20041747 Ver 1_Complete File_20041029

North Carolina
Michael F. Easley, Governor
NCDENR
Department of Environment and
Natural Resources
William G. Ross Jr., Secretary
Alan W. Klimek, RE, Director
Coleen H. Sullins, Deputy Director
Division of Water Quality
November 15, 2004
Harnett County
DWQ Project No. 041747
DOT Project # 6C.043051
APPROVAL of 401 Water Quality Certification
Mr. Terry R. Gibson, P.E., Division Engineer
NCDOT/Division 6
P.O. Box 1150
Fayetteville, North Carolina 28302
Dear Mr. Gibson:
NOV PM @6 4, R 0 W PM
2 2 2004
DENR - WATER QUALITY
WETLANDS AND STORMWATER BRANCH
You have our approval, in accordance with the attached conditions and those listed below, to place fill
material in 14 linear feet of stream for the purpose of replacing 36 L.F. of deteriorating 52" CMP with 50
L.F. of 60"corrugated metal pipe culvert under SR 1419 in Harnett County. The project shall be
constructed in accordance with your application dated October 26, 2004 (received November 3, 2004).
After reviewing your application, we have decided that this fill is covered by General Water Quality
Certification Number 3404. 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 below and in the attached certification.
1) Sensitive Watershed Erosion and Sediment Control Practices
This project is located in a watershed with a supplementary classification of High Quality Waters
(HQW). Therefore, the Division of Land Resources' Design Standards in Sensitive Watersheds
(15A NCAC 0413.0124) must be adhered to throughout the life of this project.
225 Green Street - Suite 714, Fayetteville, North Carolina 28301-5043 One
Phone: [phone] \ FAX: [phone] \ Internet: ww.enr.state.nc.us/ENR/ NorthCarolina
An Equal opportunity / Affirmative Action Employer - 50 % Recycled \ 10 % Post Consumer Paper Naturally
Mr. Terry Gibson
November 15, 2004
Page 2
2) Upon completion of the project, the NCDOT shall complete and return the enclosed "Certificate
of Completion Form" to notify DWQ when all work included in the 401 Certification has been
completed. Also, we request that you notify Mr. Ken Averitte of the Fayetteville Regional Offi
when this work is complete.
3) NCDOT shall conduct its activities in a manner consistent with State water quality standards
(including any requirements resulting from compliance with section 303(d) of the Clean Water
Act) and any other appropriate requirements of State law and federal law. If DWQ determines tl
such standards or laws are not being met (including the failure to sustain a designated or achieve
use) or that State or federal law is being violated, or that further conditions are necessary to asst
compliance, DWQ may reevaluate and modify this certification to include conditions approprial
to assure compliance with such standards and requirements in accordance with 15A NCAC
2H.0507(d). Before modifying the certification, DWQ shall notify NCDOT and the US Army
Corps of Engineers, provide public notice in accordance with 15A NCAC 2H.0503 and provide
opportunity for public hearing in accordance with 15A NCAC 21-1.0504. Any new or revised
conditions shall be provided to NCDOT in writing, shall be provided to the US Army Corps of
Engineers for reference in any permit issued pursuant to Section 404 of the Clean Water Act, ar
shall also become conditions of the 404 Permit for the project.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearint
You must act within 60 days of the date that you receive this letter. To ask for a hearing, send a writtel
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. 27611-7447. 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 Wate
Act. If you have any questions, please contact Ken Averitte 910-486-1541, ext. 722.
nek, P.E.
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Wilmington Field Office
FRO, DWQ
Rob Ridings, Wetlands Unit
Central Files
Land Quality Section, FRO
I larnett.sr1419
Sys''
a
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY.
