HomeMy WebLinkAbout20120883 Ver 1_Application_201209260
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
BEVERLY PURDUE P O Box 25201 Raleigh, NC 27611 -5202
GOvERNOR PHONE 919 -733 2520
September 21 2012
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EUGENE COQ
SECRETARY 4 41*
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Mr Monte Matthews
U S Army Corps of Engineers
Raleigh Regulatory Field Office
3331 Heritage Trade Drive, Suite 105 1 4 G' 3
Wake Forest NC 27587
Subject Nationwide Permit #14
SR 1358E (Bear Wallow Road)
Ashe County, North Carolina
Project Number 11C 005081(DWQ Permit Fee $570)
Dear Mr Matthews
The NC Department of Transportation is scheduled to grade, drain, base and pave SR 1358E,
Bear Wallow Road in Ashe County Total project length is approximately 134 miles
Impervious surface area will increase by approximately 0 49 acres This project will require the
replacement of eight wet pipes as shown below
Stream Impacts
tStation V
NumberY
EXishugA
�P► eS�ze
-' rJ osed
Pi eS�ze
.4 I prep ��
���a
Im acts ft.
=Temporary¢ R��
Dewaterm ft.
Total Impacts
atthis Station
6 +691
41 x48
1@ 185 x 95 x
67 CSPA
10
_
40
153
7 +521
41'x 48"
12 +48
45 x 54
60 x 87 x 63
10
40
65
24 +01
45 x 60 x 46
60 x 87 x 63
10
40
65
28 +30
40 x 60 x 46
60 x 87 x 63
10
40
70
38 +48
32 x 48
60 x 87 x 63
10
40
78
40 +03
55 x 48'
60 x 87 x 63
10
40
55
42 +45
40 x 24'
50 x24
10
40
60
Permanent FiWRiprap
Impacts = 266 feet
Total project Impacts =
546 feet
P O Box250 N WnxEsaoRo NC 28659
PHONE (336) 667 9111 FAx (336) 6674549
It Mr Monte Matthews
SR 1358E (Bear Wallow Road, Ashe)
Page 2
1 The pipes at stations 6 +69 & 7 +52 are being combined into one pipe system due to a home
septic system and retauung wall on the right side of the road The road will essentially be built on
top of the new 185' pipe system
We will attempt to bury the wet pipes at stations 12 +48, 38 +48 & 40+03 All of the remaining
wet pipe slopes exceed 6% with bedrock present at some of these locations These pipes will be
placed on a grade no steeper than 6% with a nprap energy dissipater pad placed in the stream
channel at the pipe outlet These pipes may remain perched after replacement In should be noted
that a —5 waterfall is present at station 10 +00 (Rt ) so I wouldn t expect fish migration beyond
this point anyway
The replacement of the above noted wet pipes will require temporary dewatering An impervious
sandbag dike will be constructed upstream of the existing culverts to create a small pool Clean
water will temporarily be pumped around the construction areas and will be discharged
downstream Any dirty water located inside of the construction areas will be pumped into a silt
bag if necessary Once the new pipes are in place, the impervious dikes will be removed and
preconstruction streambed elevations will be restored
All of the wet pipes on this project except for the last one carry the same unnamed tributary to
Big Horse Creek (Class C Trout, ORW) This project was reviewed for the presence of
threatened and endangered species on August 31, 2012 This project will have no effect on any
federally listed endangered plant or animal species Historic compliance work will be scheduled
and concurrence with the State Historic Preservation Office will be obtained if required
The project impacts should in the long run improve water quality This SR is narrow and steep
We have had problems in the past with ABC from the roadway running off into the stream
Paving the road will help this situation Stormwater will be routed through grass or rock lined
ditches, depending on the ditch line slope Pipe sizes used will be the minimum necessary to
create a safe roadway By utilizing the erosion control measures outlined in the attachments to
this application, downstream water quality standards will be protected All appropriate BMPs will
be used during construction
Attached is a Preconstructlon Notification Form, plan sheets with proposed erosion control
measures a marked county map, a marked topography map and photographs
