20010756 Ver 1_Complete File_20010518

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Kerr T. Stevens, Director
1 61k1:!WA?0
1
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
June 15, 2001
Hoke County
DWQ Project No. 010756
APPROVAL of 401 Water Quality Certification
Mr. E.B. Nelson
NCDOT, Bridge Maintenance Unit
PO Box 289
Siler City, North Carolina 27644
Dear Mr. Nelson:
You have our approval, in accordance with the attached conditions and those listed below, to place fill
material in 100 linear feet of streams, and impact an additional 120 linear feet of streams to dewater the
construction site. The purpose of the project is the replace of a 60 inch corrugated metal pipe with a 6 foot
by 8 foot reinforced concrete box culvert on SR 1403 in Hoke County. The project should be constructed
in accordance with your application dated May 18, 2001. After reviewing your application, we have
decided that this fill is covered by General Water Quality Certification Number 3289. This certification
corresponds to the Nationwide Permit Number 14 issued by the Corps of Engineers. In addition, you should
acquire any other federal, state or local permits before you proceed with your project including (but not
limited to) Sediment and Erosion Control, Non-Discharge and Water Supply Watershed regulations. This
approval will expire with the accompanying 404 permit, unless otherwise specified in the Water Quality
Certification.
This approval is valid solely for the purpose and design described in your application (unless modified
below). Should your project change, you must notify the DWQ and submit 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 the conditions. If total wetland fills for this project (now or in the future)
exceed one acre, or of total impacts to streams (now or in the future) exceed 150 linear feet, compensatory
mitigation may be required as described in 15A NCAC 2H .0506 (h) (6) and (7). For this approval to
remain valid, you must adhere to the conditions listed in the attached certification.
1.) Upon completion of the project, the NCDOT shall complete and return the enclosed "Certification of
Completion Form" to notify DWQ when all work included in the 401 Certification has been completed.
The responsible party shall complete the attached form and return it to the 401/Wetlands Unit of the
Division of Water Quality upon completion of the project.
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 that 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.
% I
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post consumer paper
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Kerr T. Stevens, Director
1 •
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Ameandsomwdmk
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
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,
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
DWQ Raleigh Regional Office
File Copy
Central Files
c:\ncdot\SR 1956\wqc\010778wgc.doc
f
. Steven
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post consumer paper
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Kerr T. Stevens, Director
4 N • • WAA
10 ft WOW
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
fiber and seedling establishment is allowable. Also, rip-rap may be allowed if it is necessary to maintain
the physical integrity of the stream, but the applicant must provide written justification and any
calculations used to determine the extent of rip-rap coverage requested. If suitable stream mitigation is
not practical on-site, then stream impact will need to be mitigated elsewhere;
Impacts to any stream length in the Neuse, Tar-Pamlico and Randleman River Basins requires written
concurrence from DWQ in accordance with 15A NCAC 2B.0233, 15A NCAC 2B .0259 and .0250 and
15A NCAC 2H .0500. New development activities located in the protected 50-foot wide riparian areas
(whether jurisdictional wetlands or not) within the Neuse, Tar-Pamlico and Randleman River Basins
shall be limited to "uses" identified within and constructed in accordance with 15A NCAC 2B .0233,
15A NCAC 2B .0259 and .0250. All new development shall be located, designed, constructed, and
maintained to have minimal disturbance to protect water quality to the maximum extent practicable
through the use of best management practices. Activities listed as "exempt" from these rules do not need
to apply for written concurrence under this Certification;
6. Placement of culverts and other structures in waters, streams, and wetlands must be placed below the
elevation of the streambed to allow low flow passage of water and aquatic life unless it can be shown to
DWQ that providing passage would be impractical. Design and placement of culverts and other
structures including temporary erosion control measures shall not be conducted in a manner that may
result in dis-equilibrium of wetlands or stream beds or banks, adjacent to or upstream and down stream
of the above structures. The applicant is required to provide evidence that the equilibrium shall be
maintained if requested in writing by DWQ. Additionally, when roadways, causeways or other fill
projects are constructed across FEMA-designated floodways or wetlands, openings such as culverts or
bridges must be provided to maintain the natural hydrology of the system as well as prevent constriction
of the floodway that may result in destabilization of streams or wetlands;
7. If this Certification is used to access building sites, all lots owned by the applicant must be buildable
without additional fill beyond that allowed under other General Certifications. Deed restrictions must be
placed on the remaining wetlands and streams on these lots to restrict future wetland and stream fill.
