is sooner.
Non-compliance with or violation of the conditions herein set forth by a specific fill project may result in
revocation of this Certification for the project and may also result in criminal and/or civil penalties.
The Director of the North Carolina Division of Water Quality may require submission of a formal
application for individual certification for any project in this category of activity, if it is determined that the
project is likely to have a significant adverse effect upon water quality or degrade the waters so that existing
uses of the wetland, stream or downstream waters are precluded.
Public hearings may be held for specific applications or group of applications prior to a Certification
decision if deemed in the public's best interest by the Director of the North Carolina Division of Water
Quality.
Effective date: I June 2000
DIVISION OF WATER QUALITY
By
Kerr T. Stevens
Director
WQC # 3289
Wetlands/401 Unit 1621 Mail Service Center Raleigh. North Carolina 27699-1621
Telephone [phone] FAX [phone]
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1
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality 17
4 • •
;1kA
Michael F. Easley, Governor NCDENR
William G. Ross, Jr., Secretary NORTH CAROLINA DEPARTMENT OF
Gregory J. Thorpe, Ph.D., Acting Director ENVIRONMENT AND NATURAL RESOURCES
DWQ Project No.:
Applicant:
Project Name:
Date of Issuance of 401 Water Quality Certification:.
County:
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer
Rules, and any subsequent modifications, the applicant is required to return this certificate to the
401/Wetlands Unit, North Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC,
27699-162 1. This form may be returned to DWQ by the applicant, the applicant's authorized agent, or the
project engineer. It is not necessary to send certificates from all of these.
Applicant's Certification
I, , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature:
Agent's Certification
Date:
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:
Engineer's Certification
Partial Final
Da
I, , as a duly registered Professional Engineer in the State
of North Carolina, having been authorized to observe (periodically, weekly, full time) the construction of
the project,for the Permittee hereby state that, to the best of my abilities, due care and diligence was used in
the observation of the construction such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature
Date
Registration No.
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1 62 1
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. SU7[
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY DIVISION OF HIGHWAYS LYNDO TIPPETT
GOVERNOR SECRETARY
January 31, 2002
020154
Mr. Rob Riding
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, North Carolina 27699-1650
Dear Mr. Ridings:
Enclosed is the permit application for the following project:
Description: Bridge 55 - Lee County
Work Order #: B-4564
TIP Number: N/A 5 -s V3
Fee Category: $200.00
Please submit for automated payment.
Sincerely,
Art C. King
Division Environmental Officer

co StAtfu
G
STATE OF North CAROLINA
DEPARTMENT OF TRANSPORTATION
MICIiAEL F. EASLEY DIVISION OF HIGHWAYS LYNDo TIPPETT
GOVERNOR
Mr. Rob Ridings
Divsion of Water Quality
January 31, 2002
401 Wetlands Unit
1650 Mail Service Center
Raleigh, North Carolina 27699-1650
Dear Mr. Ridings:
Subject: Lee County- Bridge #55 on SR 1318
SECRETARY
0201 54
In an effort to obtain the permits needed for bridge replacement on Bridge #55 on
SR 1318 in Lee County, we are providing the pre construction notification application
and the supporting materials.
A Mimimum Criteria Checklist and a natural resource investigation was conducted by the
NCDOT . The subject project has been determined to have no effect on any listed
threatened or endangered plant or animal species. Project is outside of the critical habitat
area for the Cape Fear Shiner.
To our knowledge there are No High Quality Waters or Outstanding Water Resources
occurring in the project area. We anticipate that these activities will be authorized under
Regional General Permit Number 31.
This letter and a copy of the application materials will be submitted to N.C. Division of
Water Quality, U.S. Fish and Wildlife Service, and U.S. Army Corps. of Engineers for
approval.
If you have any questions or comments, or need additional information, please contact
our office at [phone]. Thank you for your cooperation in this matter.
Sincerely,
Art C. King
Division Environmental Officer

P.O. BOX 1067, ABERDEEN, NORTH CAROLINA 28315
PHONE [phone] FAX [phone]
Office Use Only' 020154 Form Version October 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.
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: RGP #31
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: ?
II. Applicant Information
Owner/Applicant Information
Name: North Carolina Department of Transportation
Mailing Address: W F Rosser. P F Division Engineer --
North Carolina Department of Transportation Division 8
P O Box 1067
Aberdeen North Carolina 28315
Telephone Number: 910-944-2344 Fax Number: 910-944-5623
E-mail Address: brosser( 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: E B Nelson
Company Affiliation: NCDOT Division 8 Bridge Maintenance Unit
Mailing Address: P.O. Box 289
Siler City, u 27344
Telephone Number: [phone] Fax Number: 919-663-0214
E-mail Address: enelson@a dot state nc us
PAYI' [N.T
Page 5 of 12
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Replacement of Bridge #55 on SR 1318 in Lee County
2. T.I.P. Project Number or State Project Number (NCDOT Only): B-4564
3. Property Identification Number (Tax PIN):
4. Location
County: Lee Nearest Town: Sanford
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): leaving Sanford on NC 42 W
Going under US #1 miles to SR 1318, Turn Left Project is 1.8 miles south on SR 1318,
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:
Rural/Residential
7. Property size (acres):
8. Nearest body of water (stream/river/sound/ocean/lake): Pocket Creek
9. River Basin: Cape Fear
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at httlp://h2o enr state nc us/admin/maps/.)
Page 6 of 12
10. Describe the purpose of the proposed work: Bridge Replacement
11. List the type of equipment to be used to construct the project: Crane and Excavator
12. Describe the land use in the vicinity of this project: Rural/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.
Page 7 of 12
1. Wetland Impacts
Wetland Impact
Site Number
(indicate on map)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(yes/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
None

* List each impact separately and identity temporary impacts. impacts include, out are not umited to: mechanized cteanng, grading, nn,
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 hqp://www.fcma.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:
Total area of wetland impact proposed:
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
(indicate on map)
Type of Impact* Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
(please specify)
Rip Rap 90 Pocket Creek 25' P

* List each impact separately and identify temporary impacts. impacts metude, out are not umtted to: culverts ana assoctatea 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
www.uses.eov. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 90'
Page 8 of 12
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 map)
Type of Impact* Area of
Impact
(acres) Name Waterbody
)
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.)
None

` List each impact separately and identify temporary impacts. impacts include, but are not limited to: till, 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): E] uplands F-] stream E] 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.
N/A
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
hhUp•//h2o enr state nc us/ncwetlands/-strm6de,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 hup://h2o.enr.state.nc.us/=/index,h . 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):
Page 10 of 12
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 E] 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 N/A 1?
Yes F? No ® If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet) Multiplier Required
Mitigation
1 3
2 1.5
Total
• Zone I extends out .tU teet perpenarcuiar rrom near DanK or cnannei; cone emenus an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
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.
N/A
XII. 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
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).

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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