20030755 Ver 1_Complete File_20030619

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
December 13, 2006
DWQ # 03-0755
Guilford County
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
Mr. J.M. Mills, Division Engineer
NCDOT, Division 7
PO Box 14996
Greensboro, NC 27415-4996
Dear Mr. Mills:
On June 13, 2003 you requested a 401 Water Quality Certification from the
Division of Water Quality (DWQ) for your project on SR 1131 in Guilford County. We
wrote you on June 30, 2003 discussing concerns that we have regarding the design of the
project and placing it on hold until those concerns are addressed. Therefore we are
returning your application. Once you have collected sufficient information to have a
complete application (please see our hold letter for the missing information), you will
need to reapply for the DWQ approval. Your file is hereby retired and will not be
reviewed until our earlier concerns are addressed.
Please contact me at 919-733-1786 if you have any questions or would like to
discuss this matter.
Sincerely,
John Hennessy
Transportation and Permitting Unit
cc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
NCDWQ Winston-Salem Regional Office
Central Files
File Copy
NCarolina
Transportation Permitting Unit ? vWgraill?
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] /FAX [phone] / Internet: http://h2o.enr.state.nc.us/ncwetlands
An Equal Opportunity/Affirmative Action Employer-50% Recycled/10% Post Consumer Paper
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
7 Alan W. Klimek, P.E., Director
r Division of Water Quality
1 Coleen H. Sullins, Deputy Director
Y Division of Water Quality
June 30, 2003
Guilford County
DWQ Project No. 030755
Emergency Culvert Replacement on Burnett Chapel Road (SR 1131)
CERTIFIED MAIL: Return receipt requested
Mr. J. M. Mills, PE., Division Engineer
NCDOT Division 7
P.O. Box 14996
Greensboro, NC 27415-4996
Dear Mr. Mills:
The Division of Water Quality staff has reviewed your submittal for a §401 Water Quality
Certification for the aforementioned project received June 19, 2003. Review of the water
quality certification application revealed the following deficiency:
1. Use of the NW 3/ Water Quality Certification No. 3376 normally does not require written
concurrence by the North Carolina Division of Water Quality unless there are impacts to
streams in basins with Riparian Area Protection Rules (buffer rules). Therefore, since
Randleman buffer rules are involved, the NCDOT must send seven (7) copies plus the
appropriate fee.
Pursuant to 15A NCAC 214.0507(a)(3), the permit application is placed on hold until we are supplied the
necessary information. Furthermore, until the information is received by the NC Division of Water
Quality, we request (by copy of this letter) that the US Army Corps of Engineers continue to place the
permit application on hold.
We look forward to working with you to expedite the processing of your permit application. If you have
any questions, please telephone Ms. Cynthia Van Der Wiele at 919.733.1786.
Program
99'
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
NCDWQ Winston-Salem Regional Office
File Copy
N. C. 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)
[phone] (phone), 919-733-6893 (fax), (htto //h2o.enr.state.nc.us/ncwetlands)
Customer Service #: 1-877-623-6748 .
FA
NCO NW
.t 4 4
a
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
GOVERNOR
June 13, 2003
Ms. Cynthia Van der Wiele
Wetlands/401 Unit
NC DENR Division of Water Quality
1650 Mail Service Center
Raleigh, NC 27699
(Courtesy Notification, Two Copies)
Mr. John Thomas
US Army Corps of Engineers
6508 Falls of the Neuse Suite 120
Raleigh, NC 27615-6814
(Two Copies)
030755,
LYNDO TIPPETI'
SECRETARY
ltlh 0106A
,? ??N 1 s zpo
Subject: Guilford County, Emergency Culvert Replacement on Burnett Chapel Road (SR 1131)
Project Number # 7.204111B
To Whom It May Concern:
The North Carolina Department of Transportation (NCDOT) proposes to replace a severely
damaged culvert on Burnett Chapel Road in order to maintain traffic safety. The damage is due to
flooding from flood waters received from recent rain storms. In an effort to obtain the necessary
permits for the subject culvert replacement, we are providing a pre-construction notification
application with supporting documentation. This project is underway and this is an after the fact
notification. The work is necessary immediately because the existing road collapsed onto the
existing pipe. Hazardous road conditions resulted and the road was immediately closed to traffic.
Also. the road serves as the only direct eastern route for a nearby fire department. Closure of the
road will result in considerable increases in time and distance for any fire-related emergencies
located east of the project We believe this project can be permitted under the Nationwide Permit
numbers 3 and 33. We sincerely apologize for the delay in notification but this was an emergency
replacement due to pipe failure. The construction was needed immediately.
This project is in the Randleman Lake Water Supply Watershed. However, DOT is requesting to
utilize the "No Practical Alternative" option (15A NCAC 0213.0250 (2) (e) in order to complete the
project. It is the department's opinion that no action will result in greater adverse impacts to
surface waters, will severely restrict traffic flow and decrease traffic safety.
The following information is being provided to satisfy conditions of General Water Quality
Certification.
