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HomeMy WebLinkAbout20080439 Ver 1_Application_200803114 ~.~~ ~r`~~ e.,+ Surf o ~~/~f~, . «...., STATE of NORTH CAROLINA r~'~'Q~ery DEPARTMENT OF TRANSPORTATION MICHAEL F. EASLEY LYNDO TIPPETT GOVERNOR SECRETARY March 4, 2008 N.C. Division of Water Quality Transportation Permitting Unit O Q O 2321 Crabtree Blvd./Suite 250 Q Raleigh, NC 27604-2260 Attention: Mr. Rob Riding, NCDOT Project Coordinator Subject: Proposed repair to a failed fill slope adjacent to an UT to Buffalo Creek along SR 1401 (Tollie Weldon Road) in Franklin County. WBS element 5.203511. The North Carolina Department of Transportation (NCDOT) proposes to repair the failing fill slope adjacent to an UT to Buffalo Creek along SR 1401 (Tollie Weldon Road) in Franklin County (Figure 1 - 3). Information concerning this activity is provided below: Impacts to Waters of the United States The project involves a Rerennial stream, UT to Buffalo Creek, [NCDENR-DWQ Index No. 28-78-10, Best Usage Classification C, NSW; HUC 03020101) in the Tar Pamlico River Basin. Please note that existing conditions include a failing fill slope, guard rail section that has not footing, highly eroding east bank of stream all which are resulting in a problem for maintaining safe travel along SR 1401 (Tollie Weldon Road). In order to repair the failing fill slope, Class II rip rap will be placed along the east bank of the stream. It will be necessary to temporarily dewater the stream at this site for approximately 1 day by placing sandbags in the creek upstream of the proposed activity and pumping water around to re-enter the creek downstream of construction. Due to the location of the existing channel (within the transportation facility) the stream channel will be shifted away from the roadway fill section as apart of this fill slope repair. This proposed channel change as well as shifting the guardrail towards the highway aft will allow space enough for the rip rap on a 2:1 slope to provide long term stability of the stream bank and roadway fill slope. Permanent surface water impacts associated with this work include Oft of stream loss due to the channel shift and 75ft of rip rap armoring for stabilization. Temporary surface water impacts will be 80ft of'dewatering which overlaps/includes the area of proposed permanent impacts. Although the soil survey maps this area as having hydric soils, no wetlands exist within the project footprint and therefore no wetland impacts are proposed. Division 5, 2612 N. Duke Street, Durham, NC 27704 Phone: (919) 220-4600 Fax: (919) 560-3371 w 2 Riparian Buffer The maintenance at this site involves a stream that is subject to the Tar-Pamlico River Buffer Rules. This perennial unnamed tributary to Buffalo Creek is depicted on the most recent version of the Ingleside (USGS 1979) topographic quadrangle (Figure 1) and the Soil Survey of Franklin County (USDA-SCS, 2004) (Figure 2). Construction impacts at this site will not involve riparian buffer impacts since all work to be done is within the existing transportation facility (ETF). Waters of the U.S. Mitigation Avoidance:. All wetlands and surface waters not affected by the project will be protected from unnecessary encroachment. No staging of construction equipment or storage of construction supplies will be allowed in wetlands or near surface waters. Minimization: The side slopes have been steepened to the extent possible at jurisdictional sites. Strict enforcement of sedimentation and erosion control Best Management Practices for the protection of wetlands and surface waters will be enforced during project construction. Continued coordination will occur with maintenance forces and the Environmental Officer during construction to minimize impacts to these sites. Compensatory Miti atg ion: Compensatory mitigation is not anticipated or proposed for this project. Protected Species PIants and animals with federal classifications of Endangered, Threatened, Proposed Endangered and Proposed Threatened are protected under provisions of Section 7 and Section 9 of the ESA. As of March 2008, there are three federally protected species listed for Franklin County. They include dwarf wedgemussel (Alasmidonta heterodon), Tar spinymussel (Elliptio steinstansana), and Michaux's sumac (Rhus michauxii). The roadway shoulders along Tollie Weldon Road and adjacent power line right-of--way are heavily maintained, eliminating the possibility for Michaux's sumac to exist in this area. This perennial