20001173 Ver 1_Complete File_20000913

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
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NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
September 14, 2000
Pender County
DWQ Project # 001173
APPROVAL of 401 Water Quality Certification
NC Department of Transportation
c/o M. Randall Turner
124 Division Drive
Wilmin,,ton, NC 28401
Dear Sirs:
You have our approval, in accordance with the attached conditions and those listed below, to fill 0.32 acres of
wetlands in Pender County, for the purpose of road improvements as you described in your application received by
the Division of Water Quality on September 13, 2000. After reviewing your application, we have decided that this
fill is covered by General Water Quality Certification Number 3289. This certification allows you to use Nationwide
Permit Number 14 when the Corps of Engineers issues it. 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 Water shed regulations. This approval will expire when the
accompanying 404 or CANIA 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 and you may be required to send us a new application. If the property is sold, the
new owner must be given a copy of this 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) (6) and (7). 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, which
conforms 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 John Dorney at 919-733-9646.
Sincerely,
Kerr T. Stevens
Attachment
cc: Corps of Engineers Wilmington Field Office
Wilmington DWQ Regional Office
File Copy
Central Files 001173
Division of Water Quality - Non-Discharge Branch
1621 Mail Service Center, Raleigh, NC 27699-1621 Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer - 50% recycled/10% post consumer paper
httpJ/h2o.enr.state.nc.us/wetiandc.htmi

STAIZ
JAMEs B. HUNT JR.
GOVERNOR
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
P.O. BOX 25201, RALEIGH, N.C. 27611-5201
DAVID MCCOY
SECRETARY
August 25, 2000
'i
U.S. Anny Corps of Engineers PAYMENT
Wilmington Regulatory Field Office RECEIVED
P.O. Box 1890
Wilmington, North Carolina 28402-1890
ATTENTION: Mr. David L. Timpy, Regulatory Project Manager

SUBJECT: Pre-Construction Notification (NWP-14) for the Proposed Improvements to
SR 1125 in Ponder County
The Department's road maintenance program is proposing to improve the cross-section
and pave SR 1125 in Pender County southwest of Burgaw. As you know unpaved
secondary roads throughout the state were constructed many years ago at a time when
design and safety standards were less stringent. Prior to paving these roads it is necessary
to ensure that the cross-section meets minimum standards for the design speed. Not only
does must the improved cross-section include minimum travel lane and shoulder widths,
but its vertical and horizontal alignments must fall within acceptable limits in order to
ensure that the motorist is not exposed to unnecessary risks at the posted speed limit.
The proposed work includes widening the existing unpaved 2-lane roadway within a 60'
donated right of way. The newly paved roadway will have two 10-ft travel lanes and 6-ft
grassed shoulders. A small section of the roadway alignment is confined to a very
narrow curve. The curve is too sharp to keep within the improved roadway alignment
and maintain a 45 mph speed limit. Consequently, realignment has been proposed (see
Figure 2).
The relocation of approximately 600 feet of the roadway immediately south of the
existing alignment will result in an unavoidable impact to a high quality bottomland
wetland. Thankfully, only approximately 300 feet of the realignment will impact the
fringe of this wetland system.
In order to detennine how best to minimize impacts to the wetland, the District Engineer
was asked to contrast horizontal alignments through the area using design criteria for
35mph, 45 mph and 55 mph travel speeds. These impacts were calculated to be:
Alignment Design Speed Wetland Impact
1 35 mph 0.24 acre
2 45 mph 0.32 acre
3 55 mph 0.78 acre
121 Division Drive, Wilmington, NC 28401
PHONE: [phone] FAX: [phone]

