19971021 Ver 1_Complete File_19970101

DEM ID: 871021.
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1??P?1990
JOINT APPLICATION FORM FOR
NATIONWIDE PERMITS THAT REQUIRE NOTIFICATION TO THE DISTRICT ENGINEER
NATIONWIDE PERMITS THAT REQUIRE SECTION 401 CERTIFICATION CONCURRENCE
NATIONWIDE PERMITS THAT REQUIRE INDIVIDUAL SECTION 401 CERTIFICATION
WILMINGTON DISTRICT ENGINEER
CORPS OF ENGINEERS
DEPARTMENT OF THE ARMY
P.O. BOX 1890
WILMINGTON, NC 28402-1890
ATTN: CESAW-CO-E
Telephone [phone]
t`6011
t%k
ACTION ID:
WATER QUALITY PLANNING
DIVISION.OF ENVIRONMENTAL MANAGEMENT
NC DEPARTMENT OF ENVIRONMENT, HEALTH,
AND NATURAL RESOURCES
P.O. BOX 29535
RALEIGH, NC 27626-0535
ATTN: MR. JOHN DORNEY
Telephone [phone]
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS OF
ENGINEERS. SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF
ENVIRONMENTAL MANAGEMENT. PLEASE PRINT. r
1. OWNERS NAME: N4tr6 ),lv? p°?g7'• Q+ ?o''4md, r074
2. OWNERS ADDRESS:
3. OWNERS PHONE NUMBER (HOME) : 7cn- X 3'f-2.533- ' (WORK): 7-(-37-7-7W
4. IF APPLICABLE:
PHONE
5.

AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
6. NAME OF CLOSEST STREAM/RIVER:
7 RIVER BASIN • jfo" o kk
8. IS THIS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROUT, SA, HQW, ORW,
WS I, OR WS II? YES [ ] NO
9. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROPERTY? YES [ ] NO
IF YES, EXPLAIN.
10. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
2/3/92
LOCATION OF PL D WORK (ATTACH MAP).
COUNTY: -S
NEAREST TOWN OR CITY: ?rivteN7?*?/
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.): ?- M
. -f- S. R . o u d- 7-a-vs N Frrr

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11. NUMBER OF ACRES OF WETLAND IMPACTED BY THE PROPOSED PROJECT:
FILLED: D
DRAINED: D
FLOODED: d
EXCAVATED: D
TOTAL IMPACTED : ?Fo w?
!??- Ca-v?- a S
12. DESCRIPTI N OF PROPOSED WORK (ATTACH PLANS):
erw G. D ?e 54ftt AA ? d i cL 3 S / a .
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13. PURPO,S/E OF PROPOSED WORK:
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14. STATE REASONS WHY THE APPLICANT BELIEVES THAT THIS ACTIVITY MUST BE
CARRIED OUT IN WETLANDS. ALSO, NOTE MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS. n 14
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE
(USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) REGARDING THE PRESENCE
OR ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED
SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE-
PROPOSED PROJECT. HAVE YOU DONE SO? YES [ ] NO [?]
RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE ATTACHED.
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA WHICH
MAY BE AFFECTED BY THE PROPOSED PROJECT?
HAVE YOU DONE SO? YES [?J NO [ ]
RESPONSE FROM THE SHPO SHOULD BE ATTACHED.
17. ADDITIONAL INFORMATION REQUIRED BY DEM:
A. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, AND LAKES ON
THE PROPERTY.
B. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY
PROJECT.
C. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEETS
RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
D. IF A STORMWATER MANAGEMENT PLAN IS REQUIRED FOR THIS PROJECT, ATTACH
COPY. /
E. WHAT IS LAND USE OF SURROUNDING PROPERTY?
F. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
1"3-97
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,-North Carolina
Department of Transportation
Division of Highways
George L. Teague
Bridge Maintenance Superintendent
515 Camp Rd. [phone]
Salisbury, NC 28147 Fax [phone]
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State of North Carolina IT WAA
Department of Environment,
Health and Natural Resources 4 09
Division of Water Quality _
James B. Hunt, Jr., Governor
p E H N F?
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
December 12, 1997
Stokes County
DWQProject #971021
APPROVAL of 401 Water Quality Certification and ADDITIONAL CONDITIONS
Mr. George Teague
NC DOT
515 Camp Rd.
Salisbury, NC 28147
Dear Mr. Teague:
You have our approval, in accordance with the attached conditions and those listed below,
for the purpose of paving SR 1961 at Germanton, as you described in your application dated
November 21, 1997. After reviewing your application, we have decided that this fill is covered by
General Water Quality Certification Number 3103. This certification allows you to use
Nationwide Permit Number 14 when it is issued by the Corps of Engineers. 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, Coastal Stormwater, Non-Discharge
and Water Supply Watershed regulations. This approval will expire when the accompanying 404
or CAMA permit expires unless otherwise specified to the General Certification.
This approval is only valid for the purpose and design that you described in your application
except as modified below. If you change your project, you must notify us and you may be
required to send us a new application. 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) (6) and (7). For this approval to be valid, you must follow the conditions listed in the attached
certification and any additional conditions listed below.
1. DOT shall follow guidance provided by DWQ in our 27 May 1997 letter for minimizing
damage to aquatic resources until a final policy is developed in conjunction with DOT.
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
certification Oaffice o Administrative Hearings, P.O. Box
Geneal • This Statutes to the
its conditions are final and binding unless 4you ask for ya hearing.l l-
7447This 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 John Dorney at 919-733-1786.
Sinc elyT
Z
r ton Howard, Jr. P.E.
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
Winston-Salem DWQ Regional Office eyA
Centraf ides
971021.1tr
Division of Water Quality • Non-Discharge Branch
4401 Reedy Creek Rd., Raleigh, NC 27607 Telephone [phone] FAX # [phone]
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