stream is small and within the headwaters of its system, and does not provide suitable habitat for mussel fauna. Additionally, a review of the Natural Heritage Program database (last updated February 2008) revealed no occurrences of protected species within the project area. Based on lack of suitable habitat observed during the 02/27/08 site visit and the NHP database review, biological conclusions of No Effect have been rendered for each species. Summary In order to repair the failing fill slope, Class II rip rap will be placed along the east bank of the stream. It will be necessary to temporarily dewater the stream at this site for approximately 1 day. Due to the location of the existing channel (within the transportation facility) the stream channel will be shifted away from the roadway fill section as apart of this fill slope repair. This proposed channel change as well as shifting the guardrail towards the highway aft will allow space enough for the rip rap on a 2:I slope to provide long term stability of the stream bank and roadway fill slope. Permanent surface water impacts associated with this work include SOft of stream loss due to the channel 3 shift and 75ft of rip rap armoring for stabilization. Temporary surface water impacts will be 80ft of dewatering which overlaps/includes the area of proposed permanent impacts. No wetlands exist within the project footprint and therefore no wetland impacts are proposed. Construction impacts at this site will not involve riparian buffer impacts since all work to be done is within the existing transportation facility (ETF). Application is hereby made for a NCDENR-DWQ Section 401 Water Quality Certification (WQC) No. 3627 for above-described activities. An automated payment procedure has been implemented between the NCDOT and NCDWQ. This procedure will enable the Division to apply for the 401 WQC without submitting a check for this permit application. This procedure will provide payment to the NCDWQ by charging the permit application fee of $200.00 directly to the appropriate NCDOT WBS element 5.203511. A pre-construction notification is attached with this request. Per General Condition 27 [Notification provision], the USACE is not copied on this permit request. The proposed activities meet the conditions of the Department of the Army Section 404 Nationwide Permit (NWP) 14 and the proposed impacts do not exceed the 1/10 acre of loss of Waters of the United States. Additionally this project does not involve impacts to a special aquatic site. Therefore we intend to comply with all applicable NWP conditions during construction of this project, working under NWP 14 with no notification required to the USACE. If you have any questions or need additional information, please contact Ms. Heather Montague at (919)220-4632. Sincerely, ~Il~ gcW rka~.-- tlwrll~ J.W. Bowman, P.E. Division Engineer cc: Mr. Steve Winstead, NCDOT District 3 Engineer Mr. Jonathan Tyndall, NCDOT Franklin County Maintenance Engineer Mr. Tim Robbins, NCDOT Roadside Environmental Field Ops Tech ~, - ~ ~ } g ~ ~}a ~ ~ ;;~ fF ~"`~ M , ~ },~ i * .- ~" ~- `~ S ~, ~ ~j~ .~.~, _yp~ ' ,~. d:~ '* '~ i ~/' 't '~+. ~t ~ i YES` 9 r'"'~' ~.a tt ~ ~ J¢~ .yam. f' s 3' ~ k . f l1 ^,~~ ., M.rx ~y ~ ~ ~ Ly ~ 4. ~~ 1 ~ • e ~F ~;~,r; R ~" r `'r! .~ M~ °'' ~, ~ ~ r~ '' ~w " a ~ r~ " " u £ v "~ a ~ Photograph 1. View of failing fill slope, looking North. SR 1401 (Tollie Weldon Road) -Franklin County Photograph 2. View of failing fill slope, looking South from pipe inlet. ~, _,: ~,~ r ,~ ~ . G ~ ! _i'~ } u &~v2 ^. ~ dy ~ M ~ i 7 . . ' ~. 'a ~ st~ tar ~`N ~~ r" 7 ' ~ ~ ~ ~ a .. ~ ~ ,..: .rte ~ ,~ ~ d ~ , ~ ,~ $ , ~ ~ T" ~-~' s~xF. _` ~ e ..~ ~ . 3 r,j~ ~ ~~~ _- 3 ~ ~ :e: ~Pf y~ ~ F ~~. . Pd~ s k ~~ ~~ € ~ ~h' ~~ ,~ vat'^. ,pq,,•,.`~~- „Y.c. .~~1 .. ~ b ~' ~ ~.~{ :~w ~ + v+YF y .. - ~~;r ~ :.F-s~'4a w ..tb- ,. a ¢., ~ ~, {~ s, a ...a'. ~ F ,,*. ~ ~Y ` ~ ~ ~~`~ e~ d~~ a ,~~~ ,fie `~ ~~t ~rG w, ~` ,i, r "~` r'.k~F~'.i p~ "~ ,0 ~'R i~'~,~ ~k '..~.fsi 1,R%J xrt~a`k.,,k. a Qrs. .~'is `. Photograph 2. View of upstream of proposed work, dewatering limits at tree line. SR 1401 (Tollie Weldon Road) -Franklin County Photograph 3. 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I'' ~ r, a ~+a•ti F~ ~'. ~'.. x ;~ 6~~'xc.:_~: w h,t r'6~~P2+ yf,~•`~ Y pp ~ ~. 4 d, z. l 6 yj~. R~L,, t ' ~a~ ad }} k^ '! -.vf ~( ~4- Wre t '~ ~.i \ ~• ~~'. rt ~ ed 1. ~ pia a a Project Study Area SR 1401 Tollie Weldong Roacl Franklin County USDA-SCS (2004) Figure 2 1:24,000 -- s .. - -, - ` a .