P. O. Box 14996 Greensboro, NC 27415-4996
Telephone No. 1336) 334-3192 Fax No. f336) 334-3637
i A
PROJECT INFORMATION
a Separate documentation attached as needed: b See the attached Endangered
Species Review Sheet for further information: e When Applicable - See the attached
Historic Review Letter for further information
Road Name SR Number Project Length
miles Classification
Burnett Chapel
Rd SR 1131 N/A Rural
River Basin: DWQ
ID Water Quality
Designation % Impervious
Surface
Cape Fear WS-IV N/A
Buffer Rulesa Buffer Rule Conditions where applicable)
Yes Request Exemption
Protected Species
Presentb Mapped Historic
Properties` CAMA
AEC Essential Fishery
Habitat
No No No No
PIPE REPLACEMENT INFORMATION
Site Stream Type Perennial
Station
Existing Pipe (1) 50' X 36' CMP Proposed (2) 60' X 48' CMP
Pipe
Construction Pump around with offsite detour Dewatering Sandbags & rock silt dam
Method Device*
Burial Depth One foot E/C Plan
Date
Construction As soon as practicable Duration One week
Date
Impacts (ft.) 10 ft-enclosure; 20 linear ft-rip-rap dissipaters; 50 sf-temporary sandbags and
rock silt dam
Special
Conditions
Restoration Within 15 working days of the pipe replacement the natural stream contours
Plan will be restored and seeded. Temporary silt screens will be cleaned and
removed following vegetation establishment.
RCP = reinforced concrete pipe; CMP = Corrugated metal pipe; CMPA = Corrugated metal pipe arch; E/C = Erosion
control. *A less intrusive dewatering device may be used in lieu of the one proposed.
P. O. Box 14996 Greensboro. NC 27415-4996
Telephone No. 13361 334-3192 Fax No. (3361334-3637
40
MINIMIZATION INFORMATION
Impacts will be minimized by strict enforcement of Best Management Practices for the protection of
surface waters and wetlands, restrictions against the staging of equipment in or adjacent to waters
of the US, and coordination (including a pre-construction meeting) with the Division Environmental
Officer.
MITIGATION INFORMATION
Stream mitigation is not anticipated, as the impacts to any individual stream do not exceed 150 feet
Wetland mitigation is not anticipated, as wetland impacts do not exceed 0.10 acres and do not
occur in a unique natural wetland.
APPLICATION INFORMATION
Enclosed please find the Pre-construction Notification Form and supporting documentation for the
above referenced project. If you have any questions or need any additional information, please
contact S. Lane Hall at [phone] or Jerry Parker at [phone]. Your time and effort are
appreciated.
Sincerely,
?'A u&
r. J. . Mills, P.E.
ivision Engineer, Division
Enclosures
CC: Dennis Johnson, Bridge Maintenance NCDOT
Donald Pearson, NCDOT
S. Lane Hall, NCDOT
Travis Wilson, NC Wildlife Resources
P. O. Box 14996 Greensboro, NC 27415-4996 Telephone No. (3361334-3192 Fox No. [phone]
V .,
Construction Sequence and Erosion Control Plan for Replacement of
Single Line pipe with Double Line Pipe
For Burnett Chapel Road
Work to begin immediately
Construction is anticipated to take 2 weeks.
1. Install a rock silt dam downstream of the work area to prevent incidental sediment
loss.
2. Install sandbags or a less intrusive dewatering device to allow dewatering of the work
area.
3. Install pumps to divert flow around the work area.
4. Remove one existing line of 40' long 36" CMP.
5. Excavate to sufficient depth to allow burial of pipes to at least 20% of the pipes'
diameter, place base stone, and two lines of 60' long 48" CMp.
6. Backfill the new lines of pipe and place rip rap only as needed.
7. Starting from the downstream end, remove the dewatering device and restore the
natural stream contours.
8. Notify landscape department for final seeding.
9. Silt fences to be placed as site conditions require.
10. A 10' X 15' dirt bag will be used to remove excess water in the hole where the new
pipe is being replaced.
11. Site conditions and weather may alter these plans.
12. A method less intrusive than a pump around system may be utilized if site conditions
allow.
IF
Office Use Only: ? Form Version May 2002
USACE Action ID No. DWQ No 0 7 5 5
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. 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 3 and 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: ?
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: ?
H. Applicant Information
1. Owner/Applicant Information
Name: Mr. J.M. Mills RE Division Engineer - Division 7
Mailing Address: P.O. Box 14996
Greensboro. NC 27415-4996
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: Jerry Parker
Company Affiliation: Division Environmental Officer
Mailing Address: P.O. Box 14996
Greensboro. NC 27415-4996
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: Jparker(@dot.state.nc.us
Page] of 8
f 1
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than I1 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 ofproject: Burnett Chapel Road Culvert Replacement
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): Not Applicable
4. Location
County: Guilford Nearest Town:Pleasant Garden near High Point
Subdivision name (include phase/lot number): Not Applicable
Directions to site (include road numbers, landmarks, etc.):
The project is southwest of Greensboro off I-85. From I-85, take exit 120 (Groometown
Road Exit) and head south on Groometown Road for approximately 2.3 miles. Turn left on
Kivett Road and go approx 0.5 miles to Burnett Chapel Road. Turn right on Burnett Chapel
Road and travel approx. 2.4 miles to the site.