DWQ shall be sent copies of all deed restrictions applied to these lots;
8. That appropriate sediment and erosion control practices which equal or exceed those outlined in the
most recent version of the "North Carolina Sediment and Erosion Control Planning and Design Manual"
or the "North Carolina Surface Mining Manual" whichever is more appropriate (available from the
Division of Land Resources (DLR) in the DENR Regional or Central Offices) shall be in full
compliance with all specifications governing the proper design, installation and operation and
maintenance of such Best Management Practices in order to assure compliance with the appropriate
turbidity water quality standard;
9. All sediment and erosion control measures placed in wetlands or waters shall be removed and the natural
grade restored within two months after the Division of Land Resources has released the project;
10. Measures shall be taken to prevent live or fresh concrete from coming into contact with waters of the
state until the concrete has hardened;
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1621
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post consumer paper
State of North Carolina
• Department of Environment
and Natural
Resources
Division of
Water Quality f
Michael F. Easley, G. Ross Governor
Kerr T. Stevens ' Jr., Secretary Director
NORTH CCARDOLINROAD CROSSING ENVIRONMENT TEFA E:S ( R
ELIGIBLE FOR CERTIFICATION GENERAL AND CROSSINGS), CERTIFICATION FOR cEs
), REGIONAL GENE I' NATIONWIDE PERMIT NUMBER R PROJECTS
PAMLICO/RA pERMIT 1982MBER AND USF 14 (ROAD
This General Certification is issued in confolLEMAN BUFFER RULES NEUSE/TAR_
500 and 95-217 General C of the
Regulations in 15q NC United States and subject
toWte to the
requirements of Section 401
waters Publt
waters and wetland areas as described in 33 North Carolina Division of c Laws 92-
Nationwide 2H, Section .0500 and the
regulations (i.e., Nationwide Per NCAC 2B .0200 for the dis hargeeQualtty (DWQ)
Tar-Pamlico and CFR 330 Appendix A (B) Randleman B turf No. 14 and Regional General Per (14)
of the Co of fill material to
Rules (15q NCgC 2$ uffer Permit Corps of Engineers
roads (15 n 0233, •0259 and .0250. ) and for the
Certification g and is Number limited to f]] less than one-th jrd of an acre. Neese,
2177 issued gory of activities shall include an
on January 21, 1992 on Nove This Certification replace Y fill activity for
Certiftca6on ° Number Water tuber 5, 1987, Water
Certif,
3103 issued ton Februartton Quality Certifcations Water
Engineers on authorizes Number 2732 issued on May 1, Quality
Number 2666 issued
Permi[ 14 or re- Nationwide y 11. 1997. Y , 1992 and Water QualitY
Regional General Permit 19820 when the
The State of 0031 When deemed Corps of
North Carolina certifi b
portions of Sections 301
accordance with the condition es that the specified med appropriate
s 307category of activity well n ot violate a Director of the DWQ
Condi the
hereinafter set forth. 500 and 95- PPltcable
tions of Certification: , cation: 302 303, s 306 that
and Y 217 if conducted in
1• Proposed fill or substantial
Certification re modification of
quires application to and wetlands or waters (including from
with North streams) this General
Prior written concurre he Division of Water
Water Qualit Carolina General Statute Section 143-
Y Certification must include the app er Quality;
2• In one accorpaymentdance to both agencies shall be submitted 215.3Dt also any application for
will be fee. the If a project a quires a a 401
3• In accordance and nd will
with 15A NCAC 2 higher of the two fees; CgMA Permit,
streams and/or H .0506
wetlands. In addition, bufferh) compensator
Rules in effect at the time of app y mitigation may
requirements shall be mitigation may be re Y be reqrouiredectwj forithim
and
lication. A determination of buffer,Iwet and and strew impacts to
monitoring made for any Certification for this Nationwide Permit* TY p Buffer
required in those m mitigation
as g protocols from DWQ shall at followed and written
protocols; he most current design
4. For an Plans submitted for DW
Q approval
Y project involving a stream re-alignment,
application for written D patterns and profiles as rheaexisting a stream relocation
Relocated stream designs plan must t included
401
be constructed o the channel, to the maximum extent should include the same nnel lh the should
stabilized, dry and water shall not be turned into the new practical.
Vegetation used for bank stabilization shall be limited to The new chann mensions,
include Wetlands/401 establishment of a 30 foot wide
sides of the relocated channel to the maximum wooded and extent new channel until the banks are
an adjacent 20 foot?widedY species, and should
Unit practical, q transitional vegetated buffer o
phase incorporating both
Telephone [phone] Mail Service Center coir
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gh.9 North Carolina 27699-1621
mployer FAX 733-995Ralei
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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY P.O. 13OX 25201, RALEIGH, N.C. 27611-5201 LYNDO TIPPETT
GOVERNOR SFCRii'rARY
March 4, 2002
North Carolina Division of Water Quality
401 /Wetlands Unit
1621 Mail Service Center
Raleigh, NC 27699-1621
Reference: DWQ Project No. 5.5351217 Oh?175?
NCDOT/SR1403 Hoke County
Dear Sir or Madam:
Attached is certification of completion for the work performed under the above
referenced permit. The certification is signed by our field agent. If additional
information is required please advise.
Sincerely,
W. F. Rosser, P.E.
Division Engineer
cc: E. B. Nelson, Jr. P.E.
DIVISION 8, P. O. 130X 1067, ABERDEEN, NC 28315
'Telephone: [phone] Fax: [phone]

