20030927 Ver 1_Complete File_20030729

WATER
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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.: 0 ?7
Applicant: ,uG E>7- - D10/5
Project Name: 1-; ?
Date of Issuance of 401 Water Qualit
County: G
Certification:
Z
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer
Rules, and any subsequent modifications, the applicant is required to return this certificate to the
401/Wetlands Unit, North Carolina Division of Water Quality, 1650 Mail Service Center, Raleigh, NC,
27699-1650. This form may be returned to DWQ by the applicant, the applicant's authorized agent, or
the project engineer. It is not necessary to send certificates from all of these.
Applicant's Certification
I, 1h.C-. J&WPl , 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 approve lans and s ecifications, and other supporting materials.
Signature s A / bate: l / 20/ 0 i/
Agent's Certification
I, , hereby state that, to the best of my abilities, due care
and diligence was used in the observation of the construction such that the construction was observed to
be built within substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules, the approved plans and specifications, and other supporting materials.
Signature: Date:
If this project was designed by a Certified Professional
I, , as a duly registered Professional (i.e.,
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized
to observe (periodically, weekly, full time) the construction of the project, for the Permitee hereby state
that, to the best of my abilities, due care and diligence was used in the observation of the construction
such that the construction was observed to be built within substantial compliance and intent of the 401
Water Quality Certification and Buffer Rules, the approved plans and specifications, and other
supporting materials.
Signature Registration No. Date

WETLANDS/ 401 GROUP
FEB 0 4 2004
WATER QUALITY SECTION
.110 -
e?;_
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/
WATF?Q
7
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
Coleen H. Sullins, Deputy Director
Division of Water Quality
July 29, 2003
Lincoln County
DWQ Project No. 030927
Emergency Repair of SR 1134
APPROVAL of 401 Water Quality Certification with Additional Conditions
Mr. M. L. Holder, P.E.
Division Engineer
N. C. Department of Transportation
Post Office Box 47
Shelby, North Carolina 28151-0047
Dear Mr. Holder:
You have our approval, in accordance with the attached conditions and those listed below, to install a new culvert in Glenn
Creek (70 linear feet of permanent impact and 85 linear feet of temporary impact for coffer dams, dewatering and a
downstream checkdam) in order to make an emergency repair to a culvert on SR 1134 in Lincoln County. The NC
Division of Water Quality understands that this project was constructed in accordance with the after-fact application dated
July 18, 2003 (received July 24, 2003).
After reviewing your application, we have decided that this fill is covered by General Water Quality Certification Nos.
3404 and 3366 corresponding to the U.S. Army Corps of Engineers Nationwide Permit Numbers 14 and 33. 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 implement Best Management Practices for the Protection of Surface Waters (NCDOT March I . 997)
and adhere to the requirements for WS-III Waters [15A NCAC 2B .0215 (3)(b)] with regard to riparian buffer
requirements and stormwater controls.
2. All culverts 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 widening of the streambed). Existing stream dimensions
(including the pattern and profile) are to be maintained above and below locations of culvert extensions. The culvert
shall be designed to allow for fish and other wildlife movement as well as prevent headcutting of the streams.
3. Riparian vegetation must be reestablished within the construction limits of the project by the end of the growing season
following completion of the project.
4. The use of riprap for bank stabilization is to be minimized; rather, native vegetation is to be planted when practical. If
riprap is necessary, it must be limited to the stream bank above the high water mark. Riprap shall not be placed in the
stream bottom.
5. NCDOT must submit a plan for written DWQ approval to address any headcutting, should it occur,
resulting from this project.
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 Telephone: [phone] Customer Service 1-877-623-6748
6. 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.
7. All constructed stormwater conveyance outlets shall be directed to flow in a diffuse manner at non-erosive
velocities through the entire protected stream buffers without re-concentrating. If this is not possible it may
be necessary to provide stormwater facilities.
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. Upon completion of the project, the NCDOT or its authorized agent 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. Please include photographs of
the site.
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.
