20030273 Ver 1_Complete File_20030307

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N. C. DEPARTMENT W?RANSPORTATION

TRANSMITTAL SLIP DATE
of
TO: REF. NO. OR ROOM, BLDG.

FROM: REF. NO. OR ROOM, LDG.
CTION
? NOTE AND FILE ? PER OUR CONVERSATION
? NOTE AND RETURN TO ME PER YOUR RE U
? RETURN WITH MORE DETAILS ? FOR YOUR APPROVAL
? NOTE AND SEE ME ABOUT THIS -? FOR YOUR INFORMATION
? PLEASE ANSWER -? FOR YOUR COMMENTS
? PREPARE REPLY FOR MY SIGNATURE ? SIGNATURE
? TAKE APPROPRIATE ACTION ? INVESTIGATE AND REPORT
COMMENTS:

P$ft
0C "..' CR William G. Ross Jr., Secretary
\OC? pG North Carolina Department of Environment and Natural Resources
yj r Alan W. Klimek, P.E. Director
O 'C
DWQ Project No.: Q 3 02--73 County:
Applicant: N C? oT /C - M j r r a.-
ProjectName: gc 6 Z-) jA ') S (2-- 133 O
Date of Issuance of 401 Water Quality Certification: 413 0`5
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, 27699-1621. This form may be
returned to DWQ by the applicant, the applicant's authorized agent, or the project engineer. It is not necessary to
send certificates from all of these.
Applicant's Certification
1, J. 6. VAnc? , 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 0 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and of sup serials.
Signature: Date:
Agent's Certificatioriv
1, , 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:
Engineer's Certification
Partial Final
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 GROUP
AUG Z 0 2004
WATER QUALITY SECTION
J \ NA
rF9p Michael F. Easley, Governor
William G. Ross Jr., Secretary
O North Carolina Department of Environment and Natural Resources
j r Alan W. Klimek, P.E. Director
Division of Water Quality
Y
DWQ Project No.: OYO30(6 County: Frank/,i7
Applicant: C C. urea T. c
Project Name: 0 )b53 (Mutt W;A$?C R-Cad
Date of Issuance of 401 Water Quality Certification: _ al ?f I 04
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, J 47, / wpperf-- , 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 substa c mpliance and intent of the 401 Water Quality Certification and Buffer
Rules, the approve Tans ifications, and other supporti e ' is
Signature: Date:
Agent's Certlflcat/o
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
AUG 1 0 2004
WATER itTY,i
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), http://h2o.enr.state.nc.uslncwetiands/
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F W A TF Michael F. Easley, Governor
?O,4 RpG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
0) r Alan W. Klimek, P.E. Director
Division of Water Quality
O `C
April 3, 2003
Person County
DWQ Project No. 030273
APPROVAL of 401 Water Quality Certification
Dr. Gregory J. Thorpe, PhD., Manager
Planning and Environmental Branch
North Carolina Department of Transportation
1548 Mail Service Center
Raleigh, North Carolina, 27699-1548
Dear Dr. Thorpe:
You have our approval, in accordance with the attached conditions and those listed below, to place fill material in 54
linear feet of streams for the purpose of replacing Bridge Number 63 in Person County. The project shall be
constructed in accordance with your application dated March 3, 2003. After reviewing your application, we have
decided that this fill is covered by General Water Quality Certification Number 3375. This certification corresponds
to the Nationwide Permit 14 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.
N. C. Division of Water Quality 1650 Mail Service Center Raleigh, NC 27699-1650 [phone]
Customer Service: 1 800 623-7748

W A TF Michael F. Easley, Governor
`OHO 9QG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Cl) r Alan W. Klimek, P.E. Director
D ?
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 or Steve Mitchell at 919-571-4700.
Sincerely,
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
DWQ Raleigh Regional Office
File Copy
Central Files
K imlDk.
c:\ncdot\SR 1330\wqc\030273wgc.dcc
N. C. DEPARTMENT OF TRANSPORTATION
TRANSMITTAL SLIP DATE

TO: REF. N . Ok ROOM, BLDG.