- ~~ • ~ r ~'s~ Wal3 y~' +Sif;~1 "A" /5~.~ ~ ~ ~~ ~~ ~~ ~ ~B y~ W~ ~!s ~ +.r -f~ ,''-'~ ~, ~,~ f a" tE~ .1~.~ ~~ .. 4 ill .l ,.~ ,/ x. ~ nas:~. '\ ,'r! ~R~ ~!'~~ ~, I' I~ ' I~ A I ~ ,~~ E TF--I----------I----------------~- ~~ POWER LINE ROW l Note: ~~~~ Proposed Class II rip rap ® Proposed Class fill in SW - ETF Existing Transporation Facility _Z Guardrail ~, ~"" Failing fill slope (stream bank) ~ ~ ~.J`.J~.) Woods Line dewotering ~\ ~ limits I ~v ~' "~-~.l A , I,1 1I~ 1c ~- - ~_chGn~el chance ~~~/ ~."1~~7'-- shift guardrail aft 24fit paved roadway width - - - - - - - - - - - - - - - - - ~ vlJf , ,1 ----1--- `~l~ L~~~ T -1""1 --- --___- -`------ shift guardrail 3tt POWER LiN -ETF - - - - - - - - - - - - - - - - - - - - E RO W SR 1401 Tolile Weldon Road E T F -------~------------------------------ ---------------------------- ----------------------------------------------------------------------E TF i /~ ~~Or~ _ / ~~ ~ I SITE I - Construction Plan SR 1401 (Tolile Weldon Road) Franklin County Figure 3 I' = 30' 02/28/08 Office Use Only: •. Fonn Version March OS USACE Action ID No. DWQ No. 2 0 0 8 0 4 3 9 ~~~ any par~icuiar item is not appucaoie 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 ^ Express 401 Water Quality Certification Nationwide, Regional or General Permit Number(s) Requested: NWP 14 (non reporting,) 2. If this notification is solely a courtesy copy because written approval for the 401 Certification is not required, check here: ^ 3. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII, and check here: ^ 4. 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 Owner/Applicant Information Name: NCDOT Division 5, J.W. Bowman Mailing Address: 2612 N. Duke St., Durham NC 27704 Telephone Number: (919) 220-4600 Fax Number: (919) 560-3371 E-mail Address: wbowmanna,dot.state.nc.us 2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter must be attached if the Agent has signatory authority for the owner/applicant.) Name: Company Affiliation: Mailing Address: Telephone Number: Fax Number: E-mail Address: III. Project Information Attach a vicinity map clearly showing the location of the property with respect to local landmarks such as towns, rivers, and roads. Also provide adetailed -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, Page 1 of 8 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 maybe included at the applicant's discretion, so long as the property is clearly defined. For administrative and distribution purposes, the USAGE requires information to be submitted on sheets no larger than 11 by 17-inch format; however, DWQ may accept paperwork of any size. DWQ prefers full-size construction drawings rather than a sequential sheet version of the full-size plans. If full-size plans are reduced to a small scale such that the final version is illegible, the applicant will be informed that the project has been placed on hold until decipherable maps are provided. Name of project red channel change, bank stabilization of the temporary dewatering of an UT to Buffalo Creek adjacent SR 1401 (Tollie Weldon Road) in Franklin County. 2. T.I.P. Project Number or State Project Number (NCDOT Only): WBS # 5.203511 3. Property Identification Number (Tax PIN): 4. Location County: Franklin Nearest Town: Henderson Subdivision name (include phase/lot number): N/A Directions to site (include road numbers/names, landmarks, etc.): From Henderson (at junction with US 1) take Hwy 39 South for approximated 6 6 miles to Epsom. At Epsom on the Vance County/Franklin County line make a left onto SR 1523 (New Bethel Church Road) and travel 0 80 mile and make a right onto SR 1401 (Tollie Weldon Road). Travel proximately 2.6 miles to the project site. 5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that separately lists the coordinates for each crossing of a distinct waterbody.) Decimal Degrees (6 digits minimum): 36.2400 °N 78.2807 °W 6. Property size (acres): 0.14 acre 7. Name of nearest receiving body of water: UT to Buffalo Creek 8. River Basin: Tar-Pamlico (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/maps/.) 