Attachments
mcerely,
, P.E.
cc: Wilmington District Corps of Engineers
Steve Lund, USACE Asheville Field Office
Trish Simon, Division Environmental Officer
Mooresville Regional Office
Mike Parker, NCDWQ Asheville Regional Office
Central Files
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617
Telephone: [phone] Customer Service 1-877-623-6748
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STATE of NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPETT
GovERNOR SECRETARY
I SAD31401 GROUP
Jut ® t6 fJq 21 Nft
%gLITYZCr
MEMO TO. John Domey, DENR/DWQ/401/Wetlands Unit II®N
FROM: Trish Simon, Division 12 Environmental Officer
DATE: July 18, 2003
SUBJECT: Pre-Construction Notification/401 Automated Payment
Enclosed are seven copies of a pre-construction notification for an emergency NCDOT
project in Lincoln County for your review.
Project information for the 401 Automated Payment Procedure
• Work order number: 150463-55120005-12B.205511-3855
• TIP #: NA
• Project Category: $200.00 Fee
PAYMENT
is RECEIVED
Post Office Box 47 Shelby, North Carolina 28151-0047
?y a?Fo
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY P.O. BOX 25201, RALEIGH, N-C. 27611-5201 LYNDO TIPPETT
GOVERNOR SECRETARY
P.O. BOX 47, 1710 East Marion Street
Shelby, N. C. 28151-0047
July 18, 2003 c /?A?
40
*e'4* I Mr. Steve Lund - NCDOT Projects 4(9v
US Army Corp of Engineers
Asheville Regulatory Field Office ®?
151 Patton Avenue, Room 208 03 0927 Area,
Asheville, N. C. 28801-5006 U910?t
Dear Mr. LLund: `Z/0*
The North Carolina Department of Transportation, Division of Highways, request the issuance of
a Section 404 Permit, Nationwide Permit #14, Maintenance and #33, Temporary Construction,
Access, and Dewatering for an emergency pipe replacement project. The pipe was washed out
during the flooding of 7/12/03.
COUNTY: Lincoln
LOCATION: SR 1134, west of Lincolnton
STREAM: Glenn Creek, WS4111 Waters (from source to Little Creek), Broad
River Basin
PROJECT DESCRIPTION: The project consists of the replacement of a 60' long, 60" CMP
with a 70' long, 128" x 83" CMPA. The original pipe was washed out due to the flooding on
7/12/03. This project is considered an emergency project and construction is to commence
immediately. There will be a minimal increase in pipe length and five feet of riprap will be used at
the inlet and outlet for structure protection and stabilization. The pipe is to be buried one foot
below streambed elevations. Thalweg elevations were taken upstream and downstream of the
washed out pipe in areas that were not impacted by storm debris. Based upon these elevations,
the proposed pipe gradient will be at 1.8%. Stream destabilization is not anticipated. Due to the
amount of storm debris that must be removed before the new pipe installation, it is proposed that
a temporary instream check dam will be used to catch sediment to prevent downstream water
degradation during the debris removal process. Temporary cofferdams will be used to manage the
water course during construction. Upon project completion, the area impacted by the temporary
cofferdams and temporary instream device will be restored to pre-construction conditions. I have
enclosed a PCN application, a sketch of activities, and location maps relative to the project.
Mr. Steve Lund
Emergency Pipe Replacement, SR 1134
July 18, 2003 - Page 2
Based upon the "Guidelines for the Location and Design of Hazardous Spill Basins", which
are referenced in DOT's Best Management Practices for the Protection of Surface Waters, the
applicable locations for the placement of hazardous spill basins are at stream crossings on
highways functionally classified as rural or urban arterials and where the stream crossing is within
1/2 mile of the critical area. The proposed project is located in Class WS-III watershed; however,
it is not within '/2 mile of the critical watershed area nor is SR 1134 classified a rural or urban
arterial. Hazardous spill basins are not required. Enclosed is the NCDOT hazardous spill basin
checklist.