o 1J rn

?%
FROM: II REP. NO. Olt ROOM, BLDG.
,lnrl g N?.,rro,.r ?
AC
? NOTE AND FILE ? PER OUR CONVERSATION
? NOTE AND RETURN TO ME ? PER YOUR REQUEST
? RETURN WITH IMQRE DETAILS ? FOR YOUR APPROVAL
? NOTE AND SKf ME ABOUT THIS ? FOR YOUR INFORMATION
? PLEASE ANSWER ? FOR YOUR COMMENTS
? PREPARE REPLY FOR MY SIGNATURE ? SIGNATURE
? TAKE APPROPRIATE ACTION ? INVESTIGATE AND REPORT
COMMENTS: ,
c
030273
s,.a STAif °?
N" M
M. n
STATE OF NORTH CAROLINA
030273
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPETT
GOVERNOR SECRETARY
March 3, 2003
N.C. Dept. of Environment and Natural Resources-Division of Water Quality - 14 1 GROUP
2321 Crabtree Blvd. Vllt
Raleigh, NC 27604-2260 MAR 0 7 2003
Attention: Mr. John Dorney
Coordinator WATER QUALITY SECTION
Subject: Proposed replacement of Bridge No. 63 on SR 1330 over Castle Creek in
Person County. NCDOT Work Order No. 5.3852008.
Reference: NCDOT permit application (March 3, 2003)
The North Carolina Department of Transportation (NCDOT) plans to replace
Bridge No. 63 on SR 1330 over Castle Creek in Person County. Construction of the
project will necessitate impacts to waters of the United States. Application was made for
a Department of the Army Section 404 Nationwide Permit (NWP) 14 and NWP 33 and
North Carolina Department of Environment and Natural Resources-Division of Water
Quality (DWQ) Section 401 Water Quality Certification (WQC) No. 3375 and WQC
3366 by permit application dated March 3, 2003.
An automated payment procedure has recently been implemented between the
NCDOT and NCDWQ. This procedure will enable the Division to apply for the 401
WQC without submitting a check for this permit application. This new procedure will
provide payment to the NCDWQ by charging the permit application fee dirdctly to the
appropriate NCDOT work order.
The NCDOT work order for this project is 5.3852008. Project impacts are less
than one acre of cumulative wetland/water impacts and less than 150 linear feet
cumulative impacts to streams; therefore, please note that a fee of $200.00 is required for
this project. If you have any questions or need additional information, please contact me
at [phone].
Sincerely,
Christopher A. Murray, P.W.S. PAYMENT
Environmental Officer RECEIVED
Division 5, 2612 N. Duke Street, Durham, NC 27704
Phone: [phone] Fax: [phone]
N. C. DEPARTMENT OF TRANSPORTATION
TRANSMITTAL SLIP DATE

TO: REF. NO. OR ROOM, BLDG.
O
V
.ern A-
FROM: REF. NO. OR ROOM, BLDG.
Lr' ? A
1"lJ r?'o.?
ACTIOJ4
? NOTE AND FILE ? PER OUR CONVERSATION
? NOTE AND RETURN TO ME ? PER YOUR REQUEST
? RETURN WITH MORE DETAILS ? FOR YOUR APPROVAL
? NOTE AND SEE ME ABOUT THIS ? FOR YOUR INFORMATION
? PLEASE ANSWER ? FOR YOUR COMMENTS
? PREPARE REPLY FOR MY SIGNATURE ? SIGNATURE
? TAKE APPROPRIATE ACTION ? INVESTIGATE AND REPORT
COMMENTS:
030273