Page 2
August 25, 2000
David L. Timpy, USACE
Wetland impacts were computed by mapping the boundary of the wetland along the
proposed interface with the realigned roadway. Wetland boundary was established by the
Division Environmental Officer, utilizing the 1987 delineation methodology.
Alignment 3 was chosen as the recommended alignment. The 35-mph design speed was
determined to be inadequate based upon concerns that the public is not likely to observe a
posted speed limit of only (up to) 35 mph in this kind of remote setting, a fact which
would expose many motorists to an unnecessary risk while traversing the curved
alignment at (presumably) higher rates of speed. The 45 mph design was chosen as the
best compromise to safely accomplish the purpose and need of the project, while
minimizing impacts to the wetland.
Section 7 Issues
As of June 16, 2000, the Fish and Wildlife Service has listed 10 species as endangered
and threatened, and 1 other species which has been proposed for listing as an endangered
species in Pender County. Table 1 provides relevant information regarding these species.
Table 1. Federally Protected Species Listed for Pender County
Species
Acipensezr bl•evii ostr1(ill
Alligator mississippiensis
Caretta caretta
Charadrius melodus
Picoides borealis
Trichechus ntanatus
Amaranthus plunilus
Carer lutea
L,ysimachia asperzrlaefolia
Scit,albea amcricana
Common Name Status Habitat
shortnose sturgeon E No
American alligator T(S/A) No
loggerhead sea turtle T No
piping plover T No
red-cockaded woodpecker E No
manatee E No
seabeach amaranth T No
golden sedge PE No
rough-leaved loosestrife E No
American chaffseed E No
Thalictrum coole_vi Cooley's meadowrue E No
Note: "E", "PE", "T" and "T(S/A)" denote Endangered, Proposed Endangered,
Threatened and Threatened due to Similarity of Appearance; "Habitat" indicates whether
suitable habitat for the species is listed in project area.
Based upon an analysis of the habitat requirements of the listed species and the kind of
habitat to be effected by the proposal, it is reasonable to conclude that the project will
have No Effect on any listed federal species. No further action is required.
Coastal Zone Issues
Although Pender County is one of the 20 coastal counties in which the Division of
Coastal Management regulates development, the proposed work will not occur within an
Area of Environmental Concern. Consequently, a CAMA permit will not be required.
Streams/Surface Waters
The proposed work will not effect streams or surface waters.
Ili . , 4
Page 3
August 25, 2000
David L. Timpy, USACE
Compensatory Mitigation
In view of the fact that 0.32 acre of a high quality bottomland community will be
unavoidably impacted by the proposal, the Department proposes to provide compensatory
mitigation to offset this impact. Specifically, 0.64 acre of the bottomland community at
the Haw's Run Wetland Mitigation Site will be committed as compensatory mitigation
for the 0.32 acre impact.
Please review the information provided, including the PCN, at your earliest convenience.
I am available to answer questions you may have and to accompany you to the site
if/when you want to go. Thanks for your time and consideration.
Sincere ,
M. Randall Turner, Division Environmental Officer
Division 3
Attachment
Cc: John Hennessy, NCDWQ (7 copies of attachment)
Phil Harris, P.E., NCDOT
Chad Kimes, NCDOT
.1
T PAYMENT
RECEIVED
??CFD
DEM ID: CORPS ACTION ID:
NATIONWIDE PERtiiIT REQUESTED (PROVIDE NATIONIVIDE PEM1IT #) : 14
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR;NATIONWIDE PERMITS THAT REQUIRE:
•? 1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE FIELD OFFICE
OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7) COPIES SHOULD BE
SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT (SEE AGENCY ADDRESSES SHEET).
PLEASE PRINT.
1. OWNERS NAME: NCDOT
2. MAILING ADDRESS: 124 Division Drive
SUBDIVISION NAME:
CITY: 1 mington, STATE: N.C. ZIP CODE: 28401
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF IFFERENT FROM
MAILING ADDRESS ABOVE): SR 1125 (John Henry Store Road), Pender
County
3. TELEPHONE NUMBER (HOME): (WORK) : (c)10) 251-5724
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL,
ADDRESS, PHONE NUMBER: M. Randall Turner Division Environmental Office
591 0 I N F WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP OR
AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Pender NEAREST TOWN OR CITY: BurgaW
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.)
SR 1125 Near Crossing of Moore's Creek
6. IMPACTED OR NEAREST STREAM/RIVER: Moore's Creek (nearest Stream)
RIVER BASIN: ('anP Fear Ri vPr Rasin
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER SUPPLY