By copy of this letter it is requested that Mrs Marla Chambers with the North Carolina Wildlife
Resources Commission comment directly to you concerning the 404 Nationwide Permit
application with a copy sent to me A trout buffer variance will be needed from 3 +50 — 8+00,
10 +50 — 11 +50, 12+00 —15 +50 32 +25 — 36+00 36 +00 — 42 +50 and 52+00 — 53 +00
By copy of this letter, I am forwarding three (3) copies of this application package to Amy
Chapman, NCDENR, Division of Water Quality, 401/Wetlands Unit for her review It is
requested that any comments related to the 401 certification be forwarded directly to me with a
copy sent to the US Army Corps of Engineers
Mr Monte Matthews
SR 1358E (Bear Wallow Road, Ashe)
Page 3
We would like to begin construction as soon as possible If further information is required, please
let me know Your early review and consideration will be appreciated
Sincerely,
14A
Heath Slaughter
Division Environmental Officer
Enclosures
cc Marla Chambers NCWRC
Amy Chapman, Division of Water Quality (3 copies)
Amy Euhss, Division of Water Quality
Matt Gantt PE, Land quality Section
Mike Pett -Rohn, PE, Division Engineer
Doug Tetzlaff, District Engineer
Randall Miles, County Maintenance Engineer
Heath Slaughter, Division Environmental Officer
Scott Pipes Roadside Environmental Field Operations Technician
Tc
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PROGRAM
Mr Heath Slaughter
Division 11 Environmental Supervisor
North Carolina Department of Transportation
Post Office Box 250
North Wilkesboro North Carolina 28659
Dear Mr Slaughter
September I8 2012
Subject EEP Mitigation Acceptance Letter
Improvements to SR 1358E (Bear Wallow Road) Ashe County WBS Number
I I C 005081
The purpose of this letter is to notify you that the Ecosystem Enhancement Program (EEP) will provide the
compensatory stream mitigation for the subject project Based on the information supplied by you on September 13
2012 the impacts are located in CU 05050001 of the New River basin in the Northern Mountains (NM) Eco-
Region and are as follows
New
05050001
Stream
Wetlands
Buffer (Sq Ft )
Cold
Cool
Warm
Riparian
Non
Coastal
Zone]
Zone 2
NM
Ri anan
Marsh
Impacts
185
0
0
0
0
0
0
0
(feettacres)
This impact and associated mitigation need were under projected by the NCDOT in the 2012 impact data
EEP will commit to implement sufficient compensatory stream mitigation credits to offset the impacts associated
with this project as determined by the regulatory agencies using the delivery timeline listed in Section F 3 c ui of the
N C Department of Environment and Natural Resources Ecosystem Enhancement Program In Lieu Fee Instrument
dated July 28 2010 If the above referenced impact amounts are revised then this mitigation acceptance letter will
no longer be valid and a new mitigation acceptance letter will be required from EEP
1929
If you have any questions or need additional information please contact Ms Beth Harmon at 919 715
Sincerely
Suzanne Klimek
EEP Acting Di for
cc Mr Monte Matthews USACE — Raleigh Regulatory Field Office
Ms Amy Euliss Division of Water Quality Transportation and Permitting Unit
Ms Linda Fitzpatrick NCDOT — PDEA
File SR 1358E —Division I i
kutoY Pro" 0" Stag M�
North Carolina Ecosystem Enhancement Program 1652 Mad Service Center Raleigh NC 27699 -16521 919 715 -04761 www nceep net
`O�pE W ATF9 pG
O <
Office Use Only
Corps action ID no
DWQ project no
Form Version 1 3 Dec 10 2008
Page 1 of 10
PCN Form — Version 1 3 December 10 2008 Version
Pre- Construction Notification PCN Form
A Applicant Information
1
Processing
la
Type(s) of approval sought from the
Corps
® Section 404 Permit El Section 10 Permit
1 b Specify Nationwide Permit (NWP) number 14 or General Permit (GP) number
1 c
Has the NWP or GP number been verified by the Corps?
❑ Yes
® No
1 d
Type(s) of approval sought from the DWQ (check all that apply)
® 401 Water Quality Certification — Regular ❑ Non-404 Jurisdictional General Permit
❑ 401 Water Quality Certification — Express ❑ Riparian Buffer Authorization
1 e
Is this notification solely for the record
because written approval is not required?