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
Kerr T. Stevens, Director
I*) ! X76-6
DWQ Project No.: 5.5351217
/•• 2
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
County: HOKE
Applicant: W. F. ROSSER,P.E. DIVISION ENGINEER, DIVISION 8
Project Name: PIPE REPLACEMENT SR 1403
Date of Issuance of 401 Water Quality Certification: JUNE 15, 2001
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer
Rules, and any subsequent modifications, the applicant is required to return this certificate to the
401/Wetlands Unit, North Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC,
27699-1621. This form may be returned to DWQ by the applicant, the applicant's authorized agent, or the
project engineer. It is not necessary to send certificates from all of these.
Applicant's Certification
I, , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature:
Agent's Certification
Date:
I, , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature:
Engineer's Certificatiory
Partial ? Final
rte- )JGl?io?? as a duly registered Professional Engineer in the State
of North Carolina, having been authorized to observe (periodically, weekly, full time) the construction of
the project,for the Permittee hereby state that, to the best of my abilities, due care and diligence was used in
the observation of the construction such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporti g materials.
Signature Registration No. 2 02 Of
Date l??i7LaZ--
Wetlands/401 Unit 1621 Mail Service Center Raleigh, North Carolina 27699-1 62 1
Telephone [phone] FAX [phone]
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MYi?d
e
MMMUM CRITERIA DETERMINATION CIMCKLI W
The following questions provide direction In determining whether a proposed project hu only a
miniastsm potential for environmerAW effecu. Answer the following questions by checking
either yes or no. Refer to the etbched guidance for assistance.
TIP Pro jet! No.
State Project No. X512 / -7 _ 4? ? /SS??
ProjectLeeation: i4o1.::* ec. he. A oN s2 iyo?
Pro j sat Dweription: )eep l2 c t wi C•'14 o (n D " Li?l i? k,/ 9)'e L ' )2613e-
Anticipated Permit or Consultation Requirements: Iq JAI 4 ,< 33
Special Project Information:
01®756
1 PA?MFNr
RECE/VED
•?.?.,J.,.,,,1.r1•1 iL-v. rax.yl7-r??-oxso Jul 20 2000 10:58 P.05
PART A: M] mum CRITERIA YES NO
1. Is the proposed project listed as z type Which Would qualify ® ?
as a Non-Major Action under the Minimum Criteria?
PART Bs UAMMMUM CRITERIA EXCEPTIONS
2. Is the proposed project likely to precipitate signifl=t, foreseeable
alterations in land sera, planned Growth, or development patteffis?
3_ Does the proposed action divide or disrupt an established community?
4. Does the proposed action bnma an existing commuaity7 ?
5. Does the proposed action provide new access to areas containing
significant amounts of exploitable natural resources?
6. Is the proposed action likely to have a significant detrimental impact
i
on a
r quality?
7. Is the proposed action likely to love a significant detrimental impact ?
on ambient noise levels for adjoining areas?
8. Is the proposed action likely to have a significant impact on travel ?
patterns or traffic volumes?
9. Is the proposed action likely to significantly affect water quality? ?
14. Does the proposed action require the relocation of significant numbers (]
of people?
11. Is the project likely to be controversial?
12. Will the proposed action require the use of land owned by the
U. S. Forest Service or the National Park Service?
PART C: COMPLIANCE WITH STATE A.ND FEDE REGULATIONS
Ecological im acts
13. Is a federally protected threatened or endangered species, or its habitat, ?
likely to be impac%ed by the proposed action?
14. Does the action rcquira the p:acem=t of fill in waters of the United States? L-i
2
.. NLJU\rp•l LT-V. raxaJl?-fJJ-J52S5 Jul 20 2000 10:58 P. C6
13. Dow the project require the placement of a si"cant amount of $11 in ?
high quality or relatively rare wetland ecosystems, such as mountain bogs
orpinisavannaha?
16. Does the project require me= rolocation or chauael changes?
17. Is the propoood action located in an Area of Environmental Conce.-n,
as defted in the Coastal Area Management Act?
Cultural Reaourcee
18. Will the project havc an "effoc2" on a property or site listed on the
National Register of Historic Places?
19. Will the proposed action require acquisition of additional right of way
from publicly owned parkland or recreeiional areas?
Reviewed by; Dale: s /o d ?
Project Planning Engineer
9 E]
? n
11 2
? z
If my questions 2 through 12 are answered "Yes". the proposed project does not qualify as a
Non-Major Action. A state environmental assessment (EA) will be required. For asistance,
contact:
William D. Gilmorc, P. E.
Manager, Project Development and Envirommental Analysis Branch
P. 0. Box 25201
Raleigh, NC 27611
[phone]
Fax: [phone]
Que3tions in Pare C are designed to assist the Engineer in-detemlining whether a permit or
consultarion with a state or federal resource agency may be required. If any question in Part C is
answered "Yes", refer to the Environmental Guidance section of this document and contact the
appropriate individual for assistance.
3

