20011227 Ver 1_Complete File_20010815

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Michael F. Easley, Governor
William G. Ross Jr., Secretary.
North Carolina Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D.
Acting Director
Division of Water Quality
February 216 2002
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
Mr. C. E. Lassiter, P.E., Division Engineer
Division 2, NCDOT
P.O. Box 1587
Greenville, NC 27835
Re: Paving and widening of SR 1126 in Pamlico County
DWQ 011227
Dear Mr. Lassiter:
On September 5, 2001 the Division of Water Quality wrote to you concerning your plants to impact .09 acres of
wetlands and/.02 acres of buffers regarding the proposed development in Pamlico County. This letter informed you that
the project was incomplete and was being placed on hold until the additional information outlined in the letter was
supplied. To date, we have not received this additional information. Unless we hear from you in writing within 3 weeks of
the receipt of this letter, we will consider that you no longer want to pursue this project and we will retire the file and
consider the application as withdrawn. Please be aware that reapplication for this project will require a Certification fee
and new applications. -
Please call Mr. Mike Horan of my staff at 919-733-3574 if you would like to discuss this matter.

W 01 Unit Supervisor ,
Cc: File copy -
Central files
Washington DWQ Regional Office '
Washington Regulatory Field Office US Army Corps of Engineers .

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N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone] C
to
NIMEW
ustomer` Service
1 800 623-7748
State of North Carolina
Department of Environment MAF
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross, Jr., Secretary Gregory J. Thorpe, Ph.D., Acting Director NCDENR
September 5, 2001
Mr. C.E. Lassiter, P.E., Division Engineer
Division 2, NCDOT
PO Box 1587
Greenville, NC 27835
Re: Permit Application for paving and widening of SR 1126 in Pamlico County
DWQ No. 011227
Dear Mr. Lassiter:
The Division of Water Quality has reviewed your submittal for a. 401 Water Quality Certification for the
aforementioned project. Review of your application revealed it lacking necessary information required for
making an informed permit decision. The permit application was deficient in the following areas:
The application identifies 750 square feet of proposed impacts to protected riparian buffers. However,
no plan drawings were submitted that indicate the location of the protected buffers and there proximity
to the proposed project. Please project appropriate drawings that display the location of the protected
resources in conjunction with the proposed project work.
The proposed stormwater design does not provide diffuse flow prior to the stormwater entering the
riparian buffers.
Therefore, pursuant to 15A NCAC 2h .0507(a)(5), we will have to place the permit application on hold
until we are supplied the necessary information. Furthermore, until the information is received by the NC
Division of Water Quality, we request (by copy of this letter) that the US Army Corps of Engineers place
the permit application on hold.
Hopefully, we can work together to expedite the processing of your permit application. If you have any
questions or require additional information, please contact John Hennessy at 919-733-5694.
ely,
J Dorney
ate Quality Certific do rrogram
cc: DWQ Washington Regional Office
USACE Washington Field- Office
File Copy
C:\ncdot\SR 1927\correspondence\011214hid.doc
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
1
V'
Office Use Only: Form Version April 2001
USACE Action ID No. DWQ No. 01 12 2 7
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
?3 Fe
I. Processing
1. Check all of the approval(s) requested for this project: AUG 2001
® Section 404 Permit
? Section 10 Permit 9? -
® 401 Water Quality Certification
® Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 18
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: ?
II. Applicant Information
1. Owner/Applicant Information
Name: North Carolina Department of Transportation
Mailing Address: P.O. Box 1587
Greenville. N.C. 27835
Telephone Number: 252 830 3490 Fax Number: 252 830 3341
E-mail Address:
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: Jav Johnson
Company Affiliation: Division 2 Environmental Officer
Mailing Address: Same as above
Telephone Number: Same Fax Number: Same
E-mail Address: ibiohnson(a_,)dot.state.nc.us
r p;` NI ? T
Page 3 of 12 REC.E_NEv

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: Pamlico 1126
2. T.I.P. Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Pamlico Nearest Town: Olympia
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): N.C. 55 east from Newbern
toward Bavboro. Take left on SR 1126 to Project.
5. Site coordinates, if available (UTM or Lat/Long): UTM 18 321361E 3894673N
(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.) Reelsboro Quad
6. Describe the existing land use or condition of the site at the time of this application:Existing
gravel secondary road
7. Property size (acres): N/A
8. Nearest body of water (stream/river/sound/ocean/lake): Upper Broad Creek
9. River Basin: Neuse
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admi.n/maps/.)
Page 4 of 12
e
10. Describe the purpose of the proposed work: Widen existing gravel road
11. List the type of equipment to be used to construct the project: Typical road construction
equipment.
12. Describe the land use in the vicinity of this project: Residential, Agricultural
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.
No previous permits have been issued.
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 additional permit requests are anticipated in the near future.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
Page 5 of 12
r
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Wetland Impacts Fill in 404 wetlands
Wetland Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(es/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
Area 1 Fill .005 Yes < 50' freshwater
Area 2 Fill .08 Yes <50' freshwater
Area 3 Fill .007 Yes <50' freshwater

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://N w .lema.,ov.
*** 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: N/A
Total area of wetland impact proposed: .09 Acre
2. Stream Impacts, including all intermittent and perennial streams N/A
Pipe will not be replaced
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 seci )

* 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, ditch ing/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.aov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
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)
Name Water)
(if applicable) Type of Waterbody
(lake, pond, estuary, sound
bay, ocean, etc.)

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage. bulkheads,. etc.
4. Pond Creation N/A
If construction of a pond is proposed, associated wetland and stream impacts should be
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
infonnation related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
The fill area has been desiened for a minimal amount of fill to allow for a safety standard
for new secondary road constuction. Only the wetland area indicated will be impacted and
the new side ditches will be constructed to flow into a sediment basin and sheet flow over
vegetated uplands prior to entering the wetlands and not directly discharging into any
stream
VIII. Mitigation
Page 7 of 12
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/nc,%A,,etIands/strmgide.htm1.
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.
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
Page 8 of 12
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 http://h2o.enr.state.nc.us/wM/index.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information: N/A
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 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 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 ® 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. Total disturbance will not exceed 40' linear from edge of road
Zone* Impact
(square feet) Multiplier Required
Mitigation
1 3 N/A
2 1.5 N/A
Total 750 N/A
* Zone I extends out 30 f pedicular om near bank of channel; Zone 2 extends an
04
additional 20 feet from a
ge of ne I.
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.
When adequate upland is present in the existing R/W new side ditches from the Proiect will
contain and transport stormwater toward wetlands or streams however the stormwater
will flow through a silt basin and over vegetated uplands prior to entering wetlands or the
stream bufffer area. A detail map is enclosed. When no upland exists to construct side
ditches stormwater will sheet flow over the vegetated road shoulder and into wetlands.
XII. 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.
N/A
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Page 10 of 12
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
Applicant/Age,n)ION atur Date
(Agent's signa We is alid 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 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 Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 11 of 12
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: Date: E
z

A
pplicant/Owner•
-

Cou
n
f;
Investigator: _
'Sd ki't5C' State: - N •C . ---
Do Normal Circumstances exist on the site? Ye No Community ID:
Is the site significantly disturbed (Atypical Situation)? Yes ® Transect ID:
Is the area a potential Problem Area? Yes IQ Plot ID: -
If needed, explain on reverse.
VEGETATION
Dominant Plant Species Stratum Indicator Dominant Plant Species Stratum Indicator

2. r. eft eASA i3-?o 10. - -- -

4. - 12.
- -- -_ - ---
5.- -- --- 13.- - -
6.-- ---- --- - 14.- - -- - - -
7.-- - ---- ---- --- 15.----- - - ----
8. ----- - - --- 16.- -- ---
Percent of Dominant Species that are OBL, FACW or FAC
(excluding FAC-).
7 6-0% --------------------------------
Remarks: VVT L#.,)Z V 73 do* 1419?
HYDROLOGY
- Recorded Data (Describe in Remarks):
- Stream, Lake, or ride Gauge
- Aerial Photographs
LOther
No Recorded Data Available W eland Hydrology Indicators:
Primary Indicators:
- Inundated
- Saturated in Upper 12 Inches
_ Water Marks
_ Drift Lines
_ Sediment Deposits
Field Observations: - Drainage Patterns in Wetlands
Secondary Indicators (2 or more required):
Depth of Surface Water: (in.) _ Oxidized Root Channels in Upper 12 Inches

