20021000 Ver 1_Complete File_20010621

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
DWQ Project No.: Q, County: an v1
Applicant: C 0-1 X -V \0 LGc-A sx b- a t
Project Name:. opt
Date of Issuance of 401 Water Quality Certification: ` J /V 70, 2-
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, ?rTr c G !j,, 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 butlt,:witl iri substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules, the apped ns ajdheci?pt ons, and other supporting materials.
Agent1 Certification
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
M
WTOMR
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/
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
July 1, 2002
Union County
DWQ Project No. 021000
SR 1946 (Rock Rest Road)
APPROVAL of 401 Water Quality Certification with Additional Conditions
Mr. Benton G. Payne, P.E., Division Engineer
NCDOT Division 10
716 West Main Street
Albemarle, North Carolina 28001
Dear Mr. Payne:
You have our approval, in accordance with the attached conditions and those listed below, to incur 40
linear feet of impacts to an unnamed tributary to Reedy Branch in order to improve SR 1946 (Rock Rest
Road) in Union County. The project should be constructed in accordance with your application dated
June 18, 2002 (received June 21, 2002). After reviewing your application, we have decided that this fill is
covered by General Water Quality Certification Nos. 3366 and 3375 corresponding to the U.S. Army
Corps of Engineers Nationwide Permit Numbers 33 and 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 you may be required to
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. NCDOT shall use Best Management Practices for the Protection of Surface Waters (NCDOT March
1997) and Sedimentation and Erosion Control Guidelines for Sensitive Watersheds (15A NCAC 4B
.0024). These measures must be implemented prior to any ground-disturbing activities to minimize
impacts to downstream aquatic resources. 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.
2. Storm water shall be directed to buffer areas or retention basins and not routed directly to streams
where practicable.
3. 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. The presence of equipment in the channel must be minimized.
4. Existing vegetated buffers shall not be mowed in order to utilize it for storm water sheet flow.
5. Riparian vegetation must be reestablished within the construction limits of the project by the end of
the growing season following completion of construction.
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), 91,9-733-6893 (fax), http://h2o.enr.state.nc.us/ncwetlandsP
6. 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.
Michael Parker of the Mooresville Regional Office at 704.663.1699.
Sincerely,
Attachment
P,W.KI P.E.
Pc: Wilmington District Corps of Engineers
Steve Lund, USACE Asheville Field Office
NCDWQ Mooresville Regional Office
Central Files
File Copy

401 ffs D 021000
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
GOVERNOR
DIVISION OF HIGHWAYS
June 18, 2002
U. S. Army Corps of Engineers
Asheville Regulatory Field Office
Attention: Mr. Steve Lund, MS, PWS FILE COPY
151 Patton Avenue, Room 208
Asheville, NC 28801-5006
W. LYNDO TIPPETT
Ty SECRETARY
Jum 2 I
Subject: Secondary Road Improvements to SR 1946 (Rock Rest Road), Union County.
State Work Order No. 6.692342 (DWQ Minor Permit Fee $200.00).
Dear Mr. Lund:
The North Carolina Department of Transportation (NCDOT) proposes to upgrade SR 1946 from
SR 1945 (Snyders Store Road) to SR 1903 (Gilboa Road), in Union County. SR 1946 is an
unpaved roadway that will be upgraded to a paved roadway. The total project length is 1.20
miles.
Transportation and highway laws of North Carolina (G.S. 136-44.6, 136-44.7, 136-44.7A, 136-
44.8 and 136-44.9) require the NCDOT to develop annual work programs for construction and
maintenance of secondary roads. These general statutes specifically set forth requirements for
annual construction and paving of existing unpaved roads. Paving of these roads is performed in
priority order as established by the NCDOT for each unpaved road within a given county. This
number is based on characteristics of each road, including number of homes, schools, churches,
businesses, industries, recreational facilities, traffic counts, presence of school bus routes, and
value as a thoroughfare. SR 1946 is scheduled for paving in the 2002-2003 Secondary Roads
Construction Program.
Protected Species
The subject project has been reviewed for the presence of listed threatened and endangered
species. It has been determined that the construction of this project will have no effect on any
listed plant or animal species.
Impacts to Waters of the United States