?C? WA
T ?RQ
?O G
Cl)
D ?
Pre-Construction Notification (PCN) 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' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian 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
Water Quality Certification. The USACE Individual Permit application form is available online at
http://www.saw.usace.army.miI/wetlands/Perm app htm.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at http://www.saw.usace army mil/wetlands/re?-,tour htm, or contact one of the field
offices listed at the end of this application. 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 type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://h2o.enr.state.nc.us/ncwetlands to read about current requirements for the 401 Water Quality
Certification Program 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 lacking 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 http://www.saw.usace.army.mil/wetlands/nwpfinatFedReL,.pdf.
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/ncwetlands/fees.html. 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: 0 1 0756 Form Version April 2001
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
I. Processing
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: 14 1 3
I If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
H. Applicant Information
Owner/Applicant Information
Name: NLn oT - ?>Xinc-,rr-- M,4iNriF-nrANGiL uNi-r
Mailing Address: (> c) p
,oy 2 S
5 L_,L eL G 1 N N L
Z'7 S,4 4
Telephone Number: 91 L3 74 Z -5 1,4 9 Fax Number: &&5-oz/4
E-mail Address: ehelsor, e do 4-, St?,Le. vi c., vs
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:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
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 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: P, R.r)c,c A
2. T.I.P. Project Number (NCDOT Only): N
3. Property Identification Number (Tax PIN):
4. Location
County: /4c 1r- f- Nearest Town: 2,4E )-6 n
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): 5e /yy 3 ove ?2
(??r>n?r?•2s G,2EiE?
5. Site coordinates, if available (UTM or Lat/Long): N/A
(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. Describe the existing land use or condition of the site at the time of this application:
-_- 2 f_41Q & AJ-r 1 &J_ A e OE A
7. Property size (acres): N ffi,
8. Nearest body of water (stream/river/sound/ocean/lake): Peor>LC-* 64*A14..
9. River Basin: 6,4Pff- F"je_
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://li-o.enr.state.nc.us/admin/maps/.)
Page 4 of 12
10. Describe the purpose of the proposed work: 21EnLA4.1- (moo ' LMP w -rµ Y
12.G. Rvv cuc-wipe- "
11. List the type of equipment to be used to construct the project: Exe-AYA-M Iz
12. Describe the land use in the vicinity of this project: (L?,s?o??-nay
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.
t4 1A
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application: No
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
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
1. Wetland Impacts t4 A,
Wetland Impact
Site Number
(indicate on ma
Type of Impact* Area of
Impact
(acres) Located NNithin
100-year Floodplain**
yes/no Distance to
Nearest Stream
linear feet)
Type of Wetland***