?f - Water-Stained Leaves
Depth to Free Water in Pit (in.) - Local Soil Survey Data

h
D
S
l
i
?r ? _ FAC-Neutral Test
lain in Remarks)
Other (Ex
ept
to
aturated Soi
: (
n.) p
-
Remarks: V-*Aa"j ' a 6 /0-,3/ 6 A.16v /--?
B2 Appendix B Blank and Example Data Forms
SOILS
Map Unit Name ) ?-
Series and P ase :e rain?g Class:
-
---
---
Iv
Taxonomy (u p -6=111111L" 4 /@ V d ((( Field Observations
014-3 ?--
-
Confirm Mapped Type? Yes No
Profile Descriotion-
Depth Matrix Color Mottle Colors Mottle Abundance/ Texture, Concretions,
(inches) Horizon ' (Munsell Moist) (Munsell Moist) S
ize/Contrast
Structure. etc

Hydric Soil Indicators:
Histosol
_ Histic Epipedon - Concretions
High Organic Content in Surface-Layer in Sandy Soils
- Sulfidic Odor Organic Streaking in Sandy Soils
Aquic Moisture Regime
- Reducing Conditions - Listed on-Local Hydric Soils List
- Listed on National Hydric Soils List
- Gleyed or Low-Chroma Colors _ Ot
her (Explain in Remarks)
Remarks: V c"-ems tf
tjOT
WETLAND DETERMINATION
Hydrophytic Vegetation Present? ® No (Circle) (Circle)
Wetland Hydrology Present? Yes
Hydric Soils Present? Yes ? Is this Sampling Point Within a Wetland? Yes fro
Remarks: 6)al- . V` ' tt-k 10"' C) - -Z, // ?w -_413 Approved by HQUSACE 3/92

Appendix B Blank and Example Data Forms B3
wed'
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: Date: _9??1 1 _
Applicant/Owner: cDor County: --_
Investigator: _ J0 hit !?-2n State: to
•?-. -
Do Normal Circumstances exist on the site? 'GP No Community ID: -
Is the site significantly disturbed (Atypical Situation)? Yes Transect ID:
Is the area a potential Problem Area? Yes o Plot ID:
If needed, explain on reverse.
VEGETATION
Dominant Plant ecies Stratum Indicator Dominant Plant Species Stratum Indicator
c?l±w.. !?/ f
1
/UCed?ar.. c>7 H
?f • A a s
_
.
,
9.4 . - -
10.
3. 01iA e- 3- -

6.&%zz d- 14. - -- ---
7. -- ---- 15.----- -- --- ---
8.-- ------ --- - 16.- - --
Percent of Dominant Species that are OBL, FACW or FAC
(excluding FAC-).
Remarks: k4k a
HYDROLOGY
- Recorded Data (Describe in Remarks):
- Stream, Lake, or Tide Gauge
_ Aerial Photographs
y? Other
,e- Recorded Data Available Wetland Hydrology Indicators:
Primary Indicators:
Inujidated
?turated in upper 12 Inches
_ Water Marks
_ Drift Lines
_ Sediment Deposits
Field Observations: _ Drainage Patterns in Wetlands
?j Secondary Indicators (2 or more required):
Depth of Surface Water: (in.) Ox?Ized Root Channels in Upper 12 Inches
.?tained Leaves
-
Depth to Free Water in Pit: (in.) cal Soil Survey Data
_-<b
_ FAC-Neutral Test
Depth to Saturated Soil: (in.) - Other (Explain in Remarks)
Remarks: 1
B2 Appendix B Blank and Example Data Forms
SOILS
Map Unit Name LL l
ri
S
d Ph
`
Z
'?
'
(
e
es an
ase): __?.fr l
.
O?i ]
L?+?17 L %
woK Drainage Class:
? f
Taxonomy (Subgroup): fft ji , Field Observations
v rµ oc. v L°. `-- Confirm Mapped Type? Yes No
Profile Description:
Depth Matrix Color
(inches) Horizon {Munsell Moist) ( Mottle Colors Mottle Abundance/ Texture, Concretions,
M
l
unse
l Moist) Size/Contrast Structure, etc

Hydric Soil Indicators:
_ Histosol Concretions
- Histic Epipedon - High Organic Content in Surface Layer in Sandy Soils
Sulfidic Odor
c Moisture Regime
R
iucin
Conditi
n go oG9enic Streaking in Sandy Soils

=
rLis ed on Local Hydric Soils List
g
qS
o
s isted on National Hydric Soils List
)eyed or Low-Chroma Colors - Other (Explain in Remarks)
Remarks:
WETLAND DETERMINATION
Hydrophytic Vegetation Present? (91 No (Circle) (Circle)
Wetland Hydrology Present? No
Hydric Soils Present? es No LS this Sampling Point Within a Wetland? 0 No
Remarks:
Approved by HQUSACE 3/92
Appendix B Blank and Example Data Forms B3

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Office Use Only: 01 1227 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 ?,
AUG 1 5 2001
1. Check all of the approval(s) requested for this project:
® Section 404 Permit r
? Section 10 Permit
® 401 Water Quality Certification
® Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 18
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: ?
II. Applicant Information
1. Owner/Applicant Information
Name: North Carolina Department of Transportation
Mailing Address: P.O. Box 1587
Greenville N.C.27835
Telephone Number: 252 830 3490
E-mail Address:
2. Agent Infonnation (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: Jav Johnson
Company Affiliation: Division 2 Environmental Officer
Mailing Address: Same as above
Telephone Number: Same Fax Number: Same
E-mail Address: jbiohnsonAdot state nc us
PAYM ENT
RECEIVED
Fax Number: 252 830 3341
Page 3 of 12
A
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: Pamlico 1126
2. T.I.P. Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Pamlico Nearest Town: Olympia
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): N.C. 55 east from Newbern
toward Bayboro. Take left on SR 1126 to project.
5. Site coordinates, if available (UTM or Lat/Long): UTM 18 321361E 3894673N
(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.) Reelsboro Quad
6. Describe the existing land use or condition of the site at the time of this application:Existin
gravel secondary road
7. Property size (acres):
8. Nearest body of water (streanl/river/sound/ocean/lake): Upper Broad Creek
9. River Basin: N
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admi.n/maps/.)
Page 4 of 12
10. Describe the purpose of the proposed work: Widen existing gravel road
11. List the type of equipment to be used to construct the project: Typical road construction
equipment.
12. Describe the land use in the vicinity of this project: Residential, Agricultural
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.
No previous permits have been issued.
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 additional permit requests are anticipated in the near future.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
Page 5 of 12
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Wetland Impacts Fill in 404 wetlands
Wetland Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(es/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
Area 1 Fill .005 Yes < 50' freshwater
Area 2 Fill .08 Yes <50' freshwater
Area 3 Fill .007 Yes <50' freshwater

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http:,'%?tiw?i.fema.sov.
*** 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: N/A
Total area of wetland impact proposed: .09 Acre
2. Stream Impacts, including all intermittent and perennial streams N/A
Pipe will not be replaced
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 seci

* List each impact separately and identity temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.us.Qs.nov. Several internet sites also allow direct download and printing of USGS maps (e.g., wivw.tooozone.com,
www.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
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)
Name Water)
(if applicable) Type of Waterbody
(lake, pond, estuary, sound
bay, ocean, etc.)