For the record only for DWQ 401
Certification
❑ Yes ® No
For the record only for Corps Permit
❑ Yes ® No
If
is payment into a mitigation bank or in lieu fee program proposed for mitigation
of impacts? If so attach the acceptance letter from mitigation bank or in lieu
fee program
® Yes
❑ No
1 g
Is the project located in any of NC s twenty coastal counties If yes answer 1 h
below
❑ Yes
® No
1h Is the project located within a NC DCM Area of Environmental Concern (AEC)?
❑ Yes
® No
2
Project Information
2a
Name of project
SR 1358E Bear Wallow Road
2b
County
Ashe
2c
Nearest municipality / town
Tuckerdale
2d
Subdivision name
2e
NCDOT only T I P or state
project no
11 C 005081
3
Owner Information
3a
Name(s) on Recorded Deed
NCDOT
3b
Deed Book and Page No
3c
Responsible Party (for LLC if
applicable)
3d
Street address
801 Statesville Road
3e
City state zip
North Wilkesboro NC 28659
3f
Telephone no
336- 903 -9202
3g
Fax no
336- 667 -4549
3h
Email address
hslaughter@ncdot gov
Page 1 of 10
PCN Form — Version 1 3 December 10 2008 Version
4 Applicant Information (d different from owner)
4a Applicant is
❑ Agent ❑ Other specify
0 Name
4c Business name
(if applicable)
4d Street address
4e City state zip
4f Telephone no
4g Fax no
4h Email address
5 Agent/Consultant Information (d applicable)
5a Name
5b Business name
(if applicable)
5c Street address
5d City state zip
5e Telephone no
5f Fax no
5g Email address
Page 2 of 10
PCN Form — Version 13 December 10 2008 Version
B
Project Information and Prior Project History
1
Property Identification
1 a
Property identification no (tax PIN or parcel ID)
1b
Site coordinates (in decimal degrees)
Latitude 36 56429 Longitude 8153943
(DD DDDDDD) (DD DDDDDD)
1 c
Property size
81 acres
2
Surface Waters
2a
Name of nearest body of water (stream river etc ) to
proposed project
UTs to Big Horse Creek
2b
Water Quality Classification of nearest receiving water
C Trout ORW
2c
River basin
New
3
Project Description
3a
Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application
Unpaved road in a rural area
3b
List the total estimated acreage of all existing wetlands on the property
0 acres
3c List the total estimated linear feet of all existing streams (intermittent and perennial) on the property
400 linear feet
3d
Explain the purpose of the proposed project
Upgrade roadway
3e
Describe the overall project in detail including the type of equipment to be used
See attached cover letter
4
Jurisdictional Determinations
4a
Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the pasty
Comments
El Yes ED No El Unknown
4b
If the Corps made the jurisdictional determination what type
of determination was made?
❑ preliminary ❑ Final
4c
If yes who delineated the jurisdictional areas?
Name (if known)
Agency /Consultant Company
I Other -
4d
If yes list the dates of the Corps jurisdictional determinations or State determinations and attach documentation
5
Project History
5a
Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past?
❑ Yes ® No ❑ Unknown
5b
if yes explain in detail according to help file instructions
6
Future Project Plans
6a
Is this a phased project?
❑ Yes ® No
6b
if yes explain
Page 3 of 10
PCN Form — Version 13 December 10 2008 Version
C Proposed Impacts Inventory
1 Impacts Summary
la Which sections were completed below for your project (check all that apply)
❑ Wetlands ® Streams tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2 Wetland Impacts
If there are wetland impacts proposed on the site then complete this question for each wetland area impacted
2a
2b
2c
2d
2e
2f
Wetland impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps 404 10
Area of impact
Permanent (P) or
(if known)
DWQ — non -404 other)
(acres)
Temporary
❑ Yes
❑ Corps
W1 ❑ P ❑ T
❑ No
❑ DWQ
❑ Yes
[:1 Corps
WZ P ❑ T
❑
❑ No
❑ DWQ
❑ Yes
❑ Corps
W3 ❑ P ❑ T
❑ No
❑ DWQ
❑ Yes
❑ Corps
W4 ❑ P ❑ T
❑ No
❑ DWQ
❑ Yes
❑ Corps
W5 ❑ P [IT
❑ No
❑ DWQ
El Yes
El Corps
W6 ❑ P ❑ T
A No
❑ DWQ
2g. Total wetland impacts
2h Comments
3 Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site then complete this
question for all stream sites impacted
3a
315
3c
3d
3e
3f
3g
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number
(PER) or
(Corps 404 10
stream
length
Permanent (P) or
intermittent
DWQ — non -404
width
(linear
feet)
Temporary (T)
(INT)?