' 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 h=:/hNtiv%t.fcma.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
Type of Impact* Length of
Impact
linear feet)
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
(please specify)
GuLV 2T /00 !?El?DL?25 4e• tj
i ?iv?t?o a ms( Iii rt Icov l Zc ?? r

" 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 flo%vs. USGS maps are available through the USGS at 1-800-358-9616, or online at
w%o y.us¢s.V_ov. Several internet sites also allow direct download and printing of USGS maps (e.g., w%N\%.1oDOZ011c.com,
w\ w.manouest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 22.0
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
Site Number
indicate on ma
Type of Impact* Area of
Impact
(acres)
(if Name applicable) ) Wate Type of Waterbody
(lake, pond, estuary, sound.
bay, ocean, etc.)

List each impact separately and identity temporary impacts. Impacts include, but are not limited to: fill, excavation. dredging,
flooding, drainage, bulkheads, etc. `
4. 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.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
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.
1.1 D ??-TFi2nrM77yifz?s - ,e p .+Z4'0Q 1 GULV 1442..7-
5TIt w,A-n1 -rv f- iE Pj,/ a 2TF_o A-+2b u.i n f tec_. trA-7r1 oN
171yrL2S1oru TO &#E L+N/Ei-> wl rli-TII:(L rA-6a;e_
Page 7 of 12
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.
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,nc.us/iicwetlaiids/strmgide.htm1.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
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/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at litti)://li2o.ciir.state.iic.us/Avrr)/indcx.litm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
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 N
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 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 213 .0233
(Meuse), 15A NCAC 213 .0259 (Tar-Pamlico), 15A NCAC 213 .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
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 buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet) Multiplier Required
Mitigation
1 3
2 1.5
Total
- cone i extenas out -ju teet perpenwcular from near bank of channel; Gone 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.
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.
t4 /4
XH. Sewage Disposal (DWQ Only)
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.
XIH. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No M
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).
A
c/L-0
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization 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 Stanlev
Telephone: [phone] Caldwell Haywood McDowell Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulator, Field Office Alamance Durham Johnston Rockingham
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes
6508 Falls of the Neuse Road Ashe Franklin Nash Sum.
Suite 120 Caswell Forsyth Northampton Vance
Raleigh. NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Dade Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Berne Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hvde 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
ate"/.5 -01
'511v10 /
Pitt
Tvrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page I 1 of 12
US Fis
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
h and Wildlife Service / National N
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
larine 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]
DiNision of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
CAM and NC Coastal Counties
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Senice Center
Raleigh, NC 276994617
Telephone: [phone]
Fax: [phone]
Division of Coastal Management Beaufort ChoNvan Hertford Pasquotank
1638 Mail Service Center Berrie Craven Hyde Pender
Raleigh. NC 27699-1638 Brunstyick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kemerstiille, NC 27284-9180 Averv Stokes
Telephone: [phone] Burke Sum'
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
WaynesOlle, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
Page 12 of 12

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010756
MINMUM CRITERIA DMRWNATION o
The following questions provide direction in determining whether a 1
mini= potential for environme:mai effects. Answer the Wowing
either yes or no. Refer to the attached guidance for assistance.
TIP Project No.