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads,,etc.
4. Pond Creation N/A
If construction of a pond is proposed, associated wetland and stream impacts should be
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.
The fill area has been designed for a minimal amount of fill to allow for a safety standard
for new secondary road constuction. Only the wetland area indicated will be impacted and
the new side ditches will be constructed to flow into a sediment basin and sheet flow over
vegetated uplands prior to entering the wetlands and not directly discharging into any
stream
VIII. Mitigation
Page 7 of 12
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/ncwetlands/strm?*ide.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.
N/A
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
Page 8of12
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 http://h2o.enr.state.nc.us/wile/index.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information: N/A
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
coc cdinator at [phone] to review current thresholds for environmental documentation.
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and 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 ® 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. Total disturbance will not exceed 40' linear from edge of road
Zone* Impact
(square feet) Multiplier Required
Mitigation
1 3 N/A
2 1.5 N/A
Total 750 N/A
* Zone I extends out 30 feet pedicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or .0260.
XI. Stormwater (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.
When adeauate upland is present in the existing R/W new side ditches from the Proiect will
contain and transport stormwater toward wetlands or streams however the stormwater
will flow through a silt basin and over vegetated uplands prior to entering wetlands or the
stream bufffer area. A detail map is enclosed. When no upland exists to construct side
ditches stormwater will sheet flow over the vegetated road shoulder and into wetlands.
XII. 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.
N/A
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Page 10 of 12
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
Applicant/Agen aturr , Date
(Agent's signa s talid 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 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 Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 11 of 12
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: -.?k ?t --- - - Date: a
Applicant/Owner County: I&s-
Investigator: State: A) c..
Do Normal Circumstances exist on the site? Ye No Community ID:
Is the site significantly disturbed (Atypical Situation)? Yes ( Transect ID:
Is the area a potential Problem Area? Yes IQ Plot ID: -?
If needed, explain on reverse.
VEGETATION
Dominant Plant Species Stratum Indicator Dominant Plant Species Stratum Indicator
1.61%..9 ro...1."
2. (hAn -
rn?.d/ a&4-A!'-w 3.0 9.- -
10. - -- -- -
4.---
5. --
_ 12. - ---
13.

6.- - --
---- ---- -
14.-
-

7.--- ----
8. -----
--- ---
- -- -
- ----
15.------
16.
-- --
Percent of Dominant Species that are OBL, FACN or FAC
(excluding FAC-). ? 070
> G ----____________________
Remarks: V-rr L*eM51Z) V J . 3 )4?
HYDROLOGY
- Recorded Data (Describe in Remarks):
_ Stream, Lake, or Tide Gauge
_ Aerial Photographs
LOther
No Recorded Data Available Wetland Hydrology Indicators:
Primary Indicators:
- Inundated
_ Saturated in Upper 12 Inches
_ Water Marks
_ Drift Lines
_ Sediment Deposits
Field Observations: _ Drainage Patterns in Wetlands
44 Secondary Indicators (2 or more required):
Depth of Surface Water. (in.)
A _ Oxidized Root Channels in Upper 12 Inches
Water-Stained Leaves
Depth to Free Water in Pit: >>a (in.) _
_ Local Soil Survey Data
_ FAC-Neutral Test
Depth to Saturated Soil: (in.) - Other (Explain in Remarks)
Remarks: vjf? t'7416 /0-?iv r l,. /V15i ?C-
B2 Appendix B Blank and Example Data Forms
SOILS
Map Unit Name
(Series and
Pa s e):, d rainage Class:
A
J6
Taxonomy( p): '
((( Field Observations
V O
IL)
?
-- --
- -- Confirm Mapped Type? Yes No
Profle Description-
Depth Matrix Color
(inches) Horizon' (Munsell Moist)
Mottle Colors Mottle Abundance/ Texture, Concretions,
(Munsell Moist) Si
C
ze/
ontrast Structure. etc.

Hydric Soil Indicators:
_ F istosol
- Histic Epipedon Concretions
High Organic Content in Surface Layer in Sandy Soils .
- Sulfidic Odor
Aquic Moisture Regime - Organic Streaking in Sandy Soils
Listed on Local Hydric Soils List
Reducing Conditions
- Gleyedor Love-Chroma Colors Listed on National Hydric Soils List
- Other (Explain in Remarks)
Remarks: VJ e4 lm., . 5 a 6 i(s c,*,-- /V o + /
WETLAND DETERMINATION
Hydrophytic Vegetation Present? ® No (Circle) (Circle)
Wetland Hydrology Present? Yes
Hydric Soils Present? Yes Is this Sampling Point Within a Wetland? Yes (moo
Remarks: jogl,% V- ? la'V-01 - a..// -'AvS Gt v..t? XjO'?'?i•G
Approved by HQUSACE 3/92
Appendix B Blank and Example Data Forms B3
w'N".,dz
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: SR // C' Date: 'fl le-l

Applicant/Owner: ?f1 e. o _ _
County: Pw.:"A
Investigator: -? 1n S State: !y .e. -
Do Normal Circumstances exist on the site? No Community ID:
Is the site significantly disturbed (Atypical Situation)? Yes Transect ID:
Q
Is the area a potential Problem Area? Yes o Plot ID:
(If needed, explain on reverse.
VEGETATION
Dominant Plant Species _ Stratum Indic
tor Dominant Plant Species Stratum Indicator
a
1. e4?aEr.? GI H C?iW?+ 6V _ft A 0
2.1 a S _ dlJ, ia.t ?i? ?.
A
5.A
6.
???. 9.--- _
10.
- -- -
13.
14.
- - -

7.-- -- ---- 15. -- - ---
8.-- ------ --- - 16.- --
Percent of Dominant Species that are OBL, FACW or FAC
(excludin FAC-).
Remarks: V.l A-V'd VWJ ?*3 ,?-
HYDROLOGY
- Recorded Data (Describe in Remarks):
- Stream, Lake, or Tide Gauge
_ Aerial Photographs
Other
No Recorded Data Available Wetland Hydrology Indicators:
Primary Indicators:
Inundated
_,-t-aturated in Upper 12 Inches
_ Water Marks
- Drift Lines
_ Sediment Deposits
Field Observations: - Drainage Patterns in Wetlands
Secondary Indicators (2 or more required):
Depth of Surface Water: (in.) O)Oi ized Root Channels in Upper 12 Inches
.:' at tained Leaves
Depth to Free Water in Pit: (in.) - oval Soil Survey Data
_ FAC-Neutral Test
Depth to Saturated Soil: (in.) - Other (Explain in Remarks)
Remarks: 1
B2 Appendix B Blank and Example Data Forms
SOILS
Map Unit Name LL l/
(Series and Phase): Q/?o?!LTZ+?y1 LIJfiGN Drainage Class:
440 , . - --- Taxonomy (Subgroup):v ?Ytdjs"- V rit Oc. Field Observations
Confirm Mapped Type? Yes No
Profile Description.
Depth Matrix Color Mottle Colors Mottle Abundance/ Texture, Concretions,
(inches) Horizon (Munsell Moist) (Munsell Moist) Size/Contrast Structure, etc.
Hydric Soil Indicators:
Histosol Concretions
Histic Epipedon High Organic Content in Surface Layer in Sandy Soils
Sulfidic Odor 0009anic Streaking in Sandy Soils
_Aptric Moisture Regime =rLis ed on Local Hydric Soils List
Racing Conditions fisted on National Hydric Soils List
)eyed or Low-Chroma Colors _ Other (Explain in Remarks)
Remarks: 9?? . .
WETLAND DETERMINATION
HydrophyUc Vegetation Present? & No (Circle) (Circle)
Wetland Hydrology Present? No
Hydric Soils Present? es No Is this Sampling Point Within a Wetland? G No
Remarks: (A ?4,V -4 / Gt ?d
Approved by HOUSACE 3/92
Appendix B Blank and Example Data Forms B3
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A
Office Use Only: Form Version April 2001
USACE Action ID No. DWQ No.O 1 1227
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
AUG
1. Check all of the approval(s) requested for this project:
® Section 404 Permit
? Section 10 Permit
® 401 Water Quality Certification
® Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 18
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: ?
II. Applicant Information
1. Owner/Applicant Information
Name: North Carolina Department of Transportation
Mailing Address: P.O. Box 1587
Greenville N.C.27835
Telephone Number: 252 830 3490 Fax Number: 252 830 3341
E-mail Address:
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: Jav Johnson
Company Affiliation: Division 2 Environmental Officer
Mailing Address: Same as above
Telephone Number: Same Fax Number: Same
E-mail Address: jbiohnson(&dot.state.nc.us
Page 3 of 12
PAYMENT
RECEIVED
r. '
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: Pamlico 1126
2. T.I.P. Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Pamlico Nearest Town: Olympia
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): N.C. 55 east from Newbern
toward Bavboro. Take left on SR 1126 to proiect.
5. Site coordinates, if available (UTM or Lat/Long): UTM 18 321361E 3894673N
(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.) Reelsboro Quad
6. Describe the existing land use or condition of the site at the time of this application: Existing
gravel secondary road
7. Property size (acres): N/A
8. Nearest body of water (stream/river/sound/ocean/lake): Upper Broad Creek
9. River Basin: Neuse
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
Page 4 of 12
10. Describe the purpose of the proposed work: Widen existing gravel road
11. List the type of equipment to be used to construct the project: Typical road construction
equipment.
12. Describe the land use in the vicinity of this project: Residential, Agricultural
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.
No previous permits have been issued.
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 additional permit requests are anticipated in the near future.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
Page 5 of 12
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Wetland Impacts Fill in 404 wetlands
Wetland Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(yes/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
Area 1 Fill .005 Yes < 50' freshwater
Area 2 Fill .08 Yes <50' freshwater
Area 3 Fill .007 Yes <50' freshwater

List each impact separately and identity temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http:,-w??w.fema.,ov.
*** 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: N/A
Total area of wetland impact proposed: .09 Acre
2. Stream Impacts, including all intermittent and perennial streams N/A
Pine will not be replaced
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 seci )

* List each impact separately and identity 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, ditch ing/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.2ov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapcuest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
Page 6 of 12
I 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)
Name Wat)
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.)

