HomeMy WebLinkAbout20130320 Ver 1_401 Application_20130313oF WaT-119p�
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20130320
Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre - Construction Notification (PCN) Form
A. Applicant Information --� . '
1. Processing
1 a. Type(s) of approval sought from the
Corps:
Section 404 Permit El Section 10 Permit
1b. Specify Nationwide Permit (NWP) number: 13 and 39 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):
X 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 N No
For the record only for Corps Permit:
❑ Yes ® No
1f. 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:
Cook Bank Stabilization
2b. County:
Ashe
2c. Nearest municipality / town:
West Jefferson
2d. Subdivision name:
NA
2e. NCDOT only, T.I.P. or state
project no:
TN/A
3. Owner Information
3a. Name(s) on Recorded Deed:
Marianne Cook
3b. Deed Book and Page No.
132/1516 n.
3c. Responsible Party (for LLC if
applicable):
N/A
19
D
3d. Street address:
360 NE 105 St. MAR
3e. City, state, zip:
Miami Shores, FL 33138
3f. Telephone no.:
N/A
3g. Fax no.:
N/A
3h. Email address:
N/A
Page 1 of 10
PCN Form — Version 1.3 December 10, 2008 Version
B. Project Information and Prior Project History
I. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
12310 - 001 -913
1 b. Site coordinates (in decimal degrees):
Latitude: 36.339979 Longitude: - 81.412785
(DD.DDDDDD) (- DD.DDDDDD)
1c. Property size:
1.5 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to
proposed project:
South Fork New River
2b. Water Quality Classification of nearest receiving water:
WS -V, HOW
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: Residential and Forest Land
3b. List the total estimated acreage of all existing wetlands on the property: 0
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property: 230
3d. Explain the purpose of the proposed project: Bank Stabilization to prevent further erosion that endangers the existing
home and septic system
3e. Describe the overall project in detail, including the type of equipment to be used: The project seeks to install 180' of bank
stabilization via a rock slope and install 34LF of pipe to prevent further erosion that endangers the existing home and
septic system. The project will be constructed from the top of bank and utilize a tracked excavator.
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 past?
Comments:
❑Yes 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): Unknown
Agency /Consultant Company:
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 1.3 December 10, 2008 Version
. ;a.s K[ . . ..,__ - -
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 ❑P ❑T
02 ❑P ❑T
03 ❑P ❑T
04 ❑P ❑T
4f. Total open water impacts
4g. Comments:
S. Pond or Lake Construction
If Pond or lake construction proposed, then 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:
5h. Is a dam high hazard permit required?
❑ Yes ❑ No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
6. Buffer Impacts (for DWO)
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 ❑ Tar - Pamlico ❑ Other:
Project is in which protected basin? NA
❑ 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
impact
required?
B1 ❑P ❑T
El Yes
❑ No
B2 ❑ P ❑ T
❑ Yes
❑ No
B3 ❑P ❑T
❑Yes
❑ No
6h. Total buffer Impacts
6i. Comments:
Page 5 of 10
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) — required by DWO
6a. Will the project result in an impact within 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
F. Supplementary Information
I. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal /state/local) funds or the
❑ Yes ® No
use of public (federal /state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
environmental document pursuant to the requirements of the National or State
❑ Yes ® No
(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 2B .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 (DWO 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
AGMAUTHMATION MM
PO L. i I!
Streetaddrem
PropertyOwner: MARI
k
5'70
.C,p : S12Lo j N.0 .
The erredeesigoret r tered property owners of the sbm noted prnpertY. do hereby authorize
4 �'
of SPA
(AgereU (now of aons wmg firm)
to act on my behalf and take actions neoesssry for the pn cmgng, Mmm and meptance
of this permit or ceenificalon a"dwnpmpwWebov* i+daN d and special conditions attadred.
