20021428 Ver 1_COMPLETE FILE_20020904

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Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
June 30, 2003
DWQ# 02-1417
Vance County
Mr. Michael Shields
Maria Parham Hospital
566 Ruin Creek Road
Henderson, NC, 27536
APPROVAL of 401 Water Quality Certification and Tar-Pamlico River Buffer Rules with Additional Conditions
Dear Mr. Shields:
You have our approval, in accordance with the attached conditions, to place fill in 0.023 acre of wetlands and 220 linear feet of
intermittent and perennial streams and to impact 17,709 square feet of protected Tar-Pamlico Buffers in order to construct the Maria
Parham Hospital Road Access in Vance County, as described in your application received by the Division of Water Quality on September
4, 2002, and in revised plans received June 24, 2003. After reviewing your application, we have determined that this fill is covered by
General Water Quality Certification Number 3404, 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 14 when 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 Certification replaces the one issued to you on October 25, 2002.
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 as well as the additional conditions
listed below:
1. Deed notifications or similar mechanisms shall be placed on all lots with remaining jurisdictional wetlands and waters or areas within
50 feet of all streams and ponds. These mechanisms shall be put in place within 30 days of the date of this letter or the issuance of
the 404 Permit (whichever is later). A sample deed notification format can be downloaded from the 401Metlands Unit web site at
htto://h2o.enr.state.nc.us/ncwetlands ;
2. The culvert must be designed, constructed and placed to allow aquatic life passage;
3. You are required to return the attached Certification of Completion form to notify DWQ when all work included in the 401 Certification
has been completed.
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 which conforms to Chapter 150B of the North Carolina
General Statutes to the Office of Administrative Hearings, P.O. Box 6714, Raleigh, N.C. 27699-6714. 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 call Debbie Edwards in our Raleigh Regional Office at 919-571-4700 or Cyndi Karoly in the Central Office at 919-733-
9721. Questions regarding stormwater should be directed to Todd St. John at 919-733-9584.
Sincerely,
4_4
?b Alan W. Klimek, P.E.
N. C. Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (http://h2o.enr.state.nc.us/ncwetiands)
Customer Service #: 1-877-623-6748
P*E-MW
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Attachments
cc: Corps of Engineers Raleigh Regulatory Field Office
Raleigh DWQ Regional Office
Central Files
File Copy
Todd Preuninger, 11010 Raven Ridge Road, Raleigh, NC, 27614
021417mod
Environmental Consultants, PA
Road • Raleigh, North Carolina 27614 • Phone: [phone] • Fax: [phone]
Transmittal
To: Cur a'. ko.rO-N"
Dyia,
We Transmit to you Herewith:
?& Drawings
? Specifications
? Brochures or photos
? Correspondence
? As per your request
Project Date: !o y 03
Project Name: ?a?•- ?p?p :?p?
File:
5. For your information and files
For comment or approval
? Returned for correction, resubmit
? Approved as noted
Under Separate Cover:
? By mail
? By courier
? By express
No. Copies Document No. Date Description

vr-; ;.,.>?, JUN 4 20
-V1W cis

Remarks:
Cc %J'o

e «,t„'? -4n
If enclosures are not as listed as above, kindly notify us at once. ^?1..:?"-?•??? •
Y
Charlotte Office:
236 LePhillip Court, Suite C
Concord, NC 28025
Phone: [phone]
Fax: [phone]
Greensboro Office:
3817-E Lawndale Drive
Greensboro, NC 27455
Phone: [phone]
Fax: [phone]
Hickory Office:
622 Coon Mountain Lane
Taylorsville, NC 28681
Phone [phone]
Fax: [phone]
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Mr. Michael Shields
Maria Parham Hospital
566 Ruin Creek Road
Henderson, NC, 27536
October 25, 2002
DWQ# 02-1417
Vance County