r -?
'm
r-
This project cannot be completed without impacts to waters of the United States. The project lies
in the Yadkin River Basin (Hydrologic Unit # 03040105), affecting the drainage of an unnamed
tributary to Reedy Branch. Stream impacts will be incurred due to the replacement of an existing
716 West Main Street, Albemarle, NC 28001 • [phone] 9 Fax [phone]
pipe. There will be approximately 40 linear feet of permanent impacts to the existing stream
channel as a result of the proposed construction.
Wetland Impacts
There are no wetland impacts that will result from the construction of this project.
Stream Impacts
There will be one intermittent stream impacted as a result of the proposed project. Table 1
includes information related to site number, stream name, existing pipe length (ft), existing pipe
width (in), proposed replacement or extended pipe length (ft) and width (in).
Table 1. Ln acts to Streams from im rovements to 'SR 1946 R (Rock Rest Road
Site
No.
Stream Name .. Existing
Length
feet Existing
Width
(inches) i Proposed
Length
feet Proposed..,
Width
inches
Sta. 54+03 UT of Reed Branch 40' 36" 48' 48"

Note: "UT" refers to unnamed tributary.
Dewatetin-9
The NCDOT proposes to temporarily dewater the stream, as needed, during the construction of
the project. This will involve the temporary placement of sandbags, sheet metal cofferdams, or
Class B or Class 2 riprap, covered with filter fabric, in the stream channel approximately 10 feet
upstream of the proposed pipe inlet. In order to maintain water flow during construction, water
upstream of this impervious structure will be temporarily pumped out and conveyed downstream
of the construction activity where it will be allowed to filter through vegetation before flowing
back into the stream channel.
This activity will result in temporary impacts to the aforementioned surface water. Approximately
70 linear feet of stream channel will need to be dewatered. This would result in 245 square feet of
dewatered streambed. Any dewatering activity that occurs will be conducted for less than five
consecutive working days and the sandbags or rip rap covered filter fabric will be entirely
removed from the stream channel after construction. The volume of temporary fill required for
this activity would consist of no more than 6 cubic yards per structure.
The NCDOT believes that this project can be authorized under a Section 404 Nationwide Permit
14 and 33.
Avoidance/Minimization
All wetlands or surface waters not affected by the project will be protected from unnecessary
encroachment. No staging of construction equipment or storage of construction supplies will be
allowed in or near wetlands or surface waters.
r,
The side slopes have been steepened to the extent possible and the proposed roadway adjusted to
lessen the impacts to jurisdictional sites. Sedimentation and erosion control Best Management
Practices for the protection of wetlands and surface waters will be enforced during project
construction. Continued coordination will occur between maintenance forces and the Division
Environmental Officer during construction in an effort to minimize impacts to jurisdictional sites.
Compensatory Mitigation
At this time, the NCDOT does not anticipate the need for compensatory mitigation based upon
the limited impacts associated with the construction of this project.
Summary
The purpose of this letter is to request authorization to construct the proposed project under
Section 404 Nationwide Permit (NWP) 14. Additionally, the NCDOT requests authorization
under Section 404 Nationwide Permit 33 for temporary impacts that will result from dewatering
activities associated with this project. Application is also made to the North Carolina Division of
Water Quality (NCDWQ) for Section 401 Water Quality Certificate (WQC) No. GC3375 that is
required for this project. The 401 WQC No. GC3366 (which corresponds to NWP 33) does not
require written concurrence from the NCDWQ as the NCDOT intends to comply with the
conditions for the WQC.
If you have any questions or need any additional information concerning this project, please fee
free to contact Mr. Larry Thompson, Division Environmental Officer, at [phone].
Sincerely,
6,, lam; 1 OaUA
Benton G. Payne, P. E.
Division Engineer
BGP/LBT
cc: Mr. John Dorney, NCDWQ
Ms. Marella Buncick, USFWS
Mr. David Cox, NCWRC
Mr. Marc Morgan, County Maintenance Engineer
Mr. Larry Thompson, Div. 10 DEO
Area Field Operations Unit
Office Use Only: Form Version April 2001
USACE Action ID No. DWQ No0 210 0 Q
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
L 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: NWP 14 & 33
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
IL Applicant Information
Owner/Applicant Information
N
Mailing Address: 10' Highway Division
716 West Main Street
Albemarle, NC 28001
Telephone Number: [phone] Fax Number: [phone]
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: Benton G. Payne, P. E.
Company Affiliation: Division Engineer
Mailing Address: N. C. Department of Transportation
716 West Main Street
Albemarle NC 28001
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: bpaynepdot.state. nc.us
Page 1 of 9
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: SR 1946 (Rock Rest Road)
2. T.I.P. Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN):
4. Location
County: Union County Nearest Town: Monroe
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): From Monroe, travel south on
US 601, turn left onto SR 1003 (White Store Road) which turns into Old Monroe Marshville
Road, turn right onto SR 1903 (Gilboa Road and right onto SR 1946 (Rock Rest Road).
5. Site coordinates, if available (UTM or Lat/Long): see attached
(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/Agricultural
7. Property size (acres):
8. Nearest body of water (stream/river/sound/ocean/lake): Maple Springs Branch
Page 2 of 9
9. River Basin: Yadkin (Hydrologic Unit 03040105)
(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/.)
10. Describe the purpose of the proposed work: Grading drainage, base, paving and erosion
control to bring existing xisting gravel road in compliance with standard safety design specifications.
Work will require replacing (see plan sheets) one culvert.
11. List the type of equipment to be used to construct the project: Heavy construction equipment
(back hoe track hoe excavator dump trucks etc.).
12. Describe the land use in the vicinity of this project: Rural residential/agricultural.
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.
N/A
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application: N/A
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
Page 3 of 9
7
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
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, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
s: 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://ww-%v.fema.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)
Sta. 54+03 (1) 48" x 54' CUP 14' UT to Reedy Branch 3.5' Intermittent
Sta. 54+03 Inlet Stabilization 13' UT to Reedy Branch 3.5' Intermittent
Sta. 54+03 Outlet Stabilization 13' UT to Reedy Branch 3.5' Intermittent