clwya
ie only n
State Project No. ~5121 - 401
Projett Location: ?4dk c ec. he. A oN s 2 ly o g ISSUED
ProjectDwcriptlon: ,ee-pl2,cme•,4 e lean eIVIP w/ PAL 265e-
Anticipated Permit or Consultation Requirements: ?•/ ?,?/ ,< 3 3
r n i
special Protect Information: a' ?'?, ?•, ,
PA YA4[ t j
Ptco [v
--?, • •? LTV. rax•71?-roo-o??n Jul 20 2000 10:58 P.05
PART A; M NIMUM CRITERL , YES NO
1. Is the proposed project listed as z type which would qualify ® ?
as a Non-M4or Action undcr the Minimum Criteria?
PART 8 s UM CRITERIA EXCEPTIONS
2. Is the proposed project likely to precipitate significant, foreseeable ?
alterations in land ure, plarmad Growth, or development patoerns?
3_ Does the proposed action divide or disrupt an established community?
4. Does the proposed action bypass an existing oornmunity? ?
5. Does the proposed action provide new scceas to area containing
sigaift=ant amounts of exploitable amoral resources?
6. Is the proposed action likely to have a significant detrimental impact
i
on s
r qusli:y?
7. Is the proposed action likely to hive a sipZcaut detrimental impact ?
on ambient noise levels for adjoining asters?
8. Is the proposed action likely to have a significant impact on travel []
puttcrus or traffic volumes?
9, Is the proposed action likely to significantly affect water quality? ?
10, Does the proposed action require the relocation of significant numbers ?
of people?
11. Is the project likely to be controversial? ? z
12. Will the proposed action require the use of land owned by the
U. S. Forest Service or the National Park Scrrice?
PART C: COMPLIANCE WITH STATE AND FEDE REGULATIONS
Ecological im acu
13. Is a federally protected threatened or endangered species, or its habitat, []
likely to be Lmpaeted by the propoamd action?
14. Dees he action require the p!a=cmt of fill in waters of the United States?
2
,.. 1 1 NUU%ru i UCV. tax;yt'J--??o-J5t55 .iul 20 2000 10:58 P. C6
15. Does the project require the plw=cnt of a significant amount of rill in ?
high quality or relatively rare wetland ecosystems, such as mountain bogs
or pinesavannaha?
16. Does the project require stxc= rolocation or clu=ol changes? r
17. Is the proposed action located in an An= of Environmental Concern, ?
as defied in the Coastal Area Management Act?
Cults* Resources
18. Will the projeot have an "effect" on *property or site listed on the ?
National Register of Historic Places?
19. will the proposed action require acquisition of additional right of way ? z
from publicly owned parkland or recreational areas?
Reviewed by; Date: S /o D l
Project Planning Engineer
,? 00-L.:?
TC O
If any questions 2 through 12 are answered "yes", the proposed project does not qualify as a
Non-Major Action. A state environmental assessment (EA) will be required. For assista=,
cont =
William D. Gilmore, P. E.
Manager, Project Development and Envim=ental Analysis Branch
F. 0. Box 252U1
Raleigh, NC 27611
[phone]
Fax: [phone]
Questions in Put C are designed to assist the Engineer in-detertniWng whether a permit or
consultation wit a state or federal resource agency may be required. if any question in Part C is
answered "yes", refer to the Environmental Guidance Section of this document and contact the
apPmPiate individual for assistance.

TFRQ
?0? N NA
?O G
D ?
Pre-Construction Notification (PCN) 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' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian 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
Water Quality Certification. The USACE Individual Permit application form is available online at
http://www.saw.usace.army.miI/wetlands[Perm-app.htm.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at http://www.saw.usace.army.mil/wetlands/reu-tour.htm, or contact one of the field
offices listed at the end of this application. 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 type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://h2o.enr.state. nc.us/ncwetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full tent 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 lacking 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 http://www.saw.usace.army.mil/wetlands/nwpfinalFedReL,pdf.
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/ncwetlands/fees.html. 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: Form Version April 2001
USACE Action ID No. DWQ No. 0 1 0 7 5 6
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
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: 14 , 33
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 (see section VIII - Mitigation), check here: ?
H. Applicant Information
Owner/Applicant Information
Name: NLD0T- F>9-toc-,&_ 10AiNriF_NjkNGi]? uNI -r
Mailing Address: Pc:) & c X 229
51L-rL2 GiN nl?
27 344
Telephone Number: _919 74 Z. - s to o 9 Fax Number: (o 3 - c z 4
E-mail Address: CricIs c?ri e dv4-. Sh?-?. hc. vs
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:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 3 of 12
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: &a Dc-,C A
2. T.I.P. Project Number (NCDOT Only):
I Property Identification Number (Tax PIN):
4. Location
County: 1401,t Nearest Town: 2AeFG/2n
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): s,2 /yv 3 ave rz
P+EnnLI,rLf, GAeF_0E.1G
5. Site coordinates, if available (UTM or Lat/Long): N/A
(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. Describe the existing land use or condition of the site at the time of this application:
2f151Q&N-ri&L Ae-t%A
7. Property size (acres): N
8. Nearest body of water (stream/river/sound/ocean/lake): Per)r>Ls,24, C?*,1E L
9. River Basin: G,4p#-
F ?-
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://li2o.enr.state.ne.us/admin/maps/.)
Page 4 of 12
10. Describe the purpose of the proposed work: 29PLAZA- &0' LMP W I TO x g
2,L. Acv Gui-vf-?2T
11. List the type of equipment to be used to construct the project: 15,,c.AYA-rbiz
12. Describe the land use in the vicinity of this project: 2fAiosnt-naL-
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
N 1A
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application:- N p
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
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
1. Wetland Impacts /4 A,
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
(acres) Located,"ithin
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet)
Type of Wetland***