5. Site coordinates, if available (UTM or Lat/Long): See the attached USGS map.
(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): Not Applicable
7. Nearest body of water (stream/river/sound/ocean/lake): Deep River
8. River Basin: Cape Fear
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/inaps/.)
Page 2 of 8
s
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Damaged culvert crossing in area of low density residences
10. Describe the overall project in detail, including the type of equipment to be used: The
project will involve replacing a damaged and undersized 50 if X 36 inch culvert nine with
two new 60 if pipes with 48 inch circular diameters. One of the 48 inch pipes will be placed
directly in the stream bed whereas the second pipe will be placed adjacent to the first pipe
with a sill to allow for periods of high flow. Both pipes wull be buried to a depth that is at
least 20% of their diameter. The increase in size and number of culverts has been
recommended by the District Engineer as necessary in order to handle the drainage, avoid
disruption of utility services and alleviate the need for excessive road fill. The work is
necessary immediately because the existing road is collapsing onto the existing pipe.
Hazardous road conditions have resulted and the road is presently closed to traffic. Also, the
road serves as the most only direct eastern route for a nearby fire department. Closure of the
road will result in considerable increases in time and distance for any fire-related
emergencies located east of the project site that are within the fire department's jurisdiction
Right-of-way width is illustrated on the attached site plan. Equipment used will be standard
road construction equipment (trackhoe grader, backhoe and bulldozer).
11. Explain the purpose of the proposed work: To maintain traffic safety and to reduce future
maintenance costs.
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.
Not Applicable
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
Page 3 of 8
i I
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: Permanent stream impacts will
result from channel enclosure and placement of Lip-rap energy dissipaters Temporary stream
impacts will result from placement of cofferdams and siltscreens. .
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 identity temporary impacts. Impacts include, but are not hmttea to: mecnantzea cieanng, gmamg, nu,
excavation, flooding, ditchingtdrainage, etc. For dams, separately list impacts due to both structure and flooding.
100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at hUn:/hvwtvfcuna.eov.
"• List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wctland, 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: Not Applicable
Total area of wetland impact proposed: Not Applicable
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 map) (linear feet) Before Impact (please specify)
Burnett Chapel Culvert (en) 10
(tmp)50 sf
UT to Deep River Approx. five
Perennial
Road replacement r 201f feet
See below*

* List each impact separately and identify temporary impacts. impacts mctuae, out are not umuea to: cmverts ano assocuatea np-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
tvxvvv.uses.aov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.tooozone.cont,
www.ntauuuest.com, etc.).
Page 4 of 8
*Cumulative impacts (linear distance in feet) to all streams on site: Project should involve
increase of ten linear feet impacts. - enclosure (en), 10
temporary_(tmn) sandbags and rock silt dams in streams---approximately 50 sf.
riprap (rp) permanent placement ofriprap at each end of pipes ---approximately 20 If total
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 Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.
N/A

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: 611, cxcavation, dredging,
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.): Not Applicable
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): Not Applicable
Size of watershed draining to pond: N/A Expected pond surface area: N/A
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.
Culvert replacement activities are necessary to maintain traffic safety. Impacts will be
minimized by strict enforcement of Best Management Practices for the protection of wetland and
surface waters, restrictions against the staging of equipment in or adjacent to waters of the US,
and coordination (including a pre-construction meeting) with the Division Environmental
VIII. Mitigation
Page 5 of 8
T
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http //h2o enr state nc us/ncwetlands/strmg_ide htmi.
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.
A finding of insignificant impact is anticipated, therefore a mitigation plan is not provided
Cumulative impacts are less than 150 feet. The maximum amount of impact to a single
stream is approximately 70 linear feet. No Outstanding Resource Waters, federally protected
species or their habitats or essential fishery habitats occur in the project area. The project is
not located in a High Quality Water.
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 http://h2o.cnr,state.nc.us/wip/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): Not Applicable
Amount of buffer mitigation requested (square feet): Not Applicable
Page 6 of 8
Amount of Riparian wetland mitigation requested (acres): Not Applicable
Amount of Non-riparian wetland mitigation requested (acres): Not Applicable
Amount of Coastal wetland mitigation requested (acres): Not Applicable
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
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 213 .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify Randleman )?
Yes ? No ® If you answered "yes", provide the following information:
*Requesting a "No Practical Alternative" option due to the emergency nature of the
project. Please see cover letter.
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
I N/A 3
2 N/A 1.5
Total N/A
" Zone l 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 (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.
Not Applicable
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.
Not Applicable
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.
Not Applicable
XM. 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).
Applicant/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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Name: PLEASANT GARDEN Location: 035' 56' 59.2" N 079'50'09.7" W
Date: 6/17/2003 Caption: Burnett Chapel Road (SR 1131) Guilford County
Scale: 1 inch equals 2000 feet

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