9. Describe the existing conditions on the site and general land use in the vicinity of the project at the time of this application: Site is surrounded by wooded land and agriculture land. i 0. Describe the overall project in detail, including the type of equipment to be used: The NCDOT proposes to repair the failing fill slope adiacerrt to an UT to Buffalo Creek. Class II Page 2 of 8 rip rap will be placed along the east bank of the stream It will be necessary to teinporari(y dewater the stream at this site by placing sandbags in the creek upstream of the proposed activity and pumping water around to re-enter the creek downstream of construction Due to the location of the existing channel (within the transportation facility) the stream channel will be shifted away from the roadway fill section as apart of this fill slope repair Equipment may include excavator, backhoe, bulldozer, grader and crane. l 1. Explain the purpose of the proposed work: The proposed work is needed to repair the failing fill slope and will provide stream bank stability while also facilitating a stronger footing for the guardrail section along the roadway. 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. N/A 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. N/A 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. Each impact must be listed separately in the tables below (e.g., culvert installation should be listed separately from riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts, permanent and temporary, must be listed, and must be labeled and clearly identifiable on an accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial) should 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 descnbe the impact in Section VIII below. If additional space is needed for listing or description, please attach a separate sheet. 1. Provide a written description of the proposed impacts: The NCDOT proposes to repair the failin fg ill slope adiacent to an UT to Buffalo Creek Class II rip rap will be placed along the east bank of the stream It will be necessary to temporarily dewater the stream at this site b~placing sandbags in the creek upstream of the proposed activity and pumping water around to re-enter the creek downstream of construction. Due to the location of the Page 3 of 3 existing channel (within the transportation facility) the stream channel will be shifted away from the roadway fill section as apart of this fill slope repair 2. Individually list wetland impacts. Types of impacts include, but are not limited to mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding. Wetland Im act P Type of Wetland Located within Distance to Area of Site Number Type of Impact (e.g., forested, marsh, 100-year Nearest Impact (indicate on map) herbaceous, bog, etc.) Flood lain p Stream (acres) (yes/no) (linear feet) NlA Total Wetland Impact (acres) N/A 3. List the total acreage (estimated) of all existing wetlands on the property: N/A 4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib walls, 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. To calculate acreage, multiply length X width, then divide by 43,560. Stream Impact Perennial Average Stream Impact Area of Number Stream Name Type of Impact or Width Before Length Impact (indicate on map) Intermittent Impact (linear feet) (acres) Site 1 Ut to Buffalo Crk Fill for channel change Perennial 3 ft 50 0.003 concurrent concurrent Temporary dewatering 80 0.005 Rip rap for stabilization 75 0.005 concurrent concurrent Total Stream Impact (by length and acreage) 80 0.005 ~. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic Ocean and any -other water of the U.S.). Open water impacts include, but are not limited to fill, excavation, dredging, flooding, drainage, bulkheads, etc. Open Water Impact Site Number (indicate on map) Name of Waterbody (if applicable) Type of Impact Type of Waterbody (lake, pond, estuary, sound, bay, ocean, etc.) Area of Impact (acres) N/A Total Open Water Impact (acres) N/A Page 4 of 8 6. List the cumulative impact to all Waters of the U.S. resulting from the project: Stream Impact (acres): 0.005 Wetland Impact (acres): NONE Open Water Impact (acres): NONE Total Impact to Waters of the U.S. (acres) 0.005 Total Stream Impact (linear feet): 80 7. Isolated Waters Do any isolated waters exist on the property? ^ Yes ®No Describe all impacts to isolated waters, and include the type of water (wetland or stream) and the size of the proposed impact (acres or linear feet). Please note that this section only applies to waters that have specifically been determined to be isolated by the USACE. 8. 