GOVERNOR
NCDENR Division of Water Quality
John Hennessy
2321 Crabtree Blvd.
Suite 250
Raleigh, NC 27604-2260
OCTOBER 27, 2004
041-747
RE: Minor Road Crossings / SR 1419 / Harnett County
State Project # 6C.043051
USACOE NWP#14 / NCDENR WQC 3404
Dear Mr. Hennessy:

Enclosed, please find seven (7) copies of a PCN and related documentation for a Minor Road
Crossing (Culvert Replacements along SR 1419 in Harnett County. The project will be
completed in compliance with NCDENR Division of Water Quality General Certification 3404,
and, USACE Nationwide Permit #14.
This project is being submitted under the 401 Automated Payment Procedure. The State
Project number is 6C.043051, and, the permit fee is $200,00.
This project does not require written notification to the Corps of Engineers, as discussed
with Richard Spencer.
A separate color copy of this submission has been forwarded to Ken Averitte of the
Fayetteville Regional Office.
If you should have any questions or comments regarding this notification, please feel free to
contact me.
incerely, /1")
/740 S
a4411?
James . Rerko, PWS
Division 6 Environmental Officer
LYNDO TIPPETT
SECRETARY
OC [ ?z 9 2004 T'y
DENR WATER QA ERI B W-H
WEDS AND STDRMW
P. O. Box 1150, Fayetteville, NC 28302-1150 - Telephone [phone] - Fax [phone]
Color Ce?y
.-M
OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EAKEY
GovERNOR
U. S. Army Corps of Engineers
Wilmington Regulatory Field Office
P.O. Box 1890
Wilmington, North Carolina 28402-1890
ATTN: W. Richard Spencer
NCDOT Coordinator
October 12, 2004
Q4174T
W. LYNDO nPPETr
SECRETARY
P&RWO,
0 C T 2 ,9 2004
WETLAN S MND STORUAUTER BRANCH
Dear Sir:
Subject: Notification for Nationwide Permit 14 (Minor Road Crossing)
Culvert Replacement SR 1419-Harnett County
State Project No. WBS 6C.043051
The North Carolina Department of Transportation (NCDOT) has scheduled to grade, drain, base
and pave SR 1419, Avery Spence Road in Harnett County. Total project length is 0.6 Haile. The
roadway will be widened from 16 feet to 20 feet and stabilized grass shoulders (6 foot) will be
provided. This project will require the replacement of a wet cross line as shown below:
Crossing Roadway Station Existin Culvert Pro posed Culvert
Crossing #1 Sta 10+50 36LF 36" RCP 50LF 60" CNT
New stream impacts =14 linear feet
The pipe is perched at the downstream end, and will be replaced with one (1) foot of pipe burial
to allow for aquatic life movements
Construction of this project will require impacts to waters of the United States in the Cape Fear
River Basin. Crossing #1 conveys an Unnamed tributary to Avents Creek (Class HQW).
Crossing #1 presently consists of a 36LF 36" CMP that is in a deteriorated condition. Extensive
corrosion was noted along with the pipe being at grade on the upstream end and perched (3"-6")
at the downstream end. Just upstream of the culvert, there is a small in-line pond that is
controlled by a weir. The typical section of the UT to Avents Creek is five feet in width with
stabile side slopes. The 60" CUT will be buried one foot to accommodate aquatic life
movements. All work within the UT to Avents Creek will be conducted in accordance with
NCDOT's Best Management Practices for Construction and Maintenance Activities Manual.
P. O. Box 1150, Fayegeville, NC 28302-1150 - Telephone [phone]- Fax [phone]
RESOURCE STATUS
In general, there will be a minor impact as the result of the replacement of the culvert along SR
1419 in Harnett County. Approximately 14 linear feet of stream impact is expected. A
Nationwide Permit #14 / NCDENR 401 WQC 3404 is required for the project.
Endangered Species: Plants and animals with Federal classification of Endangered (E) or
Threatened (T) are protected under provisions of Section 7 and Section 9 of the Endangered
Species Act of 1973, as amended. As of January 29, 2004, the U. S. Fish and Wildlife Service lists
four federally protected species for Harnett County.