PropertyownwSAddress(if
Air APli rAt�dQbb��
N 1a5 :5
MiAIRI SOC -Qf59
We hereby oectify the above a Lion strbmaW in this applfcadan is tare and Umrae to-
�egbest crow iorrow�dge. -
Audmked S sore
T000 /T000 Qj
MAR 2 6 2013
Ott vOL8LL89CC '��i i�► "o�?'s '�►�oz�fo/
COOK BANK STABILIZATION
.sgE
VICINITY MAP (NTS)
NORTH CAROLINA COUNTY MAP
(ASHE COUNTY)
TOPOGRAPHIC SURVEYOR:
ENGINEER:
SHEET INDEX:
BLUE RIDGE GEOMATICS, PA
BLUE RIDGE ENVIRONMENTAL CONSULTANTS, PA
CS
COVER SHEET
D2
DETAILS
1305 S. COLLEGIATE DRIVE
1305 SOUTH COLLEGIATE DRIVE
Cl
GRADING PLAN
D3
DETAILS
WILKESBORO, NC 28697
WILKESBORO, NC 28697
C2
PROFILES
D4
NOTES
LICENSE # 0576
LICENSE # C,3448
C3
ESC PLAN
D5
NOTES
C4
AERIAL PLAN
D6
NOTES
CITY/TOWN: WEST JEFFERSON, NC
D1 DETAILS
SITE COORDINATES: LATITUDE= 36.339979° N LONGITUDE =-81A12785* W
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NOTES
NCY REVIEW.
NOT RELEASED FOR CONSTRUCTION o,.��
00
NOT SCALE- PLANS MIST RFRFCRVFOasarrWPIF1:ArT
NPDES INSPECTION NOTES
1 THIS GENERAL PERMIT IS APPLICABLE TO POINT SOURCE DISCHARGES FROM CONSTRUCTION ACTIVITIES DMURBING ONE OR MORE
ACRES OF LAD THE SUBMISSION OF A PROPOSED EROSION AND SEDIMENTATION CONTROL PLAN TO THE DIVISION OF LAND RESOURCES
OR DELEGATED LOCAL PROGRAM SHALL BE CONSIDERED TO TAKE THE PLACE OF A NOTICE OF INTENT FOR COVERAGE UNDER THIS
ODOUR PERMIT FOR THOSE PROJECTS REOUIRM THIS PERMIT COVERAGE COVERAGE UNDER THIS GENERAL PERMIT SHALL BECOME
EFFECTIVE UPON ISSUANCE OF AN APPROVAL FOR THE EROSION MID SEDMENTATDN CONTROL PLAN BY THE LAND OLILLIIY SECTION OF
THE DIVISION OF LARD RESOURCES OR DELEGATED LOCAL PROGRAM PRIOR TO 114E COIWBDEII:HT OF CONSTRUCTION AND LARD
DISTURBODACTNRESAPPROVALOF THEEROSION AND SEGMENTATION CONTROL PLAN SWILL BE OBTAINED
2. THIS PROJECT IS SUB ECT TO THIS PERMIT IN ADDITION TO THE APPROVED EBSC PLAN BECAUSE ALL CONSTRUCTION ACTIVIIES
DISTURBING 1 OR MORE ACRES OF LAND ARE SUBJECT TO STORMWATER PERMITTING REOUI EME NTS UNDER THE NATIONAL POLLUTANT
DISCHARGE ELIMINATION SYSTEM (NPDES) REFER TO A COPY OF GENERAL PERMIT NO NC(D1oD00 AND GRANTED COVERAGE UNDER THIS
GENERA STORMWATER PERMIT
& THE APPLICANT MUST COMPLY WITH THE APPLICABLE TERMS AND CONDITIONS OF THIS STORMWATER PERMIT, AND ARE SUBJECT TO
ENFORCEMENT BY THE DIVISION OF WATER OUAUTY FOR ANY VIOLATIONS.