other)
(feet)
S1 ®P ®T
Piping Riprap &
Dewatenng
UT #1 to Big
Horse Creek
® PER
❑ INT
® Corps
® DWQ
3
153
S2 ®P ®T
Piping Riprap &
Dewatenng
UT #1 to Big
Horse Creek
® PER
❑ INT
® Corps
® DWQ
3
65
S3 ®P ®T
Piping Riprap &
UT #1 to Big
® PER
® Corps
3
65
Dewatenng
Horse Creek
❑ INT
® DWQ
S4 ®P ®T
Piping Riprap &
Dewatenng
UT #1 to Big
Horse Creek
® PER
❑ INT
® Corps
® DWQ
3
70
S5 ®P ®T
Piping Riprap &
Dewatenng
UT #1 to Big
Horse Creek
® PER
❑ INT
® Corps
® DWQ
3
78
S6 ®P ®T
Piping Riprap &
UT #1 to Big
® PER
® Corps
3
55
Dewatenng
Horse Creek
❑ INT
® DWQ
3b. Total stream and tnbutary impacts
See Next
1 Comments
Page 4 of 10
PCN Form — Version 1 3 December 10 2008 Version
C Proposed Impacts Inventory
1 Impacts Summary
la Which sections were completed below for your project (check all that apply)
❑ Wetlands ® Streams tributaries ❑ Buffers
❑ Open Waters ❑ Pond Construction
2 Wetland Impacts
If there are wetland impacts proposed on the site then complete this question for each wetland area impacted
2a
2b
2c
2d
2e
2f
Wetland impact
Type of jurisdiction
number —
Type of impact
Type of wetland
Forested
(Corps 404 10
Area of impact
Permanent (P) or
(if known)
DWQ — non -404 other)
(acres)
Temporary
❑ Yes
❑ Corps
W1 P ❑ T
❑
❑ No
❑ DWQ
❑ Yes
❑ Corps
W2 ❑ P ❑ T
❑ No
❑ DWQ
W3 ❑ P ❑ T
❑ Yes
❑ No
❑ Corps
❑ DWQ
❑ Yes
❑ Corps
W4 ❑ P ❑ T
❑ No
❑ DWQ
❑ Yes
❑ Corps
W5 ❑ P ❑ T
❑ No
❑ DWQ
❑ Yes
❑ Corps
W6 ❑ P ❑ T
❑ No
❑ DWQ
2g. Total wetland impacts
2h Comments
3 Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site then complete this
question for all stream sites impacted
3a
3b
3c
3d
3e
3f
3g
Stream impact
Type of impact
Stream name
Perennial
Type of jurisdiction
Average
Impact
number
(PER) or
(Corps 404 10
stream
length
Permanent (P) or
intermittent
DWQ — non -404
width
(linear
Temporary (T)
(INT)?
other)
(feet)
feet)
S1 ®P ®T
Piping Riprap &
UT #2 to Big
® PER
® Corps
1
60
Dewatenng
Horse Creek
❑ INT
® DWQ
S2 ❑ P FIT
❑ PER -
❑ INT
❑ Corps
❑ DWQ
S3 ❑ P ❑ T
❑ PER
❑ INT
❑ Corps
❑ DWQ
❑ PER
❑ Corps
S4 ❑ P ❑ T
❑ INT
❑ DWQ
❑ PER
❑ Corps
S5 ❑ P ❑ T
❑ INT
❑ DWQ
S6 ❑ P ❑ T
❑ PER
❑ INT
❑ Corps
❑ DWQ
3h. Total stream and tributary impacts
546
31 Comments 266 feet of the impacts are due to piping and nprap The rest is dewatering
Page 4 of 10
PCN Form — Version 13 December 10 2008 Version
4 Open Water Impacts
If there are proposed impacts to lakes ponds estuaries tributaries sounds the Atlantic Ocean or any other open water of
the U S then individually list all open water impacts below
4a
4b
4c
4d
4e
Open water
Name of waterbody
impact number —
(if applicable)
Type of impact
Waterbody type
Area of impact (acres)
Permanent (P) or
Temporary
01 ❑ PEI T
02 ❑P ❑T
03 ❑P ❑T
04 ❑ PEI T
4f Total open water unpacts
49 Comments
5 Pond or Lake Construction
If pond or lake construction proposed the complete the chart below
5a
5b
5c
5d
5e
Wetland Impacts (acres)
Stream Impacts (feet)
Upland
Pond ID
Proposed use or purpose
(acres)
number
of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f Total
_
5g Comments N/A
5h Is a dam high hazard permit required
❑ Yes No If yes permit ID no
51 Expected pond surface area (acres)
51 Size of pond watershed (acres)
5k Method of construction
6 Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer then complete the chart below If yes then individually list all buffer impacts
below if any impacts require mitigation then you MUST fill out Section D of this form
6a _
❑ Neuse El Tar Pamlico El Other
Project is in which protected basin?