Page 4 of 9
" List each impact separately and identify temporary impacts. Impacfs 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 losstgain),
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.us¢s.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mMuest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 30 feet permanent
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact
Site Number
indicate on ma)
Type of Impact* Area of
Impact
(acres) Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ean. etc.)

s 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): ? 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.
All wetlands or surface waters not affected by the project will be protected from unnecessary
Page 5 of 9
Encroachment No staaina of construction equipment will be allowed in or near wetlands or
waters of the U S Strict enforcement of sedimentation and erosion control Best Manangement
Practices for the protection of wetlands and surface waters will be enforced during all phases of
project construction.
Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/strmaide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
No mitigation is 12roppsed for this project.
Page 6 of 9
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 htti)://h2o.enr.state.nc.uS/NVM/index.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):
VIII. 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 ?
IX. 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
Page 7 of 9
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
Mitigation
1 3
2 1.5
Total
' Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NC AC 2B .0242 or .0260.
N/A
X. 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.
Existing road base is 20 feet in width - Proposed pavement width is 20 feet. Construction of this
project will not yield an increase in impervious acreage. Temporary dewatering and all
appropriate Best Management Practices for sediment and erosion control will be implemented
during pipe replacement/extension activities.
XI. 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
Page 8 of 9
XH. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (I 5A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
XIM 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).
_v
Applicant/Agent's Signature Lthorization Date
(Agent's signature is valid only if a letter from the applicant is provided.)
Page 9 of 9
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SCALE 1:24 000
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