4. APPLICANT MUST IMPLEMENT THE EROSION AND SEDIMENTATION CONTROL PLAN APPROVE) FOR THE PROJECT BY THE NO DIVISION OF
LAND RESOURCES (DER) OR BY AN APPROVED LOCAL PROGRAM ADHERENCE TO THAT EASC PLAN IS ENFORCEABLE COMPONENT OF THE
STORMWATER PERMIT
5 A RAIN HUGE LUST BE KEPT ON WE
S ALL EROSION AND SEDIMENTATION CONTROL MEASURES MUST BE INSPECTED AT LEAST ONCE A WEB( AND WITHIN 24 HOURS AFTER ANY
STORM EVENT GREATER THIN A HALF INCH (DURING A 24H R PERIOD) ff ANY DEVICE FAILURE IS SE:N, IMMEDIATE CORRECTIVE ACTION
MUST BE TAKEN
7 AL OUTLETS WHERE STORMWWATER RUNOFF IS LEAVING THE SITE MUST BE INSPECTED AND EVALUATE THE EFFECT ON NEARBY STREAMS
OR WETLANDS CORRECTIVE ACTION MUST BE TAKEN (AND RECORDED) F SEGMENT IS BEING DEPOSITED OFF SITE OR IN A STREAM OR
WE7LARD OR IS CAUSING AVISDLE INCREASE IN TIIEDITY (CLOLDINESS) OF ANYAFFECTED STREAM.
S. FSEDMENf N4 BEING DEPOSITED INA8TREAHA OR NJETI/IFD,DWO MUST BE CONTACTED WITHIN 24 HOURS
I RECORDS MUST BE KEPT OF THESE INSPECTIONS
t0 PROVIDE THE OPEftATK)N AID MAINTENANCE (0066M1,S) NECESSARY TO MAINTAIN OPTIMAL PERFORMANCE OF STORMVPAIER CONTROLS. THIS
MEANS TAKE CORRECTIVE ACTION IF EASC FACMRES ARE NOT OPERATING PROPERLY
it REGULAR INSPECTIONS ARE A CHANCE TO CHECK IMPACTS TO NEARBY WATERS F SIGNIFICANT AMOUNTS OF SEDIMENT ARE OBSERVED,
NOTFY DWO WITIDN 24 HOURS AND PROVIDE MUM NOTICE WITHIN 5DAYS (SEE PART 0, SECTION E OF THE PERMIT) PLEASE COPY
CORRESPONDENCE TO GLEE.
IL PREVENT STORMWATER CONTAINNATION FROM EQUIPMENT USED DURING CONMUICTDN. THIS INCLUDES PREVEIMW SPILLS OF DO-
FUELS, COLLANTS CEMENT, HYDRAULIC FLUIDS, ETC FEDERAL GUIDELINES MUST BE FOLLOWED AND LABEL RESTRICTIONS WHEN USING
HERBICIDES, PESTICIDES. AND FERTU2ERB
11 DEMOLITION DEBRIS AND OTHER BUILDING MATERIAL MUST BE DISPOSED OF PROPERLY MANAGE DISPOSAL OF LITTER AID SANITARY
WASTE
NPDES INSPECTION RECORD
PROJECT MONITORING FOR THE WEB( BEGINNING
RADFALLAPANf:1xGEAINa ec WDITAAEDOIt9lEARIDA WOdmOl TM DIAY AAFAUAOLMARRNLLaItE9f
DAY OR DATE
RAINFAILLMIOUNT INCHES)
NDVNS
A99ESSMEWrOFCONTROL MEASURESu
�WG4LLSOF•,o.e ,nw.rJm..no+ewvm mm.M n.
MEASURE NDENTTFA:TKDN Oa aT
FTME,smomrtvam Emomrt TRIM
GnaAOCO.ENq
DATE OF
INSPECTION
NSPECTOR
OPERATING
PROPERLY(YAS
CORRECTIVE ACTIONS TAKEN
DATE
CORRECTIVE
ACTION TAKEN
STONDVATER OISOHAROE OUTFALLB.
umros ®monwmxwe+mnu.Pm
SiOAMNgTER D6pRAA0E
OUIFAL DElTFIGTDN
DATEOF
INSPECTION
NRWLS6
NSPECTOR
SEEN
NEAR CUTFAL?