❑ Catawba ❑ Randleman
6b
6c
6d
6e
6f
6g
Buffer impact
number —
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or
for
Stream name
mitigation
(square feet)
(square feet)
Temporary
im act
required?
B1 ❑P [IT
El Yes
❑ No
B2 ❑ P ❑ T
❑ Yes
❑ No
B3 ❑P ❑T
El Yes
❑ No
6h Total buffer unpacts
61 Comments
Page 5 of 10
PCN Form — Version 1 3 December 10 2008 Version
D Impact Justification and Mitigation
1 Avoidance and Minimization
1 a Specifically describe measures taken to avoid or minimize the proposed impacts in designing project
The pipe lengths are the minimum needed to improve roadway
1 b Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques
All appropriate BMPs will be used during construction
2 Compensatory Mitigation for Impacts to Waters of the U S or Waters of the State
2a Does the project require Compensatory Mitigation for
impacts to Waters of the U S or Waters of the State?
® Yes ❑ No
2b If yes mitigation is requn-ed by (check all that apply)
® DWQ ® Corps
2c If yes which mitigation option will be used for this
project?
❑ Mitigation bank
®Payment to in lieu fee program
❑ Permrttee Responsible Mitigation
3 Complete if Using a Mitigation Bank
3a Name of Mitigation Bank
3b Credits Purchased (attach receipt and letter)
Type
Quantity
3c Comments
4 Complete d Making a Payment to In -lieu Fee Program
4a Approval letter from in lieu fee program is attached
® Yes
4b Stream mitigation requested
186 linear feet
4c If using stream mitigation stream temperature
❑ warm ❑ cool ®cold
4d Buffer mitigation requested (DWQ only)
square feet
4e Riparian wetland mitigation requested
acres
4f Non - riparian wetland mitigation requested
acres
4g Coastal (tidal) wetland mitigation requested
acres
4h Comments
5 Complete if Using a Perrnrtbee Responsible Mitigation Plan
5a If using a permittee responsible mitigation plan provide a description of the proposed mitigation plan
Page 6 of 10
PCN Form — Version 1 3 December 10 2008 Version
6 Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWQ
6a Will the project result in an impact wdhm a protected riparian buffer that requires
buffer mitigation?
❑ Yes ® No
6b If yes then identify the square feet of impact to each zone of the riparian buffer that requires mitigation Calculate the
amount of mitigation required
Zone
6c
Reason for impact
6d
Total impact
(square feet)
Multiplier
6e
Required mitigation
(square feet)
Zone 1
3 (2 for Catawba)
Zone 2
1 5
6f Total buffer mitigation required
6g If buffer mitigation is required discuss what type of mitigation is proposed (e g payment to private mitigation bank
permittee responsible riparian buffer restoration payment into an approved in lieu fee fund)
6h Comments
Page 7 of 10
PCN Form — Version 1 3 December 10 2008 Version
E Stormwater Management and Diffuse Flow Plan (required by DWQ)
1 Diffuse Flow Plan
1 a Does the project include or is it adjacent to protected riparian buffers identified
within one of the NC Riparian Buffer Protection Rules?
❑ Yes ® No
lb If yes then is a diffuse flow plan included? If no explain why
❑ Yes ❑ No
Comments
2 Stormwater Management Plan
2a What is the overall percent imperviousness of this project?
%
2b Does this project require a Stormwater Management Plan?