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads,,etc.
4. Pond Creation N/A
If construction of a pond is proposed, associated wetland and stream impacts should be
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 constriction (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.
The fill area has been designed for a minimal amount of fill to allow for a safetv standard
for new secondary road constuction. Only the wetland area indicated will be impacted and
the new side ditches will be constructed to flow into a sediment basin and sheet flow over
vegetated uplands prior to entering the wetlands and not directly discharging into any
stream
VIII. Mitigation
Page 7 of 12
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.etir.state.nc.us/ncwetlands/strmgTide.htmi.
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.
N/A
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
Page 8 of 12
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 http://h2o.enr.state.ne.us/xM/index.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information: N/A
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 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 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 ® 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. Total disturbance will not exceed 40' linear from edge of road
Zone* Impact
(square feet) Multiplier Required
Mitigation
1 3 N/A
2 1.5 N/A
Total 750 N/A
* Zone 1 extends out 30 feet pedicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B.0242 or.0260.
XI. Stormwater (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.
When adequate upland is present in the existing R/W new side ditches from the Proiect will
contain and transport stormwater toward wetlands or streams however the stormwater
will flow through a silt basin and over vegetated uplands prior to entering wetlands or the
stream bufffer area. A detail map is enclosed. When no upland exists to construct side
ditches stormwater will sheet flow over the vegetated road shoulder and into wetlands.
XII. 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.
N/A
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Page 10 of 12
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
Applicant/Agen valid aturDate
(Agent's se is 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 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 Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
NC 27889-1000
Washington 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
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 11 of 12
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: Date: aL_?
Applicant/Owner-
h
i
I County
A) e
rLs Y. _
nvest
gator: -.
State:
-_-
Do Normal Circumstances exist on the site? Ye No Community ID:
Is the site significantly disturbed (Atypical Situation)? Yes 40 Transect ID:
Is the area a potential Problem Area? Yes IQ Plot ID:
If needed, explain on reverse.)
VEGETATION
Dominant Plant Species Stratum Indicator Dominant Plant Species Stratum Indicator
1.4}y:,' r
2.r. ems. ??r ?. -_ ?RCi w
!? Id ,O 9. - -
10.- -- --

3.?wti/s.rG hw.riV --
??ie. 3.0 -
11.

4.--- ----
5.
----
---
---- --__---
12.-- --- - ---
13.- -
-
6.-- ----
7.
- ----
---- ----
---- - -
14.- -- -- -- ----
15.----
----
8.- ------ ---- -- 16.- -- -- --
Percent of Dominant Species that are OBL, FACW or FAC
(excluding FAC-). ?j
------ - -
------

?,?kr?? tij eG .
Remarks:
tSL?"^
?
HYDROLOGY
- Recorded Data (Describe in Remarks):
_ Stream, Lake, or Tide Gauge
_ Aerial Photographs
LOther
- No Recorded Data Available Wetland Hydrology Indicators:
Primary Indicators:
_ Inundated
- Saturated in Upper 12 Inches
_ Water tvvlarks
_ Drift Lines
_ Sediment Deposits
Field Observations: - Drainage Patterns in Wetlands

411 Secondary Indicators (2 or more required):
10 (in.)
Depth of Surface Water: 1 - Oxidized Root Channels in Upper 12 Inches
Water-Stained Leaves
Depth to Free Water in Pit: (in.) -
- Local Soil Survey Data
_ FAC-Neutral Test
Depth to Saturated Soil: (in.) - Other (Explain in Remarks)
Remarks: V, T / ?d ?? v ! 6 N? ???
E32 Appendix B Blank and Example Data Forms
SOILS
Map Unit Name c

e ..
(Series and P ase):
_ ? •??,t. r/ ?.n
m
raa Cla
:

????.._ /f
Taxonomy( u J?p_ !"R ?@
?'r--'- -_--
g
ss
t
? O?J?-? - Field Observations
-?-_ Confirm Mapped Type? Yes No
Profile Deserintn'
Depth Matrix Color
in
h i Horizon ' (Munsell Moist) Mottle Colors Mottle Abundance/ Texture, Concretions,
(Munsell Moist) Size/Cont
t
u
ras
Str
cture. etc.
nc

Hydric Soil Indicators:
Histosol
- Histic Epipedon
Sulfidic Odor - Concretions
High Organic Content in Surface Layer in Sandy Soils
-
Aquic Moisture Regime - Organic Streaking in Sandy Soils
Listed on Local Hydric Soils List
- Reducing Conditions
- Gleyed or Low-Chroma Colors - Listed on National Hydric Soils List
- Other (Explain in Remarks)
Remarks: J C ?t? 5a t Gtr °t? )11 O '1'
WETLAND DETERMINATION
Hydrophytic Vegetation Present? ® No (Circle) (Circle)
Wetland Hydrology Present? Yes
Hydric Soils Present? Yes Is this Sampling Point Within a Wetland? Yes IGO .L
Remarks: ?r3y? CA-r tan-d ?.$ ,L10 •?.??,vtii
approved by HQUSACE 3/92
Appendix S Blank and Example Data Forms B3
waW.,d>
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: Date:
Applicant/Owner: ?tlc, -o - County:
Investigator: - ? Jo hn S State: A- .e -
Do Normal Circumstances exist on the site? No Community ID: -
Is the site significantly disturbed (Atypical Situation)? Yes Transect ID:
Is the area a potential Problem Area? Yes o Plot ID:
(If needed, explain on reverse.
VEGETATION
Dominant Plant Species Stratum Indicator Dominant Plant Species Stratum Indicator
1. ICXecrsiw.. ? t/?r. 6V a
2 9.- -- -
10.
3.Gk_____?rL.f.r3n
4.y/?xGeTYr`!?ivi_.y_-
S.- T / , Q

13.-- - -- -
7.-
--
- 15.
-
-
-- - --- ---
8. ------ --- - 16.- -- --
Percent of Dominant Species that are OBL, FACW or FAC 7,
(excluding FAC-). ________
Remarks:
HYDROLOGY
- Recorded Data (Describe in Remarks):
- Stream, Lake, or Tide Gauge
_ Aerial Photographs
Other
Recorded Data Available Wetland Hydrology Indicators:
Primary Indicators:
Inundated
:?aturated in Upper 12 Inches
_ Water Marks
_ Drift Lines
- Sediment Deposits
Field Observations: _ Drainage Patterns in Wetlands
Secondary Indicators (2 or more required):
Depth of Surface Water: (in.) OXIi sized Root Channels in Upper 12 Inches
: at twined Leaves
Depth to Free Water in Pit /n I/ (in.) - oval Soil Survey Data
_ FAC-Neutral Test
Depth to Saturated Soil: (in.) - Other (Explain in Remarks)
Remarks:
?? .??
B2 Appendix B Blank and Example Data Forms
SOILS
F p Unit Name
ri
d Ph
'?
es an
e
ase): _ ?
O?611 L iJ?N Drainage Class: _
•
Taxonomy (Subgroup):y? Field Observations
V.'i4 Gt J ?` Confirm Mapped Type? Yes No
Profile Description:
Depth Matrix Color
(inches) Horizon fM a1Q Nbistl Mottle Colors Mottle Abundance/ Texture, Concretions,
(Munsell Moist) Si
ze/Contrast Structure. etc