APPROVAL of 401 Water Quality Certification and Tar-Pamlico River Buffer Rules with Additional Conditions
Dear Mr. Shields:
You have our approval, in accordance with the attached conditions, to place fill in 0.022 acre of wetlands and 220 linear feet of
intermittent and perennial streams and to impact 17,709 square feet of protected Tar-Pamlico Buffers in order to construct the Maria
Parham Hospital Road Access in Vance County, as described in your application received by the Division of Water Quality on September
4, 2002. After reviewing your application, we have determined that this fill is covered by General Water Quality Certification Number
3375, which can be downloaded from our web site at http://h26.enr.state.nc.us/ncwetiands . This Certification allows you to use
Nationwide Permit Number 14 when 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 pen-nits 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 as well as the additional conditions
listed below:
1. Deed notifications or similar mechanisms shall be placed on all lots with remaining jurisdictional wetlands and waters or areas within
50 feet of all streams and ponds. These mechanisms shall be put in place within 30 days of the date of this letter or the issuance of
the 404 Permit (whichever is later). A sample deed notification format can be downloaded from the 401Metlands Unit web site at
http://h2o.enr.state.ne.us/ncwetiands;
2. The culvert must be designed, constructed and placed to allow aquatic life passage;
3. You are required to return the attached Certification of Completion form to notify DWQ when all work included in the 401 Certification
has been completed.
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 which conforms to Chapter 150B of the North Carolina
General Statutes to the Office of Administrative Hearings, P.O. Box 6714, Raleigh, N.C. 27699-6714. 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 call Debbie Edwards in our Raleigh Regional Office at 919-571-4700 or Cyndi Karoly in the Central Office at 919-733-
9721. Questions regarding stormwater should be directed to Todd St. John at 919-733-9584.
Sincerely,
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone]
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
i
Alan W. Klimek, P.E. Director
Division of Water Quality

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PROJECT "O. "H_ ®
LN1q? PROJECT No. Ip?PH-01000 THE JOHN R. McADAMS MARIA PA?L?? ? HOSPITAL
rnENAME' MPHO1000-WA COMPANY, INC.
a ENGINEERS/PLANNERS/SURVEYORS
= SCALE: '?,?=zoo HENDERSON, VANCE COUNTY, NORTH CAROLINA
RESEARCH TRIANGLE PARIS, NC
`, ROAD t1A1, D IMPACT' MAP P.O. BOX 14005 ZIP 27709-4005
DATE: 08-29-O2 [phone]
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W A TF Michael F. Easley, Governor
`OHO RpG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
r Alan W. Klimek, P.E. Director
.4 Division of Water Quality
O "C
Mr. Michael Shields
Maria Parham Hospital
566 Ruin Creek Road
Henderson, NC, 27536
APPROVAL of 401 Water Quality Certification and Tar-Pamlico River Buffer Rules with Additional Conditions
Dear Mr. Shields:
October 25, 2002
DWQ# 02-1417
Vance County
You have our approval, in accordance with the attached conditions, to place fill in 0.022 acre of wetlands and 220 linear feet of
intermittent and perennial streams and to impact 17,709 square feet of protected Tar-Pamlico Buffers in order to construct the Maria
Parham Hospital Road Access in Vance County, as described in your application received by the Division of Water Quality on September
4, 2002. After reviewing your application, we have determined that this fill is covered by General Water Quality Certification Number
3375, which can be downloaded from our web site at http://h26.enr.state.nc.us/ncwetiands . This Certification allows you to use
Nationwide Permit Number 14 when 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 as well as the additional conditions
listed below:
1. Deed notifications or similar mechanisms shall be placed on all lots with remaining jurisdictional wetlands and waters or areas within
50 feet of all streams and ponds. These mechanisms shall be put in place within 30 days of the date of this letter or the issuance of
the 404 Permit (whichever is later). A sample deed notification format can be downloaded from the 401/Wetlands Unit web site at
htti3://h2o.enr.state.nc.us/ncwetlands ;
2. The culvert must be designed, constructed and placed to allow aquatic life passage;
3. You are required to return the attached Certification of Completion form to notify DWQ when all work included in the 401 Certification
has been completed.
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 which conforms to Chapter 150B of the North Carolina
General Statutes to the Office of Administrative Hearings, P.O. Box 6714, Raleigh, N.C. 27699-6714. 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 call Debbie Edwards in our Raleigh Regional Office at 919-571-4700 or Cyndi Karoly in the Central Office at 919-733-
9721. Questions regarding stormwater should be directed to Todd St. John at 919-733-9584.
Sincerely,
i
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone]
ANT 1
f
Customer Service
1 800 623-7748
MEMORANDUM
TO: John Dorney
Non-Discharge Branch
Regional Contact: D bbi dward
WQ Supervisor:
Date:
SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS
Facility Name Maria Parham Hospital County Vance
Project Number 02 1417 County2
Recvd From APP: Region Raleigh
Received Date 9/4/02 Recvd By Region
Project Type road access
Certificates Stream Stream Impacts (ft.)
wlt, Permit Wetland Wetland Wetland Stream Class Acres Feet i -
Type Type Impact Score Index Prim. Supp. Basin Req. Req. F14 Stream O Y -@N I - 28-17-2-(2) F-C _ NSW 30,301. 0.02 220.00 I -
TPBR BuffersO Y ` _0N F-F_F__?-F- 0'41 r F_
F-F-PT _0N r ?--''r
Mitigation Wetland
MitigationType Type Acres Feet
Is Wetland Rating Sheet Attached? 0 Y 0 N Did you request more info? 0 Y 0 N
Have Project Changes/Conditions Been Discussed With Applicant? 0 Y 0 N
Is Mitigation required? 0 Y 0 N
Recommendation:0 Issue 0 Issue/Cond 0 Deny
Provided by Region: Latitude (ddmmss) Longitude (ddmmss)
Comments:
Reaested more info. from consutltant and it was provided. The impact.justifications are sufficiant
and it seems that this is the best crossing for the road,
cc: Regional Office
Central Office Page Number 1