Federally Protected Species for Harnett County
SCIENTIFIC NAME COMMON NAME STATUS
Notropis mekistocholas Cape Fear shiner E
Picoides borealis Red-cockaded woodpecker E
Isotria medeoloides Small-whorled pogonia T
Lysimachia asperulaefolia Rough-leaved
loosestrife E
"E" denotes Endangered (a species that is in danger of extinction throughout
all or a significant portion of its range).
T(S/A)- Threatened due to similarity of appearance, a species that is threatened
Due to similarity of appearance with other rare species and is listed for its
Protection. These species are not biologically endangered or threatened and
Are not subject to Section 7 consultation.
A biological conclusion of "No Effect" was reached for all species during the August 31, 2004
survey for protected species. Protected species were not identified, nor, was the general habitat
for each species identified.
REGULATORY APPROVALS
Application is hereby made for a Department of the Army Nationwide Permit 14 / NCDENR 401
WQC 3404 as required by the above-described activities.
The National Register was reviewed in addition to conducting a field view of the project for
significant historic features.
The project impacts are minor in nature and should not remove or degrade existing water quality
uses. Pipe sizes proposed are the minimum necessary to create a safe highway while
accommodating the 25-year design storm. By utilizing the erosion control measures, downstream
water quality standards will be protected. All appropriate BMP's will be utilized during
construction.
Attached is a Preconstruction Notification Form, plan sheets with proposed erosion control
measures, marked county road map, quad location map and photographs.
If you should have any questions, or, need additional information please contact James J. Rerko,
PWS at [phone].
Sincerely,
17W 31
James . Rerko, PWS
Division 6 Environmental Officer
ATTAcHmcNTs
cc: John Hennessy, Division of Water Quality (7 copies)
Ken Averitte, Division of Water Quality (1 copy)
Terry Gibson, P.E., Division Engineer
Ray Stone, P.E., District Engineer
Keith Anderson, Harnett County Maintenance Engineer
-17 Office Use Only: J Form VersiaaMay2002
USACE Action ID No. DWQ No.
(If any particular item is not applicable to Qus project, please enter "Not Applicable" or "NIA".)
L Processing
1. 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
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 PCI), 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:_ Terry R Gibson, P.E./NCDOT/Div 6/Division Engineer
Mailing Address: P.O. Box 1150
Fayetteville, NC 28302
Telephone Number: 910-486-1493 Fax Number: 910-486-1959
E-mail Address: tgibsonndotstatemems
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: James J. Rerko, PWS
Company Affiliation: NCBOT/DIV 6/Division Environmental Officer
Mailing Address: Same
Telephone Number:-910-437-0207 Fax Number: 910-486-1959
E-mail Address: iirerko(-,dot.state.nc.us
Page 1 of 3
11L 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-1419 (Avea Spence Rd.)
2. T.I.P. Project Number or State Project Number (NCDOT Only): 6C.043051
3. Property Identification Number (Tax PIN):
4. Location
County: Harnett Nearest Town: _Lillington
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): From intersection of US 421
and US 401 travel north alone US 401, 3.5 miles to SR 1412. Travel along SR 1412 6.8
miles, turn left onto SR 1419. Project is 1,050 feet from intersection.
5. Site coordinates, if available (UTM or Lat/Long):. (35°31'32"N 7815114411W)
(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):
7. Nearest body of water (stream/river/sound/ocean/lake): UT to Avents creek (HOW)
8. River Basin: Cape Fear River
(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.ne.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: Existing 20 foot gravel/dirt road with maintenance limits
45 foot in width. Surrounding land use is rural/agricultural.
Page 2 of 8
10. Describe the overall project in detail, including the type of equipment to be used: In
brinning SR-1419 tit) to current safety standards, i.e. 20 foot paving w/6 foot stabilized
shoulders and 3:1 side slopes within a 60 foot right-of-way. The existing culvert is
severely deteriorated with corrosion and must be replaced. Impacts will be minimized
as much as possible. The culverts will be replaced utilizing a track-hoe excavator.