(M
DEWRNE EYDENCE OF OTHER POLLUTANTS DMCHIAMNG FNMH THE
SHE SUCH AS OIL SHEEN DISCOLORATION CEMENT WASTES SANITARY
WASTE FERTILIZERS OR FUEL OR WTERWL STORAGE LEAKAGE
VIUMSEINENTAN)ARSTREAMTWBpfY REOM✓D (DRIECTNE ACTIONS TAVEN N'ASSESSNFNf W CONRROLIEASINES' ABOVE
ISTFREANVV69EBmIAO DN IT ®NASTWAK EIIADNIBIFPERI CMACIm?_
E xNO
MT14RFAWVMUSEDRENTD3m M CDRWOPENTPESR 0
15 TH REWVIHOmNW (YM_ E P W; �YA)
BYTHSSIGIWnMEIORIFY NALfAmAxCEWITHRWTISECSt %OFTEPC6IMPEMT T TT16REPORTSA =MTEANDWWLETETOTHEBESTOF W KN WLDGE
SKRRGMREOF PS UNTIEE OROESI NEE DATE
MANDATORY SELF INSPECTION PROGRAM
THE SEDIMENTATION POLLUTION CONTROL ACT WAS AMENDED IN 20M TO REQUIRE THAT PERSONS RESPONSIBLE FOR IAKADISTURBING
ACTIVITIES INSPECT A PROJECT AFTER EACH PHASE OF THE PROJECT TO MAKE SURE THAT THE APPROVED EROSION AND SEDIMENTATION
CONTROL PLAN IS BEING FOLLOWED
RULES DETAILING THE DOCUMENTATION OF THESE INSPECTIONS TAKE EFFECT OCTOBER 1, 2070
THE SEIFNINSPELMON PROGRAM IS SEPARATE FROM THE WEEKLY SELFNJONITORDIO PROGRAM OF THE NPDES STORMWATER PE NETT FOR
CONSTRUCTION ACTIVITIES THE FOCUS OF THE SELF-INSPECTION REPORT IS THE PWALLA71ON AND MAINTENANCE OF EROSION AND
SEDIMENTATION CONTROL MEASURES ACCORDING TO THE APPROVED PLAN THE INSPECTIONS SHOULD BE CONDUCTED AFTER EACH PHASE OF
THE PROJECT, AND CONTINUED UNTIL PERMANENT GROUND COVER IS ESTABLISHED
THE SEIFaNSPECTKAR REPORT FORM WILL ALSO BE AVAILABLE AS AN EXCEL SPREADSHEET FROM THE LAND OU IM WEB SITE AT
HTTPIAIWWDLRENHSTATEIJC USRPAGESISEDIMMENTATIONLJEWMMC
EFFECTIVE OCTOBER i, 2010. PERSONS CONDUCTING LAND-DISTURBING ACTIVITIES LARGER TWIN ONE ACRE MUST INSECT THEN PROJECT
AFTER EACH PHASE OF THE PROJECT. AND DOCUMENT THE INSPECTION IN VHRnia
DOES THIS ONLY APPLY TO PROJECTS APPROVED AFTER OCTOBER 1, 2DIO?
N0, IT APPLIES TO BOTH OD AMID NEW PROJECTS.
WINO CAN CONDUCT THE INSPECTION THE FINANCIALLY RESPONSIBLE PARTY, LANDOWNER OR THEIR AOBIT MAY CONDUCT THE DEVOTION.