J-4,
,. STAi[ STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
GOVERNOR
March 3, 2003
U.S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls of the Neuse Road, Suite 120
Raleigh, NC 27609
30273
LYNDO TIPPETT
SECRETARY
WETLANDS / 401 GROUP
MAR 0 7 2003
Attention: Mr. Eric Alsmeyer WATER QUALITYSECTIO
NCDOT Coordinator N
Subject: Replacement of Bridge No. 63 over Castle Creek on SR 1330 in Person
County. NCDOT State Project No. 5.3852008.
The North Carolina Department of Transportation (NCDOT) plans to replace
Bridge No. 63 over Castle Creek on SR 1330 in Person County (Figure 1 and Figure 2).
The existing one-span bridge (1 @ 20 foot 7 inch) was constructed in 1953 and has a
timber floor on timber joist piles on concrete sills. This bridge is currently in very poor
condition; it is structurally deficient with a sufficiency rating of 50 out of 100 points. It
has been determined that this structure must be replaced. The proposed replacement
structure is a 1 @ 20 foot x 6 foot crown span with wing walls that is 70 feet long
(Figures 3 and 4). Please note that the crown span is a bottomless structure that is set on
concrete footings. Surficial bedrock has been observed in the stream bed at the bridge
site.
Impacts to Waters of the United States
Construction of the project involving replacement of the existing bridge will
necessitate impact to waters of the United States in the Roanoke River basin. Here the
project study area crosses Castle Creek (DWQ Index No. 22-58-13, Best Usage
Classification C).
Bridge Demolition and Removal
Bridge No. 63 has a timber floor covered with broken asphalt on timber joist piles
on concrete sills. The bridge will be removed under Case 3, where there are no special
restrictions beyond those outlined in Best Management Practices for Bridge Demolition
and Removal.
Division 5, 2612 N. Duke Street, Durham, NC 27704
Phone: [phone] Fax: [phone]
2
Bridge Replacement
Impacts associated with the project from the replacement of the existing bridge
with a crown span with wingwalls (including minimal amounts of rip rap to protect the
structure) include 54 feet existing channel impacted and <0.01 acre fill in surface water
(Figures 3 and 4).
Dewatering
The NCDOT will dewater this perennial stream during the construction of the
project. This will involve the temporary placement of sandbags or rip rap covered with
filter fabric in the stream channel 25 feet upstream of the existing bridge and 20 feet
downstream of the existing bridge. To maintain water flow during construction, water
upstream of this impervious structure will be temporarily pumped out and conveyed
downstream of the structure. The stream will be dewatered less than four weeks. This
will result in temporary impacts to the surface water. Temporary impacts to the stream
from this activity will result in the dewatering of <0.01 ac of stream bed and 105 linear
feet stream channel. The sandbags or rip rap covered with filter fabric will be removed
after construction.
Waters of the U.S. Mitigation
Avoidance: 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.
Minimization:
• The side slopes have been steepened to the extent possible at jurisdictional sites.
• The proposed structure is a bottomless structure set on concrete footings.
• Continued coordination will occur with maintenance forces and the Environmental
Officer during construction to minimize impacts to the site. All efforts will be made
during construction to reduce the amount of rip rap at the site.
Compensatory Mitigation: Construction of the project will result in only minimal
impacts to waters of the United States. Impacts have been minimized to the maximum
extent possible during the design process. Due to minimal impacts and minimization
efforts outlined above, compensatory mitigation for impacts to waters of the United
States will not be provided for this project.
Protected Species
Plants and animals with federal classifications of Endangered, Threatened,
Proposed Endangered and Proposed Threatened are protected under provisions of Section
7 and Section 9 of the ESA. As of January 29, 2003, dwarf wedgemussel (Alasmidonta
heterodon) is listed as Endangered in Person County. A Biological Conclusion of No
Effect has been rendered for this species.
Historical Compliance
Historic compliance work to be scheduled and concurrence with Historic
Preservation Office will be obtained if required.
Summary
NCDOT proposes to replace Bridge No. 63 over Castle Creek on SR 1330 in
Person County. The proposed replacement structure is a 1@ 20 foot x 6 foot crown span
with wingwalls that is 70 foot long. Please note that the con span structure is a
bottomless structure. Impacts associated with the project (including minimal amounts of
rip rap to protect the structure) include 54 feet existing channel impacted and <0.01 acre
fill in surface water. Temporary impacts to the stream from dewatering will result in the
dewatering of <0.01 ac of stream bed and 105 linear feet stream channel.
Application is hereby made for a Department of the Army Section 404
Nationwide Permit (NWP) 14 and NWP 33 and NCDENR-DWQ Section 401 Water
Quality Certification (WQC) No. 3375 and No. 3366 for construction of this project.
The NCDOT will comply with all applicable NWP and WQC conditions. A pre-
construction notification is attached with this request. If you have any questions or need
additional information, please contact me at [phone].
Sincerely,
Christopher A. Murray, P.W.S.
Environmental Officer
cc: Mr. John Dorney, NCDWQ, Raleigh
Mr. Dallie Bagwell, NCDOT Bridge Superintendent, Raleigh
Mr. John Kearney, NCDOT Bridge Maintenance Supervisor, Oxford
777
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Office Use Only: 03027 Form Version May 2002
USACE Action ID No. DWQ No.
(it any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
L Processing
I . Check all of the approval(s) requested for this project:
® Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
® 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 14 and NWP 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 (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name: NCDOT Division 5, Christopher A. Murray
Mailing Address: 2612 N. Duke St., Durham, NC 27704
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: [e-mail]
2. Agent/Consultant 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:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
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,
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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.
Name of project: Replacement of Bridge No. 63 over Castle Creek on SR 1330 in Person
County.
2. T.I.P. Project Number or State Project Number (NCDOT Only): W.O. No. 5.3852008
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Person Nearest Town: Roxboro
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): From Roxboro, travel north east
on US 501. Turn left on SR 1330 and travel north west to project limits.
5. Site coordinates, if available (UTM or Lat/Long): Site 1: 36.4726° N. 78.9370W
(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. Property size (acres): 0.5 acre
7. Nearest body of water (stream/river/sound/ocean/lake): Site 1: Castle Creek
8. River Basin:_ Roanoke
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http //112o_enr_state.nc.us/admin/maps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Site is surrounded by wooded land and residential housing,
10. Describe the overall project in detail, including the type of equipment to be used:
Replacement of Bridge No. 63 over Castle Creek on SR 1330 in Person County. The
replacement structure is a 1 @ 20 foot x 6 foot crown span with wing walls. Equipment may
include excavator, backhoe, bulldozer, grader and crane.
11. Explain the purpose of the proposed work: The project will replace the existing, bridge that
is structurally deficient.
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IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Provide a written description of the proposed impacts: The project proposes to replace
the existing bridge with a 1 n, 20 foot x 6 foot crown span with wing walls. The stream will
also be temporarily dewatered utilizing sandbags or rip rap covered with filter fabric during
construction.
2. Individually list wetland impacts below:
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***
N/A