While front end loaders will place fill material. Eventually a motor grader will finish
grade the project prior to paving.
11. Explain the purpose of the proposed work:_ By Statue. NCDOT is renuired to pave all
unpaved Secondary Roads. To ensure that the roadway meets current safety standards,
the road will be paved to a width of 20 feet, 6 foot grass shoulders will be installed on
each side and 3:1 side slopes will be provided within the 60 foot riglht-of-way.
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.
None
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.
None
VI. Proposed Impacts to Waters of the United StatesA'VaterS 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
Page 3 of 8
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: Remove and replace existing
culvert along SR 1419, which is necessary to provide the minimum current safety
standards.
2. Individually list wetland impacts below:
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100 ycarFloodplain**
es/no Distance to
Nearest Stream
ear feet
Type of Wetland***
Crossing 91 N/A 0.0 ac No 0 LF N/A

d to mc
t Ii
it chanizcd clearing grading fill,
o
m
• List each impact separately and identify temporary impacts. Impacts include, but are no . ,
excavation, flooding, ditching/drainage, etc. For dams, separably list impacts due to both structure and flooding.
•* 100-Year floodplains arc identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FE MA-approved local IIoodplain maps. Maps are available through the FEMA Map Service Center at 1-500.358-9616, or
online at htt-.//www.fema.eov.
**• List a %Nctland type that best describes wetland to be impacted (e.g., freshwater/saltwatcr 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 ac
Total area of wetland impact proposed: 0.0 ac
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
(linear feet
Strcam Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
lease specify)
Crossing #1 Culvert 14 LF UT to Avents Creek 5 ft. Perennial

t... .. ....t m:...:#.A f.,• ?,h- ,fq 1n1 mcneinieA Tir rMn_
List each impact separately and identify temporary impacts. mmpat;fs U161uu[:, vui .u6 uv. luau w. - -- ._r
dams (separately list impacts due to both structure and flooding), relocation (include linear fed before and after, and net loss/gain),
stabilization activities (cement NNA rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If strum relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included
Page 4 of 8
Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstrearn named stream into mhich it flows. USGS maps arc available through the USGS at 1-800-358-9616, or online at
wwwusgs.pov. Scycral intemet sites also allow direct download and printing of USGS maps (e.g., N'.'ww.topo7one.com,
N3Nv1v.7n3Pq11est.c0m, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 14 LF.
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
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Name of Watcrbody

(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.
N/A

' List each impact separately ana racnmy temporary tmpauu. "puuw imiuuc, uuL zuc: uu? uuuuu w. ui4 "L41vauuu, W'x61&1F5+
flooding, drainage, bulkheads, etc.
5. 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
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of vatershed 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.
The existing culvert is severely deteriorated. It must be replaced.
VIM Mitigation
Page 5 of 3
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/ncwet]ands/strm,Ride.htmi.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
Mitii ation is not required for this project.
NVlitigation. 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 http://h2o.enr. state. nc.us/wrp/index.htm If use of
the NOW is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet): 0 LF.
Amount of buffer mitigation requested (square feet): 0 LF.
Amount of Riparian wetland mitigation requested (acres): 0 LF.
Amount of Non-riparian wetland mitigation requested (acres): 0 LF.
Amount of Coastal wetland mitigation requested (acres): 0 LF.
Page 6 of 8
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 punuant 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 El No ?
X. Proposed Impacts on Riparian and Watershed Butlers (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
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 wltllln 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. Required
Zone* (Impact square feet) Multiplier 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.
Page 7 of 8
If buffer mitigation is required, please discuss what type of mitigation is proposed (.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.
XL 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.
An erosion and sedimentation control plan will he incorporated into the construction plan
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.
N/A
XIIL Violations (required by DWQ)
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).
/o /0, Ze
A plicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 8 of 8
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