Date: ri - &- y Z
Triage Check List
Project Name: -.?? f)_-A14.11.
DWQ#: 6 z -IL,G
County: VcvA?
TO: ? ARO Mike Parker
? FRO Ken Averitte
? MRO Mike P
its R 0 Steve Mitchell
From: ?To--v^ 4c_--?tv
? WaRO. Deborah Sawyer
? WiRO Joanne Steenhuis
? WSRO Jennifer Frye
Telephone : (919) X33 ?ta4?-l
The file attached is being forwarded to your for your evaluation.
Please call if you need assistance.
? Stream length impacted
tream determination
? Wetland determination and distance to blue-line surface waters on USFW topo maps
? Minimization/avoidance issues
? Buffer Rules (Meuse, Tar-Pamlico, Catawba, Randleman)
? Pond fill _
Mitigation Ratios
? Ditching
? Are the stream and or wetland mitigation sites available and viable?
? Check drawings for accuracy
? Is the application consistent with pre_application meetings?
? Cumulative impact concern
Comments:
Environmental Consultants, PA
Road • Raleigh, North Carolina 27614 • Phone: [phone] • Fax: [phone]
5
NCDENR-DWQ
Attn: Mr. John Dorney
2321 Crabtree Blvd
Parkview Building
Raleigh, NC 27604
US Army Corps of Engineers
Attn: Ms. Amanda Jones
6508 Falls of the Neuse Rd., Ste. 120
Raleigh, NC 27615
RE: Nationwide Permit 14/401 Water Quality Certification & Buffer Compliance
Maria Parham Hospital
Henderson, Vance County, North Carolina
S&EC Project #: 02-7079
Dear Ms. Jones and Mr. Dome
Y,
On behalf of Michael Shields, President of Maria Parham Hospital, we hereby request
authorization from the US Army Corps of Engineers to use Nationwide Permit 14 to
cover impacts to wetlands and stream channels (see attached overall map). We also
request written concurrence from the North Carolina Division of Water Quality that the
project meets the 401 Water Quality Certification for the associated NWP and complies
with the Tar-Pamlico River Basin Buffer Rules. A Pre-construction Notification
Application (PCN) is attached, which includes an agent authorization form.
The proposed project consists of impacts from the construction of an access road that will
connect the hospital to Highway 158 bypass. The proposed road is located on the south
side of Highway 158 bypass and is approximately 1000 feet west of Ruin Creek Road
(SR 1128). The project is approximately 2300 linear feet in length adjacent to the Maria
Parham Hospital in Vance County, NC. Please refer to the attached USGS map, which
displays the location of the proposed project.
S&EC performed a detailed wetland delineation and buffer evaluation within the corridor
of the proposed road on August 5, 2002. On August 27, 2002, S&EC conducted a site
Charlotte Office, Greensboro Office: Hickory Office:
236 LePhillip Court, Suite C 3817-E Lawndale Drive 710 Boston Road
Concord, NC 28025 Greensboro, NC 27455 Taylorsville, NC 28681
Phone: [phone] Phone: [phone] Phone [phone]
Fax: [phone] Fax: [phone] Fax: [phone]
September 4, 2002
lipp - 4 2002
meeting with Ms. Deborah Edwards of the NC-DWQ to confirm our buffer
determination. Ms. Amanda Jones of the USACE made a site visit on August 8, 2002 to
verify our delineation.
Prior to site plan development, the applicant requested a detailed wetland delineation and
buffer evaluation within the corridor in order to avoid jurisdictional wetlands and waters
and riparian buffers to the maximum extent practicable. Impact A of the proposed road
will impact 89 linear feet of unimportant, intermittent channel and 0.007 acres of
wetland. Impact B will impact 131 linear feet of important, perennial channel and 0.015
acres of wetlands. These impacts are elaborated upon within the attached PCN form and
are shown on the attached impact map.
The proposed roadway is necessary to provide proper ingress and egress into the hospital.
Currently the hospital can only be accessed from Ruin Creek Road; however, the
proposed road will provide an additional access point from Highway 158 bypass. The
proposed alignment will impact two jurisdictional stream channels that bisect the
property to the north of the hospital. It is necessary to cross the northernmost channel
(Impact B) in order to gain access to Highway 158 bypass. In order to reduce wetland
impacts, the roadway was aligned to the east as much as possible.
The USACE's current policy requires applicants to avoid and minimize wetland and
stream channel impacts to the maximum extent practicable and compensatory mitigation
to offset unavoidable losses of waters of the US when impacts exceed the requirements
for notification (0.10 acre). The proposed road is necessary to gain accessibility into the
hospital from Highway 158 bypass. Because the streams bisect the property, impacts
were unavoidable. Because the applicant has minimized impacts to the maximum extent
practicable, S&EC believes further compensatory mitigation should not be required by
the USACE.
NC-DWQ's current policy requires written concurrence for stream impacts of greater or
equal to 150 linear feet of stream length per project. We request written concurrence that
the project complies with the 401 Water Quality Certification associated with Nationwide
