20020288 Ver 1_COMPLETE FILE_20020227

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Michael F. Easley
Governor
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D., Acting Director
Division of Water Quality
March 1, 2002
DWQ# 02-0288
Edgecombe County
Town of Pinetops
C/o Charles Joyner
P.O. Drawer 49
Farmville, NC, 27858
APPROVAL of 401 Water Quality Certification and Tar-Pamlico River Buffer Rules
Dear Mr. Joyner:
You have our approval, in accordance with the attached conditions, to construct the Town of Pinetops 1999
Sanitary Sewer Improvements project in Edgecombe County, as described in your application received by the Division of
Water Quality on February 27, 2002. After reviewing your application, we have determined that this fill is covered by
General Water Quality Certification Number 3288, which can be downloaded from our web site at
http://h2o.enr.state.nc.us/ncwetlands . This Certification allows you to use Nationwide Permit Number 12 when it is issued
by the U.S. Army Corps of Engineers. This approval is also valid for the Tar-Pamlico River Buffer Rules (15A NCAC 2B
.0259). In addition, you should get any other federal, state or local permits before you go ahead with your project including
(but not limited to) Sediment and Erosion Control, Non-Discharge and Water Supply Watershed regulations. Also this
approval will expire when the accompanying 404 permit expires unless otherwise specified in the General Certification.
This approval is only valid for the purpose and design that you described in your application. If you change your
project, you must notify us in writing and you may be required to send us a new application for a new certification. If the
property is sold, the new owner must be given a copy of the Certification and approval letter and is thereby responsible for
complying with all conditions. If total wetland fills for this project (now or in the future) exceed one acre, compensatory
mitigation may be required. as described in 15A NCAC 2H .0506 (h). For this approval to be valid, you must follow the
conditions listed in the attached certification.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must
act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition conforming to Chapter
150B of the North Carolina General Statutes to the Office of Administrative Hearings, P.O. Box 27447, Raleigh, N.C. 27611-
7447. This certification and its conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If you
have any questions, please telephone Tom Steffens or Deborah Sawyer in our Washington Regional Office at 252-946-
6481 or Cyndi Karoly at 919-733-9721.
Sincerely,
Gregory J. Thorpe, Ph.D.
Attachments /
cc: Corps of Engineers Washington Regulatory Field Office
Washington DWQ Regional Office
Central Files
File Copy
Charles Joyner, 120 N. Main St., Farmville, NC, 27828
020288
North Carolina Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree BI,oJ., Raleigh, NC 27604-2250 (Location)
r..., ,,. .YOC --% - -roo cones 1-, ..., -- ..._.... - ?,..._ -.-'-- I
INC.
?i
McDAVIDAssoCUTES, INC.
Engineers • Planners • Land Surveyors
CORPORATE OFFICE
[phone] • Fax [phone]
120 N. Main Street • P.O. Drawer 49
Fumville, NC 27828
GOLDSBORO OFFICE
[phone] • Fax [phone]
109 E. Walnut Street • P.O. Box 1776
-e Goldsboro, NC 27533
February 13, 2002
NC Department of Environment and Natural Resources F???
Division of Water Quality! F'
P.O. Box 29535 !
Raleigh, NC 27626
Attn: John Dorney
SUBJECT: Nationwide Permit Request
Town of Pinetops 1999
Sanitary Sewer Improvements
Dear Mr. Dorney:
In reference to the subject project, please find enclosed seven (7) copies of the following:
1
2
3
4
5
6
US Quad Map showing location of crossing perennial stream.
Soil Map of Area.
8" x 11" Creek Crossing from Plan Drawing/Plan Sheets 7,27,28 and 29.
Standard Drawing (SD 0032520) for creek crossing.
Copies of signed permit form.
Copy of letter to US Army Corps of Engineers.
ECEIVE.D
UALITY SECTION
F E B 1 9 2002
The project consist of f 17,600 linear feet of sanitary sewer r lace n , um
14,000 linear foot of 6" force main. All sanitary sewer lines, force l i 0VfeI AW&g RNG
within DOT right-of-way, Town of Pinetops right-of-way or acquired easements. We are not aware
of any wetlands that will be affected by this project.
Please find enclosed McDavid Check No. 15708 in the amount of $200.00 for Nationwide
DEM 401 Permit. Request DEM 401 Permit or permit waiver at your earliest convenience.
Sincerely,
McDA,VIIDD ASS CIATEESS, INC.
Charles A. J ner, Jr., P.E.
Farmville Office
CAJ:bbr
Enclosures
D405CAJ02 1 4:50pm
PINETOPS-99-SSI-NATIONWIDE-PERM-NCDENR.LTR;2 020213
McDAVIDAssoCUTES, INC.
4
I INC. Engineers - Planners - Land Surveyors
CORPORATE OFFICE GOLDSBORO OFFICE
[phone] - Fax [phone] [phone] - Fax [phone]
110 N. Main Street - P.O. Drawer 49 109 E. Walnut Street - P.O. Box 1776
Farmville, NC 27828 Goldsboro, NC 27533
a
February 13, 2002
Raleigh Regulatory Field Office
US Army Corps of Engineers
6508 Falls of the Neuse Road
Suite 120
Raleigh, NC 27615
SUBJECT: Nationwide Permit Request
Town of Pinetops 1999
Sanitary Sewer Improvements
Dear Sir:
In reference to the subject project, please find enclosed the following:
US Quad Map showing location of crossing perennial stream.
2. Soil Map of Area
3. 8" x 11" Creek Crossing from Plan Drawing/Plan Sheet 7,27,28 and 29.
4. Standard Drawing (SD 0032520) for Creek Crossing.
5. Copies of signed permit form.
The project consist of t 17,600 linear feet of sanitary sewer replacement, pump station and
14,000 linear foot of 6" force main. All sanitary sewer line, force main, etc. will be constructed
within DOT right-of-way, Town of Pinetops right-of-way or acquired easements. We are not aware
of any wetlands that will be affected by this project.
Request nationwide permit or permit waiver at your earliest convenience.
If you have any questions or need additional information please call me.
Sincerely,
McDAVID ASSOCIATES, INC.
Charles A. Joyner, Jr., P.E.
Farmville Office
CAJ:bbr
Enclosures
D405CAJ02
PINETOPS-99-SSI-NATIONWIDE-PERMrr-REQ. LTR;2
VVATFRE CEIVFD
R QUALITY SECTION
F F 0 19 2002
NON-DISCHARGE PERMITTING
4:40pm
020213