❑ Yes ® No
2c If this project DOES NOT require a Stormwater Management Plan explain why Secondary Road Project
2d If this project DOES require a Stormwater Management Plan then provide a brief narrative description of the plan
❑ Certified Local Government
2e Who will be responsible for the review of the Stormwater Management Plan?
❑ DWQ Stormwater Program
❑ DWQ 401 Unit
3 Certified Local Government Stormwater Review
3a In which local governments jurisdiction is this project?
❑ Phase II
3b Which of the following locally implemented stormwater management programs
❑ NSW
❑ USMP
apply (check all that apply)
❑ Water Supply Watershed
❑ Other
3c Has the approved Stormwater Management Plan with proof of approval been
❑ Yes ❑ No
attached?
4 DWQ Stormwater Program Review
❑ Coastal counties
4a Which of the following state implemented stormwater management programs apply
(check all that apply)
❑ HQW
❑ ORW
❑ Session Law 2006 246
❑ Other
4b Has the approved Stormwater Management Plan with proof of approval been
attached?
Yes El No
5 DWQ 401 Unit Stormwater Review
5a Does the Stormwater Management Plan meet the appropriate requirements?
❑ Yes ❑ No
5b Have all of the 401 Unit submittal requirements been met?
❑ Yes ❑ No
Page 8of10
PCN Form — Version 13 December 10 2008 Version
F Supplementary Information
1
Environmental Documentation (DWQ Requirement)
la
Does the project involve an expenditure of public (federal/state /local) funds or the
® Yes
❑ No
use of public (federaUstate) land?
lb
If you answered `yes to the above does the project require preparation of an
❑ Yes
® No
environmental document pursuant to the requirements of the National or State
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1 c
if you answered `yes to the above has the document review been finalized by the
State Clearing House? (If so attach a copy of the NEPA or SEPA final approval
❑ Yes
❑ No
letter)
Comments
2
Violations (DWQ Requirement)
2a
Is the site in violation of DWQ Wetland Rules (15A NCAC 2H 0500) Isolated
Wetland Rules (15A NCAC 2H 1300) DWQ Surface Water or Wetland Standards
❑ Yes
® No
or Riparian Buffer Rules (15A NCAC 213 0200)?
2b
Is this an after the -fact permit application?
❑ Yes
® No
2c
If you answered 'yes to one or both of the above questions provide an explanation of the violation(s)
3
Cumulative Impacts (DWQ Requirement)
3a
Will this project (based on past and reasonably anticipated future impacts) result in
❑ Yes
® No
additional development which could impact nearby downstream water quality?
3b
If you answered "yes to the above submit a qualitative or quantitative cumulative impact analysis in accordance
with the
most recent DWQ policy If you answered no provide a short narrative description
4
Sewage Disposal (DWQ Requirement)
4a Clearly detail the ultimate treatment methods and disposition (non discharge or discharge) of wastewater generated from
the proposed project or available capacity of the subject facility
N/A
Page 9 of 10
PCN Form — Version 1 3 December 10 2008 Version
5 Endangered Species and Designated Critical Habitat (Corps Requirement)
5a Will this project occur in or near an area with federally protected species or
❑ Yes ® No
habitat?
5b Have you checked with the USFWS concerning Endangered Species Act
❑ Yes ® No
impacts?
❑ Raleigh
5c If yes indicate the USFWS Field Office you have contacted
❑ Asheville
5d What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
GIS and visual observation
6 Essential Fish Habitat (Corps Requirement)
6a Will this project occur in or near an area designated as essential fish habitats
❑ Yes ® No
6b What data sources did you use to determine whether your site would impact Essential Fish Habitat?
WRC will comment
7 Historic or Prehistoric Cultural Resources (Corps Requirement)
7a Will this project occur in or near an area that the state federal or tribal
governments have designated as having historic or cultural preservation
❑ Yes ® No
status (e g National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b What data sources did you use to determine whether your site would impact historic or archeological resources?
8 Flood Zone Designation (Corps Requirement)
8a Will this project occur in a FEMA designated 100 year floodplain?
❑ Yes ® No
8b If yes explain how project meets FEMA requirements
8c What source(s) did you use to make the floodplain determination? ncfloodmaps
J Heath Slaughter
9/21/12
Applicant/Agent s Printed Name
Applicant/Agent s Sig6Ature
Date
(Agent s s ature is valid only if an authorization letter from the applicant
is provided
Page 10 of 10
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