Permit 14 and that the project meets the requirements for the Tar-Pamlico Buffer rules.
NC-DWQ's current policy does not require wetland or stream mitigation for impacts
below 1 acre of wetlands and 150 linear feet of perennial stream channel per project.
Because the total permanent impacts to important stream channels are less than 150 feet
and cumulative wetland impacts are less than 1 acre, we do not believe that mitigation
should be required by NC-DWQ. Following construction the site will contain
approximately 26% impervious surface, including the existing hospital. Because wetland
impacts are below 0.1 acres and because impervious surface will be less than 30%, we do
not believe that this project requires a pre-approved stormwater plan.
Please call if you require any additional information or have any questions.
Sincerely,
i""A_ Ilp-q
Laura Gadd
Wetland Scientist
Attachments:
Pre-construction (PCN) notification form
USGS Site Vicinity Map
Vance County Soil Survey Map
Overall Impact map & two inset impact maps
Agent Authorization form
7U?G? ??,:cliti ? ?Kdu
Todd Preuninger
Biologist
Office Use Only: Form Version May 2002
USACE Action ID No. DWQ No.
(it any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ® Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
® 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested:
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. 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
1. Owner/Applicant Information
Name: Michael Shields
Mailing Address: Maria Parham Hospital
566 Ruin Creek Road
Henderson NC 27536
Telephone Number: 252-438-4143 Fax Number: 252-438-3690
E-mail Address: shieldsm()a mphosp.org
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: Todd Preuninger
Company Affiliation: Soil & Environmental Consultants Inc.
Mailing Address: 11010 Raven Ridge Road
Raleigh, NC 27614
Telephone Number: 919-846-5900 Fax Number: 919-846-9467
E-mail Address: preuninger(@sandec.com
Page 5 of 13
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 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.
1. Name of project: Maria Parham Hospital Road Access
2. T.I.P. Project Number or State Project Number (NCDOT Only): NA
3. Property Identification Number (Tax PIN): 411-03-44, 411-03-01
4. Location
County: Vance Nearest Town: Henderson
Subdivision name (include phase/lot number): NA
Directions to site (include road numbers, landmarks, etc.): The proposed road is located on
the south side of Highway 158 bypass and is approximately 1000 feet west of Ruin Creek
Road (SR 1128). The project is approximately 2300 linear feet in length adjacent to the
Maria Parham Hospital.
5. Site coordinates, if available (UTM or Lat/Long):Impact 1: 36°20'6.11"N 78°26'57.62"
Impact 2: 36°19'58.17"N 78°27'0.52"W
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): Linear project approximately 2300 feet.
7. Nearest body of water (stream/river/sound/ocean/lake): unnamed tributaries to Ruin 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 httl2:Hh2o.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: Existing conditions on the site consist of the Maria Parham
Page 6 of 13
Hospital and wooded land east of the hospital. There are commercial businesses within the
vicinity of the project.
10. Describe the overall project in detail, including the type of equipment to be used: The
overall project consists of building an access road that will connect the Maria Parham
Hospital to Highway 158 bypass. The proposed road consists of two impacts: Impact A will
permanently impact 89 linear feet of unimportant stream channel and 0.007 acres of
wetlands. Impact B will permanently impact 131 linear feet of important, perennial stream
channel and 0.015 acres of wetlands. Typical heavy equipment associated with road
construction will be used for the project.
11. Explain the purpose of the proposed work: The purpose of the proposed work is to build an
access road from the hospital to Highway 158 bypass in order to provide proper egress and
ingress into the hospital.
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.
Ms. Deborah Edwards of the NC-DWQ completed a site visit on August 27, 2002 and confirmed
the buffers on both channels. Ms. Amanda Jones of the USACE verified the wetland delineation
on August 8, 2002.
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.
None anticipated.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
Page 7 of 13
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Provide a written description of the proposed impacts: Impact A includes 89 linear feet of
intermittent channel and 0.007 acres of wetland. Impact B consists of 131 linear feet of
permanent impacts to an important channel and 0.015 acres of wetland impact.
2. Individually list wetland impacts below:
Wetland Impact Area of Located within Distance to
Site Number Type of Impact* Impact 100-year Floodplain** Nearest Stream Type of Wetland***
indicate on ma acres es/no linear feet
Impact A Permanent/Fill 0.007 No Adjacent Headwater forest
Impact B Permanent/Fill 0.015 No Adjacent Headwater forest