Hydric Soil Indicators:
Histosol Concretions
Histic Epipedon _ High Organic Content in Surface Layer in Sandy Soils
Sulfidic Odor
c Moisture Regime O is Streaking in Sandy Soils
is ed on Local Hydric Soils List
A(_ Re}uDing Conditions =
fisted on National Hydric Soils List
_ ie<eyed or LowrChroma Colors - Other (Explain in Remarks)
Remarks:
WETLAND DETERMINATION
Hydrophytic Vegetation Present? No (Circle) (Circle)
Wetland Hydrology Present? No
Hydric Soils Present? es No Is this Sampling Point Within a Wetland? G No
Remarks:
Approved by HQUSACE 3/92
Appendix B Blank and Example Data Forms B3
' 1{o Gar r t ,. J R h L'y ?y(
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?2? e?`+ < ct £w a i?y i' ? ,c ? w r•;?,' .5 y- .
r t 3 f? ,t,+ Y ??
Cr6
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c1?` .Y r,,, '@??41` •t$: .fir .. ? ?. _ ? x H , - r l i; °£> ?. f r -.
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GoA
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Office Use Only: 0 1 1L^L^ ,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.
1. Processing
1. Check all of the approval(s) requested for this project: AUG
® Section 404 Permit
? Section 10 Permit
® 401 Water Quality Certification
® Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 18
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: ?
II. Applicant Information
1. Owner/Applicant Information
Name: North Carolina Department of Transportation
Mailing Address: P.O. Box 1587
Greenville N.C.27835
Telephone Number: 252 830 3490 Fax Number: 252 830 3341
E-mail Address:
2. Agent Information (A signed and dated copy of the Agent Authorization letter, must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: Jav Johnson
Company Affiliation: Division 2 Environmental Officer
Mailing Address: Same as above
Telephone Number: Same Fax Number: Same
E-mail Address: jbiohnsonAdot.state.nc.us
14?11<<'1" s
Page.) of 12 c?

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: Pamlico 112
2. T.I.P. Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Pamlico Nearest Town: Olympia
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): N.C. 55 east from Newbern
toward Bayboro. Take left on SR 1126 to project.
5. Site coordinates, if available (UTM or Lat/Long): UTM 18 321361E 3894673N
(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.) Reelsboro Quad
6. Describe the existing land use or condition of the site at the time of this application: Existing
gravel secondary road
7. Property size (acres)
N/A
8. Nearest body of water (stream/river/sound/ocean/lake): Upper Broad Creek
9. -River Basin: Neuse
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admi.n/maps/.)
Page 4 of 12
10. Describe the purpose of the proposed work: Widen existing gravel road
11. List the type of equipment to be used to construct the project: Typical road construction
equipment.
12. Describe the land use in the vicinity of this project: Residential, Agricultural
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.
No previous permits have been issued.
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 additional permit requests are anticipated in the near future.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
Page 5 of 12
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Wetland Impacts Fill in 404 wetlands
Wetland Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(yes/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
Area 1 Fill .005 Yes < 50' freshwater
Area 2 Fill .08 Yes <50' freshwater
Area 3 Fill .007 Yes <50' freshwater

* List each impact separately and identity 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 httu:i/w?ti w.fema.cov.
*** 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: N/A
Total area of wetland impact proposed: .09 Acre
2. Stream Impacts, including all intermittent and perennial streams N/A
Pipe will not be replaced
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 seci

* List each impact separately and identity temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.us,s._ov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
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)
Name Water)
(if applicable) Type of Waterbody
(lake, pond, estuary, sound
bay, cean, etc.)

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads,.etc.
4. Pond Creation N/A
If construction of a pond is proposed, associated wetland and stream impacts should be
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
Describe the method of construction (e.g., dam/embankment, excavation,
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.
The fill area has been designed for a minimal amount of fill to allow for a safety standard
for new secondary road constuction. Only the wetland area indicated will be impacted and
the new side ditches will be constructed to flow into a sediment basin and sheet flow over
vegetated uplands prior to entering the wetlands and not directly discharging into any
stream
VIII. Mitigation
? wetlands
installation of
Page 7 of 12
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:,I/h2o.enr.state.nc.us/ncwetlands/strmt=ide.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.
N/A
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
Page 8 of 12
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 http://h2o.enr.state.nc.us/wrp/index.him. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information: N/A
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 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 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 ® 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. Total disturbance will not exceed 40' linear from edge of road
Zone* Impact
(square feet) Multiplier Required
Mitigation
1 3 N/A
2 1.5 N/A
Total 750 N/A
* Zone 1 extends out 30 feet pedicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or .0260.
XI. Stormwater (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.
When adequate upland is present in the existing R/W new side ditches from the Proiect will
contain and transport stormwater toward wetlands or streams however the stormwater
will flow through a silt basin and over vegetated uplands prior to entering wetlands or the
stream bufffer area. A detail map is enclosed. When no upland exists to construct side
ditches stormwater will sheet flow over the vegetated road shoulder and into wetlands.
XII. 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.
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Page 10 of 12
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
Applicant/Agen iaturr Date
(Agent's signa We is?/alid 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 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 Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh
NC 27615 Chatham Granville Orange Wake
,
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page I 1 of 12
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: _SR ZZ (z __--- Date: L_-
Applicant/Owner-
Investigator: County:
State: N .C .

Do Normal Circumstances exist on the site? Ye No Community ID: -
Is the site significantly disturbed (Atypical Situation)? Yes (Q Transect ID:
Is the area a potential Problem Area? Yes IQ Plot ID: --
(If needed, explain on reverse.)
VEGETATION
Dominant Plant Species Stratum Indicator Dominant Plant Species Stratum Indicator
r /
2. r1t+, ni..+G ?. _ (442Am!-e. 10-
-- --
3.?wt:ls.?c Ir1w.r.w5c -_
3. {.fi ire. 3• -
11.--
a.--- ---- -- -- -
12.- - - ---
5. --- --r- 13.-- -
6.-- -- --- ---- 14.- - -- - -
7.-- ---- ---- --- 15.--- - - - ----
8.- ----- ---- ---- 16.- -- -- -
Percent of Dominant Species that are OBL, FACW or FAC ?j
(excluding FAC-). ---- ------------ ---------
Remarks: wpAt--M Z? V
11
HYDROLOGY
- Recorded Data (Describe in Remarks):
_ Stream, Lake, or Tide Gauge
_ Aerial Photographs
LOther
- No Recorded Data Available Wetland Hydrology Indicators:
Primary Indicators:
_ Inundated
- Saturated in Upper 12 Inches
_ Water (vtarks
_ Drift Lines
_ Sediment Deposits
Field Observations: - Drainage Patterns in Wetlands
44 Secondary Indicators (2 or more required):
A
Depth of Surface Water. (in.) - Oxidized Root Channels in Upper 12 Inches

? I _ Water-Stained Leaves
(in.)
Depth to Free Water in Pit: - Local Soil Survey Data
_ FAC-Neutral Test
Depth to Saturated Soil: (in.) - Other (Explain in Remarks)
Remarks: w-P 1476t 610-v t 6 /VOi
B2 Appendix B Blank and Example Data Forms
SOILS
Map Unit Name ) e) / /
Series and
P
ase ( rainnaa-'.-Class:
)
Taxonomy (u JtP
O? Field Observations
l Confirm Mapped Type? Yes No
Profile Description:
Depth Matrix Color Mottle Colors Mottle Abundance/ Texture, Concretions,
(inchei) Horizon' (Munsell Moist) (Munsell Moist)
i
S
ze/Contrast Structure. etc.