' List each impact separately and identify temporan• impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For darns, 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:H%v%NiN. fcma.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)
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
(please eciffi-)
GuLV 2 /00 l Eam-ZrtS 4c•

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
ti%N%r.us¢s.Yov. Several internet sites also allow direct download and printing of USGS maps (e.g., w\,?\x.topwzonc.com,
N»F\v.manguest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 220
Page 6 of 12
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S. 141A
Open Water Impact
Site Number
(indicate on ma)
Type of Impact*
ct
;(acres) of
1 Name of Waterbod}

(if applicable) Type of Waterbody
(lake, pond, estuary, sound
bav, ocean. etc.)
1

List each impact separately and taentity temporary impacts. Impacts include. but are not limited to: fill, excavation. dredging,
flooding, drainage, bulkheads, etc.
4. 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.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area
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.
1JD /1l?TFi2/vM'f7y?5c?S - I S?L_,f%4, J&1 6_ULV1SfZ-r
5TIZtLA-n1 Tb BJE nivc/LTE0 A1.auNn FfX,?AuA-T7O-
I r-ae-10- TO ISiE L.iNff- i> w/ i-TIE/L r/4.6)ztL..
Page 7 of 12
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.
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: reducin¢ 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.nc.us/ncwetlaiids/strm.gide. html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
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/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at hup:/Wo.enr.state. nc WN%Ty/index htrn. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
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 Butlers (DWQ Only)
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
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No fS 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 buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* (s uImpct are feet) Multiplier MiRequired
ti ati n
1 3
2 1.5
Total
cone I extends out % teet perpendicular trom 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 (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.
WA
XH. Sewage Disposal (DWQ Only)
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.
ry//I-
XM. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No S
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-do«-n schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
, 0
it A // b- I
/s-- Cr 7
y, n?CC?- 5?lv?a l
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization 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 Clav 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 Sum'
Suite 120 Caswell Forsvth Northampton Vance
Raleigh. NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Dade Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Berrie Dare Lenoir
Post Office Boa 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 Onlv
Page I I of 12
US Fis
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
h and Wildlife Service / National N.
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
[arine 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]
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
CAINLA and NC Coastal Counties
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 276994617
Telephone: [phone]
Fax: [phone]
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
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kernersville, NC 27284-9180 Averv Stokes
Telephone: [phone] Burke Sum
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Wavnesville. NC 28786 Clav Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Ha«vood McDowell Yancey
Page 12 of 12

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STATE OF North CAROLINA
+7 ? !'-x.11 r
? 8 2pUl
DEPARTMENT OF TRANSPORTATION '???FR' UAi,T
MICHAEL F. EASLEY DIVISION OF HIGHWAYS LYNDo TIPPE'rT
GOVERNOR SECRETARY
May 15, 2001
Rob Ridings
N.C. Division of Water Quality
401 Wetlands Unit
1650Mail Server Center
Raleigh, N.C. 27699-1786
Dear Mr. Ridings: 010756
Subject: Hoke Co. - SR 1403 Box Culvert
In an effort to obtain the permits needed for the culvert construction on SR-1403 over
Peddlers Creek in Hoke Co., we are providing the pre construction notification
application and the supporting materials. Construction of the culvert requires that the
stream be diverted during the removal of the existing pipe, and the excavation and
construction phases. All necessary steps have been taken to reduce the impact on the
stream.
To our knowledge there are No High Quality Waters or Outstanding Water Resources
occurring in the project area. We anticipate that these activities will be authorized under
Nationwide Permits numbers 14 and 33.
This letter and a copy of the application materials will be submitted to N.C. Division of
Water Quality, State Historical Preservation Office, U.S. Fish and Wildlife Service, and
U.S. Army Corps. of Engineers for approval.
If you have any questions or comments, or need additional information, please contact
our office at [phone]. Thank you for your cooperation in this matter.
Sincerely,
Art C. King
Division Environmental Officer
Ffi
P.O. BOX 1067, ABFRDF..I?N, Nowrii CAROLINA 28315
PI IONF [phone] 1 -Ax [phone]