A review of the Natural Heritage information for the threatened species listed for Lincoln
County, the dwarf-flowered heartleaf (Hexastylis naniflora) and Michaux's sumac (Rhus
michauxii), revealed no known sites in the vicinity of the project area. A survey for these species
was conducted on July 16, 2003 in the vicinity of the project. It was determined that this neither
species nor suitable habitat were located in the project area; therefore, no impact on this species is
anticipated. A review of the available information from the National Register of Historic Places
was also conducted. No historic sites will be affected by the project.
Your earliest consideration for this request would be greatly appreciated. Should you have any
questions, please call me at 704-480-9020.
Respectfully yours,
M.L. Holder, P.E.
Division Engineer
Twelfth Division
BY: ??a
Trish Simon
Division 12 Environmental Officer
Enclosures
cc: Mr. Michael L. Holder, P.E., Division Engineer
Mr. Dan Holderman, P.E., Division Bridge Engineer
Mr. Mike Parker, DENR, DWQ, Asheville Regional Office
Mr. John Dorney, DENR, DWQ, 401, Wetlands Unit
Mr. Neil Trivette, Roadside Environmental Field Engineer
File
Office Use Only: r? Form Version October 2001
USACE Action ID No. DWQ No. 03 OP 7
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: Nationwide Permit #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: ?
H. Applicant Information
1. Owner/Applicant Information
Name: Mike Holder NCDOT
Mailing Address: P.O. Box 47
Shelby, NC 28151
Telephone Number: 704-480-9020 Fax Number: 704-480-5401
E-mail Address:
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: Trish Simon
Company Affiliation: NCDOT
Mailing Address: P.O. Box 47
Shelby. NC 28151
Telephone Number: 704480-9044 Fax Number: 704-480-5401
E-mail Address: [e-mail]
Page 1 of 8
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: Emergency Pipe Replacement on SR 1134, Lincoln County
2. T.I.P. Project Number or State Project Number (NCDOT Only): 12B.205511
3. Property Identification Number (Tax PIN): NCDOT Right of way
4. Location
County: Lincoln Nearest Town: Lincolnton
Subdivision name (include phasellot number): NA
Directions to site (include road numbers, landmarks, etc.): Hwy 27 west from Lincolnton.
Turn left onto SR 1134 and proceed to site.
5. Site coordinates, if available (UTM or Lat/Long): 35°30'20'N/81°28' 17W
(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:
Pipe on a paved secondary road
7. Property size (acres): 0.10 acres NCDOT right of way
8. Nearest body of water (stream/river/sound/ocean/lake): Glenn Creek (from source to Little
Creek), WS-III
9. River Basin: Broad
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/map-/.)
Page 2 of 8
10. Describe the purpose of the proposed work: This emergency project consists of replacing a
washed out during the flooding of 7/12/03. The pipe, which was 60", 60-foot CMP, will be
replaced with a new 70-foot, 128"x 83" CMPA48" CMPA with inlet headwall and associated
slope rip= for structure stabilization.
11. List the type of equipment to be used to construct the project: A trackhoe will be used
for excavation and placement of riprap.
12. Describe the land use in the vicinity of this project: The surrounding area is mostly wooded.
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application:
No future permit requests anticipated.
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: NONE
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***

Page 3 of 8
* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drdinage, 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
(FlI M), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at hqR://www.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: 0
2. Stream Impacts, including all intermittent and perennial streams
Stream
Impact Site Length of Average Width Perennial or
: Number Type of Impact* Impact Stream Name** of Stream Intermittent?
(indicate on (linear feet) Before Impact (please specify)
map)
1 Increase in new pipe length 10 feet Glenn Creek 6 feet Perennial
Placement of riprap on 5 feet (inlet)
1 streambank for structure 5 feet (outlet) u «
protection Total = 10
feet
1 Temporary coffer dams 20 feet
Temporary instream
checkdam (to prevent 65 feet
1 additional sediment from
(downstream) "
going downstream during
storm debris removal)
List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net lossigain),
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.usgs.eov. Several intemet 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: Total Permanent impacts
from streambank riprap and increase in pipe length = 20 feet: Total temporary impacts = 85
feet.
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U. S. NO OPEN WATER HVIPACTS
Open Water Impact Area of Name of Waterbody Type of Waterbody
Site Number Type of Impact* Impact (if applicable) (lake, pond, estuary, sound,
(indicate on ma) (acres) 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.