Hydric Soil Indicators:
Histosol - Concretions
Mstic Epipedon
- Sultidic Odor High Organic Content in Surface Layer in Sandy Soils
Organic Streaking in Sandy Soils
Aquic Moisture Regime Listed on'Local Hydric Soils List
- Reducing Conditions Listed on National Hydric Soils List
- Gleyedo
r Low-Chroma Colors - Other (Explain in Remarks)
l!
Remarks: 7 &'C I a 6 u-V N
WETLAND DETERMINATION
Hydrophytic Vegetation Present? ® No (Circle) (Circle)
Wetland Hydrology Present? Yes
Hydric Soils Present? Yes ? Is this Sampling Point Within a Wetland? Yes ITo
Remarks: tA- 10"' d - 9:1- // /Ik'* 1+^ e16ev$ Gw-t? N0 ?-??S yyJr
Approved by HQUSACE 3/92
Appendix B Blank and Example Data Forms 133
W'N"Js
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: SW // 6 Date: R/
/"
Applicant/Owner: L11 d- P'Q ?
County:
Investigator: State: IV e-. -
Do Normal Circumstances exist on the site? No Community ID: _
Is the site significantly disturbed (Atypical Situation)? Yes Transect ID:
Is the area a potential Problem Area? Yes o Plot ID:
If needed, explain on reverse.)
VEGETATION
Dominant Plant Species Stratum Indicator Dominant Plant Species Stratum Indicator
1. y R a , 1s °
2 g. --- - _
10.

s.-A??TTi / t ?i_
v3P+? 13.---- ----- -
/ -
14.
7.-- --- --- -- 15. -- ---- - ---
Percent of Dominant Species that are OBL, FACW or FAC
(excluding FAC-).
----------------------------------------
Remarks: Q-
HYDROLOGY
- Recorded Data (Describe in Remarks):
- Stream, Lake, or Tide Gauge
_ Aerial Photographs
Other
,eltiRecorded Data Available Wetland Hydrology indicators:
Primary Indicators:
_ Inundated
-1aturated in upper 12 inches
_ Water Marks
_ Drift Lines
_ Sediment Deposits
Field Observations: _ Drainage Patterns in Wetlands
Secondary Indicators (2 or more required):
Depth of Surface Water: (in.) 04ized Root Channels in Upper 12 Inches
_vGVat Stained Leaves
Depth to Free Water in Pit: (in.) - ocal Soil Survey Data
FAC-Neutral Test
Depth to Saturated Soil: -?(in.) - Other (Explain in Remarks)
Remarks:
62 Appendix B Blank and Example Data Forms
SOILS
Map Unit Name f
(Series and Phase): 4103004'1' Drainage Class:
Taxonomy (Subgroup):y vYt IAjS V ri4 0u. u s Field Observations
-- Confirm Mapped Type? Yes No
Profile Description:
Depth Matrix Color Mottle Colors Mottle Abundance/ Texture, Concretions,
(inches) Horizon (Munsell Moist) (Munsell Moist Size/Contrast Structure, etc
---
Hydric Soil Indicators:
Histosol Concretions
- Histic Epipedon - High Organic Content in Surface Layer in Sandy Soils
Sulfidic Odor s O?genic Streaking in Sandy Soils
c Moisture Regime ?Lis ed on Local Hydric Soils List
j(_ R}euang Conditions -Tilted on National Hydric Soils List
-*e^Gieyed or Low-Chroma Colors - Other (Explain in Remarks)
Remarks:
WETLAND DETERMINATION
Hydrophytic Vegetation Present? (11 No (Circle) (Circle)
Wetland Hydrology Present? No
Hydric Soils Present? es No Is this Sampling Point Within a Wetland? G No
Remarks: 6kl-e 4.V_4
Approved by HQUSACE 3/92
Appendix B Blank and Example Data Forms B3
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Office Use Only: 011227 Form Version April 2001
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project, please enter "Not Applica,: " "N/A" rather than
leaving the space blank. ti {
1. Processing 1
rr ' L
1. Check all of the approval(s) requested for this project:
® Section 404 Permit
J t Z 'i
? Section 10 Permit
® 401 Water Quality Certification
® Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 18
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: ?
II. Applicant Information
1. Owner/Applicant Information
Name: North Carolina Department of Transportation
Mailing Address: P.O. Box 1587
Greenville, N.C. 27835
Telephone Number: 252 830 3490
E-mail Address:
Fax Number: 252 830 3341
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: Jav Johnson
Company Affiliation: Division 2 Environmental Officer
Mailing Address: Same as above
Telephone Number: Same Fax Number: Same
E-mail Address: ibiohnsonAdot.state.nc.us
Page 3 of 12 e

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: Pamlico 1126
2. T.I.P. Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Pamlico Nearest Town: Olympia
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): N.C. 55 east from Newbern
toward Bavboro. Take left on SR 1126 to project.
5. Site coordinates, if available (UTM or Lat/Long): UTM 18 321361E 3894673N
(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.) Reelsboro Quad
6. Describe the existing land use or condition of the site at the time of this application:Existing
gravel secondary road
7. Property size (acres): N/A
8. Nearest body of water (streani/river/sound/ocean/lake): Upper Broad Creek
9. River Basin: Neuse
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
Page 4 of 12
10. Describe the purpose of the proposed work: Widen existing gravel road
11. List the type of equipment to be used to construct the project: Typical road construction
equipment.
12. Describe the land use in the vicinity of this project: Residential, Agricultural
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.
No previous permits have been issued.
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 additional permit requests are anticipated in the near future.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
Page 5 of 12
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Wetland Impacts Fill in 404 wetlands
Wetland Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(es/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
Area 1 Fill .005 Yes < 50' freshwater
Area 2 Fill .08 Yes <50' freshwater
Area 3 Fill .007 Yes <50' freshwater

* 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 hitp: -''w?sw.fema.,ov.
*** 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: N/A
Total area of wetland impact proposed: .09 Acre
2. Stream Impacts, including all intermittent and perennial streams N/A
Pipe will not be replaced
Stream Impact Site
Number
(indicate on ma) T e of
Impact* Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)

* List each impact separately and identity 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, ditch ing/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usas.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., w-4w.topozone.com,
www.mapgtiest.coin, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
Page 6 of 12
I 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)
Name Wat)
(if applicable) Type of Waterbody
(lake, pond, estuary, sound
bay, ocean, etc.)

List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads,.etc.
4. Pond Creation N/A
If construction of a pond is proposed, associated wetland and stream impacts should be
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.
The fill area has been designed for a minimal amount of fill to allow for a safetv standard
for new secondary road constuction. Only the wetland area indicated will be impacted and
the new side ditches will be constructed to flow into a sediment basin and sheet flow over
vegetated uplands prior to entering the wetlands and not directly discharging into any
stream
VIII. Mitigation
Page 7 of 12
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/ncwetlands/strmg=ide.htm1.
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.
N/A
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
Page 8 of 12
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 http://h2o.enr.state.nc.us/wiro/index.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information: N/A
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 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 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B :0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify V
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. Total disturbance will not exceed 40' linear from edge of road
Zone* Impact
(square feet) Multiplier Required
Mitigation
1 3 N/A
2 1.5 N/A
Total 750 N/A
* Zone 1 extends out 30 feet pedicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or .0260.
XI. Stormwater (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.
When adequate upland is present in the existing R/W new side ditches from the Proiect will
contain and transport stormwater toward wetlands or streams however the stormwater
will flow through a silt basin and over vegetated uplands prior to entering wetlands or the
stream bufffer area. A detail map is enclosed. When no upland exists to construct side
ditches stormwater will sheet flow over the vegetated road shoulder and into wetlands.
XII. 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.
N/A
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Page 10 of 12
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
Applicant/Agen iaturr Date
(Agent's signa s alid 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 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 Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 11 of 12
r?
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: Date:
j--_
Applicant/Owner-
I
ti -
County: ee__
A)
nves
gator: 0. _ State: -
Do Normal Circumstances exist on the site? Ye No Community ID:
Is the site significantly disturbed (Atypical Situation)? Yes Q Transect ID:
Is the area a potential Problem Area? Yes IQ Plot ID: _
If needed, explain on reverse.)
VEGETATION
Dominant Plant Species Stratum Indicator Dominant Plant Species Stratum Indicator
1..]leg" --
2. rhea. es-Ac- OrJ a Awe w
Ltlr .0 9 - - - -
10.