* List each impact separately and identify temporary impacts. 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.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://www.fema.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.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property: NA-Entire
property was not evaluated.
Total area of wetland impact proposed: 0.022 acres
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact Length of Average
Width of Perennial or
Site Number Type of Impact* Impact Stream Name**
Stream Before Intermittent?
(indicate on map) (linear feet)
Impact (please specify)
Impact A Permanent/culvert 89' UT to Ruin Creek +/-3' Intermittent
Impact B Permanent/culvert 131' UT to Ruin Creek +/-3' Perennial
* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usQS.cov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mal2quest.com. etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 131' perennial channel,
89' intermittent channel, Total impacts: 220 linear feet
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Page 8 of 13
Open Water Impact Area of Name Waterbody Type of Waterbody
Site Number Type of Impact* Impact )
( applicable) (lake, pond, estuary, sound,
indicate on ma acres bay, ocean, etc.
NA NA NA NA NA
* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): NA
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc): NA
Size of watershed draining to pond: NA Expected pond surface area: NA
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.
The vrovosed roadwav is necessarv to create additional access to the hospital. Currentlv there is
only a single access point off of Ruin Creek Road: however, the proposed road will provide an
additional access from Highway 158 Bypass. It is necessary to cross both the intermittent and
perennial channel in order to gain access to Highway 58 bypass because of the location of the
channels and the existin buildings. These crossings cannot be avoided because the road must be
routed behind the hospital and around the existing Henderson YMCA to the north of the hospital.
Impact A was aligned partially above the intermittent channel in order to minimize stream
impacts. Impact B crosses east of a large wetland area, minimizing; wetland impacts to the
greatest extent practicable.
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
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 13
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.ne.us/ncwetlands/strmzide.html.
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.
The USACE's current policy requires applicants to avoid and minimize wetland and stream
channel impacts to the maximum extent practicable and compensatory mitigation to offset
unavoidable losses of waters of the US when impacts exceed the requirements for
notification (0.10 acre). The proposed road is necessary to provide greater additional
accessibility to the hospital. Because the applicant has minimized impacts to the maximum
extent practicable, S&EC believes further compensatory mitigation should not be required by
the USACE.
NC-DWG's current policy does not require wetland or stream mitigation for impacts below 1
acre and 150 linear feet per project. Because the total permanent impacts to important stream
channels are less than 150 feet and cumulative wetland impacts are less than 1 acre we do
not believe that mitigation should be required by NC-DWO
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at http://h2o.enr.state.nc.us/wrp/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Page 10 of 13
Amount of stream mitigation requested (linear feet): NA
Amount of buffer mitigation requested (square feet): NA
Amount of Riparian wetland mitigation requested (acres): NA
Amount of Non-riparian wetland mitigation requested (acres): NA
Amount of Coastal wetland mitigation requested (acres): NA
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ? No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ® No ? If you answered "yes", provide the following information:
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.
Page 11 of 13
Impact A
Zone* Impact
(square feet Multiplier Required
Mitigation
1 4,616 3 NA
2 1,583 1.5 NA
Total 7,199 NA
* 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.
Impact B
Zone* Impact
(square feet Multiplier Required
Mitigation
1 7,150 3 NA
2 3,360 1.5 NA
Total 10,510 NA
* 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 proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or .0260.
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Following construction the site will contain ai mroximately 26% impervious surface, including
the existing hospital. Because wetland impacts are below 0.1 acres and because impervious
surface will be less than 30%, we do not believe that this project requires a pre-approved
stormwater plan
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.
NA
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Page 12 of 13
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
NA