Page 4 of 8
4. Pond Creation NO POND CREATION
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
Pipe washed out due to flooding on 7/12/03. The washed out pipe is being replaced with slightly
larger/longer pipe to provide adequate road shoulder width; therefore, there will be only a
minimal increase in permanent impacts. Due to the large amount of storm debris in the stream
from the washed out pipe (sediment, asphalt, etc.), an instream check dam is to be utilized to
prevent offsite silt downstream during storm debris removal. The instream device will be
removed after project completion. Cofferdams will be used and the stream will be pumped
around the work site during pipe installation to minimize sediment impacts during construction.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
Page 5 of 8
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/strmgide.html.
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
IMPACTS < 150 FEET, MITIGATION NOT ANTICIPATED
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at httv://h2o.enr.state.nc.us/wm/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):
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 ?
Page 6 of 8
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.
Yes ? No ® If you answered "yes", provide the following information:
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Identify the 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.
XI.
XH.
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.
Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
No additional impervious surface is proposed in this project.
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.
Page 7 of 8
XM. 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).
This is considered an emergency project by NCDOT and the pipe replacement is to commence
immediately.
ES )
4-0
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 8 of 8
Washed out pipe and collapsed road, SR 1134
Area after some debris removal (7/16/03
Upstream of washed out pipe
Downstream of washed out pipe
NCDOT NEWTON BRIDGE 8828 466 5525
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Name: BANOAK Location: 035° 30'43.7' N 081 ° 28' 12H' W
Date: 7/17/2003 Caption: Emergency Pipe Replacement, SR 1134, Lincoln County, Glenn
Scale: 1 inch equals 1000 feet Creek, WS-III Waters, Broad River Basin
Copyright (C) 1997, Maptech, Inc.

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NCDOT NEWTON BRIDGE 8828 466 5525
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07/17 103 13:54 NO.156 11/11
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52 ?/?4 P119 96?Zl??4
5000 4000 3000 2000 1000
ail survey map was compiled by the U.S. Department of Agriculture,
onservation Service, and cooperating agencies. Base maps are 1 .5
'iotographs prepared by the U.S. Department of the Interior, Geological
LEVELAND COUNTY
me i ? v Iv?Ar
...........
.................................
.................................
.................................
.................................
.................................
.................................
SPECIAL FLOOD HAZARD .....ZONE A:::
::':; :
AREA
EXPLANATION OF ZONE DESIGNATIONS
)NE EXPLANATION
A Areas of 100-year flood; base flood elevations and
flood hazard factors not determined.
C Areas of minimal flooding. (No shading)
D Areas of undetermined, but possible, flood hazards.
V Areas of 100-year coastal flood with velocity (wave
action); base flood elevations and flood hazard factors
not determined.
NATIONAL FLOOD INSURANCE PROGRAM
FIRM
FLOOD INSURANCE RATE MAP
LINCOLN COUNTY,
NORTH CAROLINA
(UNINCORPORATED AREAS)
PANEL 25 OF 150
COMMUNITY-PANEL NUMBER
370146 0025 B
EFFECTIVE DATE:
DECEMBER 1, 1981
NCDOT NEWTON BRIDGE 8828 466 5525 07/17 '03 13:54 NO.156 10/11
NCDOT
HAZARDOUS SPILL BASIN CBECKLIST
Division.: ? Z County: Project ID: /ZS . Zvssi I
River Bann: Za A: ewG?2 Bridge No:
Route: 5/L / / 3 4
Water Quality Criteria:.
Stream: G (? /e h n Cie e l'
1,a5
Stream Crossing Blue Line On USGS
ORW
WSI
III OR ITT, Crossing Within. 0.5mi of W.S. Critical Area
WS EL
Roadway Criteria:
Route Designatibn-
Additional. Site Informlation:
Yes No
Arterial Urban F r?'
Arterial Rural r r?
Yes No
Is a Hazardous i Spill. Basin. Required? f'
Criteria Based Upon 14CDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997).
Yes No
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