3.?Irt.?s.?G kL.?:.?Ve?L _
? lie. 3• ? -- -- -
11. - _ -
4.-- --
5.--- --
-- 12. ---
13.- -
6.-- --
7.
-
- ---- ----
---- -- 14.- - -- -- ----
15.
-- -
-
8.- ---- -
---- --- ------
16.- - -- --
Percent of Dominant Species that are OBL, FACW or FAC
(excluding FAC-). j
6-V110
-------------------------
Remarks: VVXPwsM)z) V
11 7.5 am l?
HYDROLOGY
- Recorded Data (Describe in Remarks):
- Stream, Lake, or Tide Gauge
_ Aerial Photographs
LOther
No Recorded Data Available Wetland Hydrology Indicators:
Primary Indicators:
_ Inundated
- Saturated in Upper 12 Inches
_ Water Nbrks
_ Drift Lines
- Sediment Deposits
Field Observations: - Drainage Patterns in Wetlands
??"/? Secondary Indicators (2 or more required):
Depth of Surface Water. A ? (in.) _ Oxidized Root Channels in Upper 12 Inches
_ Water-Stained Leaves
Depth to Free Water in Pit: ! ?(in.) - Local Soil Survey Data

i _ FAC-Neutral Test
lain in Remarks)
Other (Ex
Depth to Saturated Soil: n.)
( p
-
Remarks: VJt44
B2 Appendix B Blank and Example Data Forms
SOILS
Map Unit Name J / '_ / 41-1 `
Series and P ase)?([?,/jf?p??- ?? n-ag'e-Class:

Taxonomy (u Vtp Field Observations
Confirm Mapped Type? Yes No
Profile Description-
Depth Matrix Color Mottle Colors Mottle Abundance/ Texture, Concretions,
(inchesl Horizon (Munsell Moist) (Munsell Moist) Size/Contrast Str
t
t
uc
ure. e
c.
- --- - /O vie
?
-_ _-- i •
O ?+w?
MIAk
_
JJ
Hydric Soil Indicators:
_ Histosol Concretions
Histic Epipedon
- Sulfidic Odor ` High Organic Content in Surface 'Layer in Sandy Soils
_ Organic Streaking in Sandy Soils
- Aquic Moisture Regime Listed on Local Hydric Soils List
- Reducing Conditions - Listed on National Hydric Soils List
- Gteyed or Low-Chroma Colors _ Other (Explain in Remarks)
Remarks: -vi t!+ IMJ .561 45 V O
WETLAND DETERMINATION
Hydrophytic Vegetation Present? r:]5> No (Circle) (Circle)
Wetland Hydrology Present? Yes
Hydric Soils Present? !! Yes is this Sampling Point Within a Wetland? Yes Lf
Remarks: ?)T d - Gt,?? ?? w• c t-'s Gts .-tom A)O +-??S o•vd'
Approved by HQUSACE 3/92
Appendix B Blank and Example Data Forms 133
w {ids
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: _S-/? Date: ?

Applicant/Owner: Lt1c.A ?
County: ?.
Investigator: - 6'V J, State: 1y.?.
Do Normal Circumstances exist on the site? No Community ID:
Is the site significantly disturbed (Atypical Situation)? Yes Transect ID:
Is the area a potential Problem Area? Yes o Plot ID:
If needed, explain on reverse.
VEGETATION
Dominant Plant Species
Stratum Indi
ator Dominant Plant Species Stratum Indicator
c
?w
?
g_ ,1, c?L/ (ill 1?
1
lC
?v
? O 9
.
, ,
-
! .
10.
ZX%
44_11
---

7.-- -- --- -- 15.--- ----- - ---
8.- ----- --- --
Percent of Dominant Species that are DBL. FACW or FAC
_(excludin g FAC-).
------------------------------------------
Remarks: I
HYDROLOGY
- Recorded Data (Describe in Remarks):
- Stream, Lake, or Tide Gauge
_ Aerial Photographs
Other
Recorded Data Available Wetland Hydrology Indicators:
Primary Indicators:
_ Inulidated
aturated in Upper 12 Inches
_ Water Marks
_ Drift Lines
_ Sediment Deposits
Field Observations: _ Drainage Patterns in Wetlands
Secondary Indicators (2 or more required):
Depth of Surface Water: '" / • (in.) Oxidized Root Channels in Upper 12 Inches
.-7Vztt Stained Leaves
Depth to Free Water in Pit: (in.) ocal Soil Survey Data
_ FAC-Neutral Test
Depth to Saturated Soil: (in.) - Other (Explain in Remarks)
Remarks:?G?i .??
B2 Appendix B Blank and Example Data Forms
SOILS
Map Unit Name y l
(Seri
s and Ph
e
ase): Drainage Class: _
?r
Taxonomy (Subgroup): 1t-A 15_
V Field Observations
ru Oc. V ar _ ,?_?_ Confirm Mapped Type? Yes No
Profile Descriotion-
Depth Matrix Color
(inches) Horizon (Munsell Moist) ( Mottle Colors Mottle Abundance/ Texture, Concretions,
M
ll
unse
Moist) Size/Contrast Structure, t
o -1 --- ?a _- _? - - - -
Hydric Soil Indicators:
Histosol Concretions
Histic Epipedon
Sulfidic Odor _ High Organic Content in Surface Layer in Sandy Soils

Agqa?ttc Moisture Regime
f-R
ucm
j
Conditions OO"nic Streaking in Sandy Soils
7-e ed on Lcoal Hydric Soils List
e
?
g fisted on National Hydric Soils List
_ke,C;leyed or Low-Chroma Colors - Other (Explain in Remarks)
Remarks:
WETLAND DETERMINATION
Hydrophytic Vegetation Present? C91 No (Circle) (Circle)
Wetland Hydrology Present? No
Hydric Soils Present? es No Is this Sampling Point Within a Wetland? S No
Remarks:
Approved by HQUSACE 3/92
Appendix B Blank and Example Data Forms B3
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PROJECT: SR 1126 OLYMPIA ROAD AND SR 1151 OLD CROSS ROAD PAMLICO COUNTY
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Office Use Only: 0 1 1 2 2 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 _.
l . Check all of the approval(s) requested for this project:
® Section 404 Permit ' ?`'?`
? Section 10 Permit f
® 401 Water Quality Certification ?'
® Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 18
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: ?
II. Applicant Information
1. Owner/Applicant Information
Name: North Carolina Department of Transportation
Mailing Address: P.O. Box 1587
Greenville. N.C. 27835
Telephone Number: 252 830 3490 Fax Number: 252 830 3341
E-mail Address:
2. Agent Information (A signed and dated copy of the Agent Authorization letter_ must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: Jav Johnson
Company Affiliation: Division 2 Environmental Officer
Mailing Address: Same as above
Telephone Number: Same Fax Number: Same
E-mail Address: ibiohnson(a dot.state.nc.us
??qy?
F y.
Page 3 of 12 rC?f? ?i
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: Pamlico 1126
2. T.I.P. Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Pamlico Nearest Town: Olympia
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): N.C. 55 east from Newbern
toward Bayboro. Take left on SR 1126 to project.
5. Site coordinates, if available (UTM or Lat/Long): UTM 18 321361E 3894673N
(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.) Reelsboro Quad
6. Describe the existing land use or condition of the site at the time of this application: Existin?
gravel secondary road
7. Property size (acres): N/A
8. Nearest body of water (stream/river/sound/ocean/lake): Upper Broad Creek
9. River Basin: Neuse
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admi.n/maps/.)
Page 4 of 12
10. Describe the purpose of the proposed work: Widen existing gravel road
11. List the type of equipment to be used to construct the project: Typical road construction
equipment.
12. Describe the land use in the vicinity of this project: Residential, Agricultural
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.
No previous permits have been issued.
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 additional permit requests are anticipated in the near future.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
Page 5 of 12
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Wetland Impacts Fill in 404 wetlands
Wetland Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(es/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
Area I Fill .005 Yes < 50' freshwater
Area 2 Fill .08 Yes <50' freshwater
Area 3 Fill .007 Yes <50' freshwater

_
I T

List each impact separately and identity temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http:/%www.fema.sov.
*** 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: N/A
Total area of wetland impact proposed: .09 Acre
2. Stream Impacts, including all intermittent and perennial streams N/A
Pipe will not be replaced
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 seci

* 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, ditch ing/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.q?ov. Several internet sites also allow direct download and printing of USGS maps (e.g., w,,Nlv.topozone.com,
www.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
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) Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.)