(Agent's signature is va i y if an authorization letter from the applicant is provided.)
Page 13 of 13
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PROJECT No. MPH-01000 MARIA PA VI HOSPITAL ®THE JOHN R. McADAMS
0 F1LENAM nENAMEc MPH01000-WA COMPANY, INC.
SCALE: HENDERSON, VANCE COUNTY, NORTH CAROLINA ENGINEERS/PLANNERS/SURVEYORS
1"=200'
ROAD "A" D IMPACT MAP RESEARCH TRIANGLE PARK, -4
(/! P.O. H 14005 ZIP 27709-d005
DATE: 08-29-02 (919) 38 381-5000
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Address: ?lo?c ?Lijr1 t??,,?.? f?jrJ?os?aw, /1/•f of '?home: ( 7-L79 443f-- W5e3

Name/Name/Description: Aze! S 940
Date: & ?v ar .2062,
"^ ^' ;went of the Army
y Corps of Engineers, Wilmington District
F .O. Box 1890
Wilmington, NC 2$402
$
Attn: - AM L? M4
Field Office: `Rctlea16 , NG
Re: Wetlands Related Consulting and Permitting
"'o Whom It May Concern:
-` ra:- °eA t roe owner, hereby designate and authorize Soil & Environmental Consultants, PA to
act 4-n my behalf as my agent in the processing of permit applications, to furnish upcn reciuessii,
sup ' ental information in support of applications, etc. from this day forward. Tl?e day of
--- /7 "II off' Zop 12-
T,; Js notification supersedes any previous correspondence concerning the agent for this projei:t.
NOTICE: This authorization, for liability and professional courtesy reasons; is valid only^i'or
government officials to enter the property when accompanied by S&EC staff. You should :all S&EC
" o ;xrainge a site meeting prior to visiting the site.
Fz sit Property Owner's Name Pr erty Owners Sigma tore
cc: Mr. Yohn Dorsey cc: Mr. Todd Preuninge r
NCDENR - DWQ Soil & Environment.-1 Consuli ants, PA
2321 Crabtree Boulevard
Raleigh, NC 27604
Greensboro oPRea. Dicke
_ •-- • • ~? 0.1 ?rosarrity Church Road 3817-E
L.dwndale Drive
23269-7197 910 B )soon Road
Greensboro, NC 27455 Taylor sville, NC 28681
_. • • ??•! 72^ ;405 Phone: [phone]
...... "704) 720-9406 Fax: [phone] phone [phone]
Fax: [phone]
2524383690
MPHADMIN
PAGE 02
¦aa
Soil & Environmental Consultairits, IRA,,
11010 Raven Ridge Road • Raleigh, North Carolina 27614 • Phone: [phone] • Fax: [phone]
www.sandEc-com
AGENT AUTHORIZATION FORM
All _Blanks To Be Filled Irv By The Current Landowner

o PAY T
ORDER
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FIRST-CITUENS BANK 15775
AND TRUST COMPANY
RALEIGH, NC 27609
66-30/531

DOLLARS 8
MEMO _
1100 L57751P 1:053 L003001:086 L 24864911'

SOIL & ENVIRONMENTAL CONSULTANTS, PA
11010 RAVEN RIDGE ROAD
RALEIGH, NC 27614
[phone]`FAX: [phone]