IS A SPECIAL CERTIFICATION REQUIRED TO DO THE INSPECTION NO
WHAT IS THE GOAL OF THE SELF-INSPECTION PROGRAM? TO MAKE SAE THAT THE APPROVED EROSION AND SEDIMENTATION CONTROL PLAN IS
BEING FOLLOWED, INCLUDING THE INSTALLATION AND MAINTENANCE OF MEASURES. AND THE PROVISION OF GROUND COVER IN ATSMY MANNER
WHAT HIS TO BE INSPECTED? ALL OF THE EROSION AND SEDIMENTATION CONTROL MEASURES. INCLUDING SEDIMENTATION CONTROL BASINS,
SEDIMENTATION TRAPS, SEDIMENTATION PONDS. RDCK DAMS. TEMPORARY DIVERSIONS. TEMPORARY SLOPE DRAINS, RDCK CHECK DAMS,
SEDIMENT FENCE OR HARRIERS, ALL FORMS OF INET PROTECTION, STORM DRAINAGE FACILITIES, ENERGY DISSIPATERS, AND STABILIZATION
METHODS OF OPEN CHANNELS MUST BE INSPECTED
WHAT ELSE RA8 TO BE DECKED? THE NEED FOR GROUND COVER SHOULD BE CHOCKED TEMPORARY OR PERMANENT GROUND COVER MUST BE
PROVIDED ON EXPOSED GRADED SLOPES AND FILLS WITHIN 21 CALENDAR DAYS OF THE COMPLETION OF A PHASE OF GRADING PERMANENT
GROUND COVER MUST BE PROVIDED WITHIN 15 WORKING DAYS OR W CALENDAR DAYS (8) DAYS IN NOW ZONES). WHCHEVER TERM IS SHORTER,
UPON THE COMPLEION OF CONSTRUCTION OR DEVELOPMENT
DO NEWLY INSTALLED SEDIMENTATION CONTROL BASINS HAVE TO BE MEASURED? YES, THE ACTUAL DMENSDNS OF THE BASINS HAVE TO BE
CHECKED, USUALLY WITH A TAPE MEASURE, AND COMPARED TO THE DIMENSIONS ON THE APPROVED PEAL
DO NEWLY INSTALLED SEDIMENTATION CONTROL BASINS HAVE TO BE MEASURED BY A PROFESSIONAL LAD SURVEYOR? NO GENERALLY THE
WIDTH AND LENGTH OF BASINS OW BE MEASURED WITH A TAPE MEASURE A LEVEL AND SURVEY ROD MAY BE USEFUL IN CHECKING THE DEPTH OF
ARASDL ONLY RELATIVE ELEVATIONS, COMPARING THE BOTTOM AND TOP ELEVATIONS ARE NECESSARY
WENT IS A SIGNIFICANT DEVIATION FROM THE APPROVED PLAN A SDNFT,AN'T DEVIATION MEANS AN OMISSION, ALTERATION OR RELOCATION OF
IN EROSION OR SEGMENTATION CONTROL MEASURE THAT PREVENTS THE MEASURE FROM PERFORMING AS INTENDED F THE APPROVED
EROSION AND SEDIMENTATION CONTROL PLAN CANNOT BE FOLLOWED. A IEVLSM PUW SHOULD BE SUBMITTED FOR REVIEW
DOES IT REQUIRE A SPECIAL FORK? A'SELF-INSPECTION REPORT FOR LAND DISTURBING ACTIVITY AS REOURED BY NCGS 1134SL1' E AVAILABLE
FOR USE IT CAN BE COMPLETED BY NAA OR COMPLETED AS AN EXCEL SPREADSHEET AN ALTERNATIVE IS TO MAKE NOTATIONS ON THE COPY OF
THE APPROVED EROSION AND SEDIMENTATION CONTROL PLAN THAT IS KEPT ON THE PROJECT SEE. RUAE 1SA NCAC 0TH 0131 STATES THAT'
DOCUMENTATION SHALL BE ACCOMPLISHED BY INITIALING AND DATING EACH MEASURE OR PRACTICE SHOWN ON A COW OF THE APPROVED
EROSION AND SEDIMENTATION CONTROL RAN OR SY COMPLETING. DATING AND SIGNING AN INSPECTION REPORT THAT LISTS EACH MEASURE,
PRACTICE OR DEVICE SHOWN ON THE APPROVED EROSION AND SEDIMENTATION CONTROL PLAL'
CAN I .UST USE THE NPDES SEF41ONRORI G REPORT? THE NPDES SEF41ONITORING REPORT MAY ONLY BE USED TO REPORT THAT THE
MAINTENANCE AND REPAIR REQUIREMENTS FOR ALL TEMPORARY AND PERMANENT EROSION AND SEDIMENTATION CONTROL MEASLES.