oF?
QG
Pre-Construction Notification (PCB Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers
Nationwide, Regional or General permits as ' (USAGE) requi Section 10 of the Rivers and Harbors Act, and red by for North Carolina the Section
404 of Div Clean
of Water Act and/or
prow reassociated General 401 Water Quality Certifications. This form is also to be used QfOarm s
g approval under any ?l?an Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 permit or Individual 401
Wad Qty Certification. The USAGE Individual Permit application foam is available online at
:
www.saw.usace.ammv miUwetlands/Perm = htm
The USACE is the lead regulatory agency. To review the
Regional or General requirements for the use of Nationwide,
permits, and to determine which permit applies to your project, please go to the
USACE website at httn://www.saw.usace.armmy. n wetlands/regtour htnm, or contact one of the field
offices listed at the end of this apphcahon. The website also lists the responsible project manager for
each county in North Carolina and provides additional information regarding the. identification and
regulation of wetlands and waters of the U.S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit
Applicants are ? has been determined by the USAGE.
encouraged to visit DWQ's 401/Wetlands Unit website at
WE [120.enr.s1ate nc us/ncwetlands to read about current
ficati on ? requirements for the 401 Water Quality
gram and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for some General Certifications is not required,
provided that the applicant adheres to all conditions of the GC. Applicants lacldng access to the internet
should contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is also required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on the last page of this application).
Page 1 of 12
CAMA Coordination - If the project occurs in any of North Carolina's twenty coastal counties (listed on
the last page of this application) the applicant should also contact the North Carolina Division of Coastal
Management (DCM) at [phone]. DCM will determine whether or not the project involves a
designated Area of Environmental Concern, in which case DCM will act as the lead permitting agency.
In such cases, DCM will require a Coastal Area Management Act (CAMA) Permit and will coordinate
the 404/401 Permits.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms '
photos, etc. to the applicable USACE Regulatory Field Office (addresses are listed at the end of this
application). Upon receipt of an application, the USACE will determine if the application is complete as
soon as possible, not to exceed 30 days. This PCN form is designed for the convenience of the applicant
to address information needs for all USACE Nationwide, Regional or General permits, as well as
information
required for State authorizations, certifications, and coordination. Fully providing the
information requested on this form will result in a complete application for any of the USACE
Nationwide, Regional or General permits. To review the minimum amount of information that must be
provided for a complete PCN for each USACE Nationwide permit, see Condition 13, 65 Fed.Reg. 12893
(March 9, 2000), available at bW://www.saw.usace.army.mil/wetiands/nvvpfin alFedRea ud£
Processing times vary by permit and begin once the application has been determined to be complete.
Please contact the appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional- Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at http://h2o-ehnr.state.nc.us/ncwedaiids/fees.htnil. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 12
Office Use Only:
USACE Action ID No.
No.
Form Version April 2001
If any Particular item is not applicable to this project, please enter
leaving the space blank. "Not Applicable" or 'N/A" rather than
L Processing
1 • Check all of the approval(s) requested for this project:
® Section 404 Permit
Section 10 Permit
401 Water Quality Certification
® Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s)
Requested: General
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ? N/A
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: N/A
II• Applicant Information
1 • Owner/Applicant Information
Name: Town of Pinetol3s
Mailing Address:
Telephone Number. Fax Number:
E-mail Address:
2. Agent 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: Charles A. Joyner, Jr., P.E.
COmpanyAffiliation: McDavid Associates, Inc.
Mailing Address: P.O. Drawer 49
Farmville, NC 27858
Telephone Number: 52-7 5 - 1 39 Fax Number:__ 252-753-2139
E-mail Address:
Page 3 of 12
M. 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 surr-ounding and site plan must include a scale and north arrow. The properties.
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 MRCS 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
USACE requires information to be submitted on sheets no lar er than 11 purposes, the
however, DW ma g by 17-inch format;
Q Y 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: Town of Pineto s 1999 Sanitar Sewer Improvements
2. T.I.P. Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): N/A
4. Location
County;- Edgecombe Nearest Town:- Pinetops
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): See attached sheet
5. Site coordinates, if available (UTM or Lat/Long): see a t t c h e .g o e .
(Note - If prglect 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• Describe the existing land use or condition of the site at the time of this application:
Residential
7. Property size (acres)- approximately -9 acres of land will b uqe th rn gh out
8. Nearest body of water (strearnhiver/sound/ocean/lake): entire pro e c t .
Town Creek
9. River Basin: Tar-Pamlico River Basin
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at httn://h2o.enr.state nc us/admin/mans/.)
Page 4 of 12
10. Describe the purpose of the proposed work. re lace o
Pump station modificatin an nes
ores mar.,
-------------
11. List the type of equipment to be used to construct the project: Ra h n P _ r a n P ?, P r
truck hea ?k
12. Describe the land use in the vicinity of this project: r e s i n r . i _ Fa rm i „
IV. Prior Project History
If jurisdictional determinations and/or permits have been
requested P%l? (including all prior phases of the same subdivision) in thd and/or obtained for this
Pte, 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 infmmation. 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 additional permit requests anticipated for this project in the firture? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the mmient
application: None
VL 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
acts to
wetlands, open water, and stream channels associated with the map all imp
Provide justification for these project. The applicant must also
and tem impacts in Section VII below. All proposed impacts, permanent
porary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and
delineation map, whether or not impacts are perennial) must be shown on a
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.
Page 5 of 12
I. Wetland Impacts N/A
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***