(WS-I OR WS-II)? YES [ ] NO [X ] IF YES, EXPLAIN:
7b. IF THE PROJECT IS LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT
ARE OF ENVIRONMENTAL CONCERN (AEC)? YES [ ] NO [X l
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF COASTAL
COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION: Rural
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROPERTY?
YES [ ) NO [X ) IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND ANY
ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES [ ] NO [X ] IF YES, DESCRIBE ANTICIPATED WORK:
9A. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND:
9B. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
10A. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY: _
FILLING: 0.32 EXCAVATION:
FLOODING: OTHER:
DRAINAGE: TOTAL ACRES TO BE IMPACTED:
10B. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED, PROVIDE
DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: FT AFTER: N/A FT
WIDTH BEFORE (based on normal high water contours): FT
WIDTH AFTER: FT
AVERAGE DEPTH BEFORE: FT AFTER:
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION:
CHANNEL ELEVATION:
OTHER:
11. IF CONSTRUCTION OF A POND
TO THE POND? NSA
WHAT IS THE EXPECTED POND
12. DESCRIPTION OF PROPOSED W,
TO BE USED (ATTACH PLANS:
PLACEMENT OF PIPE IN CHANNEL:
CONSTRUCTION OF A DAM/FLOODING:
IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED DRAINING
SURFACE AREA?
DRK INCLUDING DISCUSSION OF TYPE OF MECHANICAL EQUIPMENT
8%" x 11" DRAWINGS ONLY): Clearing, Grubbing, Grading
within 60'width followed by installation of +/- 6" aggregate base course and
lid'-- 2" of asphalt pavement. Equipment: Dozer, Tracked Excavator, Grader,
and Trucks.
13. PURPOSE OF PROPOSED WORK: Tn imnrnv existing unpaved roadway
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS):
To make an important improvement to horizontal alignment for safety reasons.
15. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) (SEE
AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE
PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: 9'8'4049
16. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF PUBLIC
FT
(STATE) LAND? YES [ ] NO [XI ( IF N0, GO TO 18 )
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL DOCUMENT
PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT?
YES [ ] NO [ X I
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA DEPARTMENT
OF ADMINISTRATION STATE CLEARINGHOUSE? YES [ ] NO [
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING COMPLIANCE WITH THE
NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE DIRECTED TO MS.
CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH CAROLINA DEPARTMENT OF
ADMINISTRATION, 1302 Marl Service Center, RALEIGH, NORTH CAROLINA 27699-1302,
TELEPHONE [phone].
17. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED ACTIVITY
INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES AND PONDS ON THE
PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, AND 38). ALL
STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON THE MAP.
MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1 aNCH EQUALS 100 FEET OR THEIR
EQUIVALENT.
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 N/A
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED. N/A
e. WHAT IS LAND USE OF SURROUNDING PROPERTY? Rural Residential wood lot,
Agricultural
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? N/A
g. SIGNED AND DATED BY AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT, AND
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF ENVIRONMENTAL MANAGEMENT
(WATER QUALITY) CERTIFICATION.
I?
i?
OWNER'S/AGENTS-SIGNATURE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18G.))
DATE

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PAYMENT
RECEIVED
- :4;
' DEM ID: CORPS ACTION ID :
"- -
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#)
NATIONWIDE PEItiiIT REQUESTED (PROVIDE NATIONWIDE PEiu.lIT 14
PRE-CONSTRUCTION NOTIFICATION APPLICATION

) FOFt'NATIONWIDE PERMITS THAT REQUIRE:

1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE FIELD OFFICE
OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7) COPIES SHOULD BE
SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT (SEE AGENCY ADDRESSES SHEET).
PLEASE PRINT.
1. OWNERS NAME: NCDOT
2. MAILING ADDRESS: 124 Division Drive
SUBDIVISION NAME:
CITY: O1 mtngton, STATE: N.C. ZIP CODE: 28401
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF IFFERENT FROM
MAILING ADDRESS ABOVE): SR 1125 (John Henry Store Road 5, Pender
3. TELEPHONE NUMBER (HOME): (WORK) : (910) 751-5/24
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL,
ADDRESS, PHONE NUMBER: M. Randall Turner Division Environmental Office
591 OC I NF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP OR
AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Fender NEAREST TOWN OR CITY: Burgaw
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.)
SR 1125 Near Crossing of Moore's Creek
6. IMPACTED OR NEAREST STREAM/RIVER: Moore's Creek (nearest Stream)
RIVER BASIN: CnnP Fear RiTPr Basin
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER SUPPLY

(WS-I OR WS-II)? YES [ ] NO [X ] IF YES, EXPLAIN:
7b. IF THE PROJECT IS LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT
ARE OF ENVIRONMENTAL CONCERN (AEC)? YES [ ] NO [X ]
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF COASTAL
COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION: Rural
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROPERTY?
YES [ ] NO [X ] IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND ANY
ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION) :
8b
ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES [ ] NO [X ] IF YES, DESCRIBE ANTICIPATED WORK:
9A. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND:
9B. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
10A. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY: _
FILLING: 0.32 EXCAVATION:
FLOODING: OTHER:
DRAINAGE: TOTAL ACRES TO BE IMPACTED:
10B. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED, PROVIDE
DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: FT AFTER: N/A FT
WIDTH BEFORE (based on normal high water contours): FT
WIDTH AFTER: FT
..
AVERAGE DEPTH BEFORE: FT AFTER:
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL ELEVATION: CONSTRUCTION OF A DAM/FLOODING:
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED DRAINING
TO THE POND? N/A
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL EQUIPMENT
TO BE USED (ATTACH PLANS: 81/2" x 11 ".DRAWINGS ONLY) : Clearing, Grubbing, Grading
within 60'width followed by installation of +/- 6" aggregate base course and
1' 2" of asphalt pavement Equipment: Dozer, Tracked Excavator, Grader,
and Trucks.
13. PURPOSE OF PROPOSED WORK: Tn imnrnve existing unpaved roadway
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS):
To make an important improvement to horizontal alignment for safety reasons.
15. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) (SEE
AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE
PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED : 8 -'600
16. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF PUBLIC
FT
.V
(STATE) LAND? YES [ ] NO [XI (IF N0, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL DOCUMENT
PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT?
YES [ ] NO [ X I
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA DEPARTMENT
OF ADMINISTRATION STATE CLEARINGHOUSE? YES ( ] NO [ )
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING COMPLIANCE WITH THE
NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE DIRECTED TO MS.
CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH CAROLINA DEPARTMENT OF
ADMINISTRATION, 1302 Marl Service Center, RALEIGH, NORTH CAROLINA 27699-1302,
TELEPHONE [phone].
17. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED ACTIVITY
INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES AND PONDS ON THE
PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, AND 38). ALL
STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON THE MAP.
MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1 INCH EQUALS 100 FEET OR THEIR
EQUIVALENT.
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 'N/A
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED. N/A
e. WHAT IS LAND USE OF SURROUNDING PROPERTY? Rural Residential ;wood lot,
Agricultural
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? N/A
g. SIGNED AND DATED BY AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT, AND
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF ENVIRONMENTAL MANAGEMENT
(WATER QUALITY) CERTIFICATION.
OWNER'S/AGENT S SIGNATURE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18G.))
DATE

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