* 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.
** 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 athttr,!,?v?%v Icur,i.g??ti.
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*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property: 0.0
Total area of wetland impact proposed: 0.0
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact Length of Average Width Perennial or
Site Number Type of Impact* Impact Stream Name** of Stream Intermittent?
(indicate on ma linear feet Before Impact lease specify)
Site I Placement of crown 34 Castle Creek 7 feet Perennial
span
Placement of rip rap
Site 1 along streambank 20 Castle Creek 7 feet Perennial
for stabilization only
Site 1 Temporary
Dewatering 105 Castle Creek 7 feet Perennial
" 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 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
Several internet sites also allow direct download and printing of USGS maps (e.g., .?_ tuhur_unc.com,
?x in:ippicst_coin, etc.)•
Cumulative impacts (linear distance in feet) to all streams on site: A total of 54 feet
permanent impact (34 feet from placement of crown span and 20 feet for placement of rip rap
along stream bank for stabilization purposes only) and a total of 105 linear feet temporary
impact for dewatering purposes.
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U. S.) below:
Open Water Impact Area of
Name
Wate Type of Waterbody
Site Number Type of Impact* Impact e)
(if
applicable) (lake, pond, estuary, sound,
indicate on ma (acres) bay, ocean etc.
N/A

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
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.): N/A
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Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
VII.
VIII.
local stormwater requirement, etc.): N/A
Size of watershed draining to pond: N/A Expected pond surface area: N/A
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 and surface waters not affected by construction will be protected from
unnecessary encroachment during construction. The side slopes of the jurisdictional sites has
been steepened to the maximum extent possible. Strict enforcement of Best Mana eg ment
Practices for the protection of wetlands and surface waters will be enforced during construction.
Only the smallest amount of fill necessary to complete the project will be placed in waters of the
United States or protected riparian buffers Please note that the crown span is a bottomless
structure that is set on concrete footings.
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
htth ;/h_?o enr.state.tic tislnr.vvetlati(l_s/strnigiclt fit till.
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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.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at enr titate,nc uti??iE?inde? l?tm. 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): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ® No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
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
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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.
Site 1
Zone* Impact Multiplier Required
(square feet Miti ation
I N/A 3 N/A
2 N/A 1.5 N/A
Total N/A N/A
* 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 NCAC 2B .0242 or .0260.
XI. Stormwater (required by DWQ)
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.
Existine: 0.1 acre impervious surface of 0.5 acre total proiect size. Proposed: 0.1 acre
impervious surface of 0.5 acre total project size. Erosion and sediment control devices along the
roiect are comprised of temporary silt fence.
XII. Sewage Disposal (required by DWQ)
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.
The project will not generate wastewater.
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
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Is this an after-the-fact permit application?
Yes El 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).
N/A
czc-?
TM O'?
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
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