* List each impact se parately and irlenfP t .
- - ------- -'- -- •°v °•••Y"••••+ ••°Y°V " 1,,,FaL L3 jinauuu, out are nor umtted to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately lis t 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 Servic a Centerat 1800-358*16, or
online at http://www.fenia.gov.
* * * List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property:
Total area of wetland impact proposed:
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
indicate on ma
1
Type of Impact*

Casing & Length of
Impact
linear feet
Stream Name**

UT_ to Tmm C Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)

Perennial
2 orI?ectional k re 20 U to Mill e 10 Perennial
3 orrec otla?s
Ing
r 15

UT to Mill Creek

10

Perennial
4 orDirection2 B re 20 UT to Mill Creek 20 Perennial

List each impact separately onri .A-+, F.,
--r--•-•+ -•-» •»-••?••? -11.FV1 a1 y 11'" s. impacts include, out are not limited to: culverts and associated rip•taA
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
www.u •nc.gov. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.topozon . gym.
www.ma2quest.com etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 90
Page 6 of 12
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S. N/A
Open Water Impact Area of
Site Number Type of Impact* Im act Name of Waterbody Type of Waterbody
indicate on ma P (lake, t pond, estuary, sound,
acres) (if applicable)
VII.
SAIAPM A soparaury ana identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation N/A
If construction of a pond is proposed, associated Wetland and stream impacts should be
ibencluded above' in the wetland and stream impact sections. Also, the proposed pond should
described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply); ? uplands
Describe the method of construction dam/embankment' excavation, ? ?'?'etlands
draw-down valve or spillway, etc.): (e.g., installation of
local s Proposed uset or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
requirement, etc.):
Size of watershed draining to pond:
Expected pond surface area;
Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It ma be useful to
information related to site 3' provide
constraints such as topography, building ordinances, accessibili and
financial viability of the project. The applicant may attach dra ty'
wings 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 devel
techniques to be followed during construction to reduce impact applicable, discuss construction
1. Measures are b bores, directional bore, rip raps excelsior matting, silk
fence.
2. crossing over culvert, rip rap, excelsior matting, Silk fence
Page 7 of 12
VIII. Mitigation
D WQ - 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, nitigation 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
mitigation as proposed. Examples of mitigation that may be practicable
but are not limited to: reducing the size of the appropriate and practicable include,
project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as
aquatic resource functions and values b : and replacing losses of
functions and values, preferable in the same waters. restoring or preserving similar
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 aph lic rd
lacking a required mitigation plan or NCWRp concurrence shall be placed on old 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, htt?J/h2o•enr.state.nc.us/ncwed ids/shmaide html. available at
1. Provide a brief description of the proposed mitt
as much information as gation plan. The description should provide
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 vie,
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.
N/A
Page 8 of 12
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wedands Unit if a
NCWRP is available as an option. For additional information rep yment into the
process for the NCWRP, check the NCWRP website at httn://h2o.enr statenon/? o/indePcatiIf
use of the NCWRP is proposed, please check the appropriate box on
the following infmmation: page three and provide
Amount of stream mitigation requested (linear feet): NIA
Amount of buffer mitigation requested (square feet). N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
M Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (fedemystateAocal)
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 (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and
required state and local buffers associated with the Pall impacts to
project, The applicant must also pro
vide
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
Water Supply Buffer Requirements), or other (please identify_? Rules and
Yes ? No ? If you answered "yes", provide the following information:
Page 9 of 12
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buff
er
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
s uare feet Multiplier Required
1 Mitigation
3
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proed of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement Prel servationtior
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XL Stormwater (DWQ Only)
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.
X1 Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-dis
wastewater generated from the . charge or discharge) of
proposed project, or available capacity of the subject facility.
XH. Violations (DWQ Only)
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 ?
Page 10 of 12
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).
r?•
-Mavor Town of Pine
a ; ....... ......
Z
Applicant(Agenfs Signature Date
(Agents signature is valid only if an authorisation letter from the applicant is provided,)
US Army Corps. Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell
US Army Corps of Engineers Avery Clay Jackson Polk
151 Patton Avenue Buncombe Cleveland Lincoln Rowan
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabarrus Graham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes
6508 Falls of the Neuse Road Ashe Franklin Nash Suny
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] ' Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax [phone] Cumberland New Hanover Scotland
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 11 of 12

US F
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
ish and Wildlife Service / National A
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
Zarine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivers Island
Beaufort, NC 28516
Telephone: [phone]
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 276994617
Telephone: [phone]
Fax: [phone]
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Westem Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kemersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
Page 12 of 12
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0 Mapped, edited, and published by the Geological Survey 2 Pdaury highway, .5 0 of USGS NOS OAA. and North Carolina Geodetic Survey ,N~ ? IaIDMFtEAS m0v Fwxd eur~oe....... Y highway. UlgM duty road. hard or
EpP , Conn by I= y lem $ Topography by PhotogrammeLTk methods from aerial photographs cN i 6 0 - I Secondary highway.
taken 1977. Rdd clrecited 1978. Map edited 1980 &b+ highway. mum Unbnp mved row - - - =-=__.=A--
T I• North Carolina ornrdirlafe 1090 0 1000 t000 800r t000 MMES 5008 60W -ice 8880 bard ) surface nterstate RDtRe ProKK1 war and 10p0046A grid ticks N 12U-4 Mr. 1•34 1 lEn:rastate Il Otft U. S. Rode 0 State Route
system (Lambert coafor"tonic) AILS a'sy,' r uri_Lf Y SECTION
100&4nder Universal Transverse Mercator grid, zone 18 CONTOUR 1NIERVA4 2 METERS NATIONAL GEODETIC VERTICAL DATUM OF 1929 N. k • f N
1927 North Amerkan Didrmr To pince on dw predicted North American Datum 1983 co t1 ATION6 NS SHOWN SHOWN TO ro THE nic NEAR M o.r M¢rFS on" jt 1TF.yATpNE5r' 1.5 lEM PINETOPS, N. C. SWJ4 TNUM31 1 15 QUMRhKW 199 2002
moue the projection lines 12 meters south and UTM GM AM 1980 IMAUWnC NORTH 4JAGRA4GLE L(r.?TIOt, NSM-W7737.5(7.5
26 meten vat as Awvm by dashed oxner ticks DECLNATM AT CENUM OF SHM 71-115 MAP COM9'i.IPS Rfiitl NATIONAL MAP ACCURACY STANDARDS F red hed line hrdicate selected fence and field lines wirers OR SALE RY U. S. GEOLOGICAL SURVEY. RESTOK VIRGINIA 22092 CONTOURS AND ELEVATIONS 1"o
ins des F reRY via bie on aerial P aPw. Thin ktormation is unchecked A FOI.DEA pESCRUM111UPOGRAPHIC MAPS AND SYMBOLS IS AVARAKE ON RE4Il1EST IN METERS
8~2 NON-DISCHARGE PERMITTING DmA w5 SW-SERBS V