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.): N/A Current land use in the vicinity of the pond: N/A 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. All wetlands and surface waters not affected by construction will be protected from unnecessary encroachment during construction. Strict enforcement of Best Management Practices for the protection of wetlands and surface waters will be enforced during construction Only the smallest amount of till necessary to complete the project will be placed in waters of the United States VIII. Mitigation DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC Division of Water Quality for projects involving greater than or equal to one acre of impacts to Page 5 of 8 treshwater wetlands or,. greater than or equal to 150 linear feet of total impacts to perennial streams. USAGE - In accordance with the Final Notice of Issuance and Modification of Nationwide Permits, published in the Federal Register on January 15, 2002, 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 USAGE or DWQ to consider the application complete for processing. Any application lacking a required mitigation plan or NCEEP 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/ncwetlandslstnn~;ide html. 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. Comnensatory mitiuation is not anticipated or proposed for this project 2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at (919) 715-0476 to determine availability, and written approval from the NCEEP indicating that they are will to accept payment for the mitigation must be attached to this form. For additional information regarding the application process for the NCEEP, check the NCEEP website at http://h2o.enr.state.nc us/wrp/index htm. If use of the NCEEP is proposed, please check the appropriate box on page five and provide the following information: Amount of stream mitigation requested (linear feet): N/A Amount of buffer mitigation requested (square feet): N/A Amount of Riparian wetland mitigation requested (acres): N/A Amount ofNon-riparian wetland mitigation requested (acres): N/A Amount of Coastal wetland mitigation requested (acres): N/A Page 6 of 8 IX. Environmental Documentation (required by DWQ) .. 1. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land? Yes ® No ^ 2. 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 (919) 733-5083 to review current thresholds for environmental documentation. Yes ^ No 3. 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. 1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233 (Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC 2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please identify )? Yes ® No ^ 2. If "yes", 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. Impact Required Zone* Multiplier ( uare f et) Miti ation 1 0 3 (2 for Catawba) None /in ETF all wor 2 0 1.5 None all wo w/i TF Total 0 None * Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone2 extends an additional 20 feet from the edge of Zone L 3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation of Property, Riparian Buffer Restoration / Enhancemerrt, or Payment into the Riparian Buffer Restoration Fund). Please_ attach all appropriate information as identified within 15A NCAC 2B .0242 or .0244, or .0260. N/A Page 7 of 8 XI... Stormwater (required by DWQ) Describe impervious acreage (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. If percent impervious surface exceeds 20%, please provide calculations demonstrating total proposed impervious level. No additional impervious surface is proposed at the project. 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. This protect will not generate wastewater. XIII. Violations (required by DWQ) Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules? Yes ^ No Is this an after-the-fact permit application? Yes ^ No XIV. Cumulative Impacts (required by DWQ) Will this project (based on past and reasonably anticipated future impacts) result in additional development, which could impact nearby downstream water quality? Yes ^ No If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with the most recent North Carolina Division of Water Quality policy posted on our website at http://h2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description: The project involves repairinu a fill slope and placement of rip rap along the east bank of this UT to Buffalo Creek with a slight channel change and temporary dewatering of the work site No additional roadway improvements will be associated with this project No additional development will result from this action XV. 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). ~w~~-- . 03~0+{~0 $ 1 Applicant/Agent`s Signature Date (Agent's signature is valid only if an authorization letter from the applicant is provided.) Page 8 of 8