PRACTICES AND DEVICES HAVE BEEN PERFORMED
WHEN DO TEE INSPECTIONS HAVE TO BE DONE? UNLIKE THE NPOES SBWONTORING REPORT, THE SEFANS'EC710N REPORT FOR
LAIDNNSTU RSING ACTIVITY DOES NOT RAVE TO BE WEEKLY RATHER THIS T OF
ON BLED A CO RAN S C MDT
INSTALLATION OF PERIMETER EROSION AND SEDIMENT CONRtOL MEASURES,
CLEARING AND GRUBBING OF EXISTING GROUND COVER,
COMPLETION OF ANY PHASE OF GRADING OF SLOPES OR FELLS,
INSTALLATION OF STORM DRAINAGE FACILITIES,
COMPLETION OF CONSTRUCTION OR DEVELOPMENT,
ESTABLISHMENT OF PERMANENT GROUND COVER UffEE NTTO RESTRAIN EROSION
WHERE DO I MAIL THE RETORT? DO NOT MAR. THE REPORT THE RECORDS MUST BE MADE AVAA AN F TO THE EROSION CONTROL INSPECTOR AT
THE SITE ANY DOCUMENTATION OF INSPECTIONS THAT OCCUR ON A COPY OF THE APPROVED EROSION AND SEDIMENTATION CONTROL PLAN
BALL OCCUR ON A SINGLE COW OF THE RAN AND THAT RAN SHALL BE MADE AVAILABLE ON THE SM ANY INSPECTION REPORTS SHALL ALM
BE WADE AVAILABLE ON THE SITE.
SELF INSPECTION FORMS
NAME OF INSPECTOR AFFILIATIOgr-'
nw+oow'm gNwoNlr IESVOraelE vunr OR �q
slumfulit: DATE.
N+aOUtmL wVNgN�r IESPOrF.6lE wm ORKfll1)
PHASE OF APPROVED EROSION AND SEDIMENTATION CONTROL PLAN.
MARK (()
INSTALLATION OF PERIMETER EROSION AND SEDIMENT CONTROL S
CLEARING AND GRUBBING OF EXISTING GROUND COYER
COMPLETION OF ANY PHASE OF GRADING OR SLOPES FOR FILLS
INSTALLATION OF STORM DRAINAGE FACILITIES
COMPLETION OF CONSTRUCTION ORDEVELOPMENT
EST SM/ENi OF GROUND COYER SUFFICIENT TO RESTRAIN EROSION
EROSION AND SEDIMENTATION CONTROL MEASURE INSPECTED
NAME?AAISM
LOCATION OF
MEASURE �R,,LLgqTALL
MEASURESbN PLAL4
MEASURESNSTALIEDSNDELAS
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MEASURE
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PROPS LY
(YESNO)
SIGNIFIGWT
DEVIATION
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DESCRIBE CORRECTIVE
ACTIONS NEEDED'
PROPOSED
DIMENSIONS
ACTU L
DIMENSIONS
GROUNDCOVELON
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LOCAn
DATEPHASEOF
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RESTRAIN
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PERMANENT GROUND COVER (BY LOCAT10M
DATE
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LOCATION OF
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ACTIONS TAKEN
RESTORE
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SEDIMENTATION DAMAGE
DATE ACTION TAKEN
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36" 20' 26"
36" 20'20"
Soil Map —Ashe County, North Carolina
Map Scale: 1:1,830 if printed on A size (6.5" x 11") sheet
N Meters N
p 0 25 50 100 150 m
Feet
0 100 200 400 600
USDA Natural Resources
Conservation Service
Web Soil Survey
National Cooperative Soil Survey
7/2/2012
Page 1 of 3
36" 20' 26"
36'21Y 20"
Soil Map -Ashe County, North Carolina
Map Unit Legend
Ashe County, North Carolina (NC009)
Map Unit Symbol
Map Unit Name
Acres in AOI
Percent of AOI
CaF
Chandler loam, 25 to 65 percent slopes
5.8
39.3%
FnE
Fannin loam, 15 to 25 percent slopes
0.4
2.7%
W
Water
1.7
11.7%
WaF
Watauga loam, 25 to 45 percent slopes
6.9
46.2%
Totals for Area of Interest
14.8
100.0%
Natural Resources Web Soil Survey 7/2!2012
Conservation Service National Cooperative Soil Survey Page 3 of 3