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads,, etc.
4. Pond Creation N/A
If construction of a pond is proposed, associated wetland and stream impacts should be
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.
The fill area has been designed for a minimal amount of fill to allow for a safetv standard
for new secondary road constuction. Only the wetland area indicated will be impacted and
the new side ditches will be constructed to flow into a sediment basin and sheet flow over
vegetated uplands prior to entering the wetlands and not directly discharging into any
stream
VIII. Mitigation
Page 7 of 12
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/ncwetiands/strm?Tide.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.
N/A
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
Page 8 of 12
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 http:Hh2o.enr.state.ne.us/wrp/index.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information: N/A
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 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 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 ® 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. Total disturbance will not exceed 40' linear from edge of road
Zone* Impact
(s uare feet) Multiplier Required
Mitigation
1 3 N/A
2 1.5 N/A
Total 750 N/A
* Zone 1 extends out 30 feet pedicular from near bank of channel. Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B.0242 or.0260.
XI. Stormwater (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.
When adequate upland is present in the existing R/W new side ditches from the Proiect will
contain and transport stormwater toward wetlands or streams however the stormwater
will flow through a silt basin and over vegetated uplands prior to entering wetlands or the
stream bufffer area. A detail map is enclosed. When no upland exists to construct side
ditches stormwater will sheet flow over the vegetated road shoulder and into wetlands.
XII. 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.
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Page 10 of 12
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
Applicant/Age n atur Date
(Agent's signa a is alid 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 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 Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 1 I of 12
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: -5-k-L ;-(&--____ Date:
Applicant/Owner
i County:
C
N
St
t
?OLS
gator: _
Invest , __-
.
e:
a
Do Normal Circumstances exist on the site? Ye No Community ID:
Is the site significantly disturbed (Atypical Situation)? Yes ( Transect ID:
Is the area a potential Problem Area? Yes IQ Plot ID: --
If needed, explain on reverse.)
VEGETATION
Dominant Plant Species Stratum Indicator Dominant Plant Species Stratum Indicator

0. o.1,46 --
1. T-
OJ aie?3 w
9.- -- ----
2. r. ems. G. Jr n -_ ? 10.- --
3.?Irti?i?l. kLrssr_ _ 'q-w1'eVA -'!5rO. 3•D 11. - -

5.- - _-- 13.- -
6.-- - --- ---- 14.- -- -- -- - -
7.-- --- ---- --- 15.------
8.- ----- - - --- 16.- - --- ---
Percent of Dominant Species that are OBL, FACW or FAC
(excluding FAC-). ?
Remarks: v1JXAN-)Z) V
HYDROLOGY
- Recorded Data (Describe in Remarks):
- Stream, Lake, or Tide Gauge
_ Aerial Photographs
_,--Other
- No Recorded Data Available Wetland Hydrology Indicators:
Primary Indicators:
_ Inundated
- Saturated in Upper 12 Inches
_ Water Marks
_ Drift Lines
_ Sediment Deposits
Field Observations: - Drainage Patterns in Wetlands
?` Secondary Indicators (2 or more required):
Depth of Surface Water. /r 0 (in.) - Oxidized Root Channels in Upper 12 Inches

/ _ Water-Stained Leaves
Depth to Free Water in Pit: (in.) _ Local Soil Survey Data

i _ FAC-Neutral Test
lain in Remarks)
Other (Ex
Depth to Saturated Soil: (
n.) p
-
Remarks: V-"-A t?d 6 ?a? v l 6 A-)*i A-e-p
B2 Appendix B Blank and Example Data Forms
SOILS
Map Unit Name c /
(Series and P ase)
rrgrpGvJ raina
eCla
:? ,J
Taxonomy( u J?p, ?e g
ss: _
Field Observations
Confirm Ma
ed T
?
pp
ype
Yes No
Profile Description=
Depth Matrix Color
(inches) Horizon' (Munsell Moist) Mottle Colors Mottle Abundance/ Texture, Concretions,
(Munsell Moist) Size/Contrast St
t
ruc
ure, etc.
- --- /D vie Y ?I^2s
S
s..
.
A
Hydric Soil Indicators:
Hstosol
Histic Epipedon
Sulfidic Odor Concretions
High Organic Content in Surface Layer in Sandy Soils .

Aquic Moisture Regime Organic Streaking in Sandy Soils
- Listed on Local Hydric Soils List
Reducing Conditions
_ Gleyed or Low-Chroma Colors ` Listed on National Hydric Soils List
_ Other (Explain in Remarks)

Gt y J13 O 'T
Remarks: Vj erg-1 ac'J 56 g, 45
WETLAND DETERMINATION
Hydrophytic Vegetation Present? (:5;> No (Circle) (Circle)
Wetland Hydrology Present? Yes
Hydric Soils Present? Yes is this Sampling Point Within a Wetland? Yes Igo"
Remarks: f)r3vl 10""C) e?S ..?? ?d •?
Approved by HQUSACE 3/92
Appendix 8 Blank and Example Data Forms B3
W'4'J"'Jr.
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: Date:
Applicant/Owner: Ll1C' County: ?.?...d ?.
Investigator: -y?5 140 q State:
Do Normal Circumstances exist on the site? `19-P No Community ID: r
Is the site significantly disturbed (Atypical Situation)? Yes Transect ID:
Q
Is the area a potential Problem Area? Yes o Plot ID:
If needed, explain on reverse.
VEGETATION
0 minant Plent S ecies Stratum Indicator Dominant Plant Species Stratum Indicator
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--
Percent of Dominant Species that are OBL, FACW or FAC 7,
(excluding FAC-).
Remarks: • l•3
HYDROLOGY
- Recorded Data (Describe in Remarks):
_ Stream, Lake, or Tide Gauge
_ Aerial Photographs
Other
y_/ No Recorded Data Available Wetland Hydrology Indicators:
Primary Indicators:
Inultdated
_Ae-1-aturated in Upper 12 Inches
_ Water Marks
_ Drift Lines
_ Sediment Deposits
Field Observations: _ Drainage Patterns in Wetlands
?f Secondary indicators (2 or more required):
Depth of Surface Water: Oxi ized Root Channels in Upper 12 Inches
__.t G at twined Leaves
Depth to Free Water in Pit: (in.) - oval Soil Survey Data
FAC-Neutral Test
Depth to Saturated Soil: _(in.) - Other (Explain in Remarks)
Remarks:
B2 Appendix B Blank and Example Data Forms
SOILS
Map Unit Name f? l
(Series and Phase): ?i?p!L! rr+-+rf L I?/N Drainage Class: _
• Field Observations
Taxonomy (Subgroup): Confirm Mapped Type? Yes No
Profile D cerinfinn-
Depth Matrix Color Mottle Colors Mottle Abundance/ Texture, Concretions,
(inches) Horizon LM=!-Moist) {Munsell Moist) Size/Contrast Structure- err-
0 -iA o ---
Hydric Soil Indicators:
Histosol Concretions
Histic Epipedon - High Organic Content in Surface Layer in Sandy Soils
Sulfidic Odor so is Streaking in Sandy Soils
c Moisture Regime -?[i?s ed on Local Hydric Soils List
YRcing Conditions --Listed on National Hydric Soils List
eyed or Low•Chroma Colors - Other (Explain in Remarks)
Remarks: "? 51 / V- . .
WETLAND DETERMINATION
Hydrophytic Vegetation Present? (91 No (Circle) (Circle)
Wetland Hydrology Present? No
Hydric Soils Present? es No Is this Sampling Point Within a Wetland? CD No
Remarks:
Approved by HQUSACE 3/92
Appendix B Blank and Example Data Forms B3
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Office Use Only: Form Version April 2001
USACE Action ID No. DWQ No.0 1 12 2 7
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
",g l'r ir?i i[
1. Processing
AW r
1. Check all of the approval(s) requested for this project: r` ?Of
® Section 404 Permit ' F
? Section 10 Permit
® 401 Water Quality Certification
® Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 18
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: ? _
II. Applicant Information
1. Owner/Applicant Information
Name: North Carolina Department of Transportation
Mailing Address: P.O. Box 1587
Greenville. N.C. 27835
Telephone Number: 252 830 3490 Fax Number: 252 830 3341
E-mail Address:
2. Agent Information (A signed and dated copy of the Agent Authorization letter_ must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: Jav Johnson
Company Affiliation: Division 2 Environmental Officer
Mailing Address: Same as above
Telephone Number: Same Fax Number: Same
E-mail Address: jbiohnso0,0ot.state.nc.us
t-? 1
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: Pamlico 1126
2. T.I.P. Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): N
4. Location
County: Pamlico Nearest Town: Olympia
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): N.C. 55 east from Newbern
toward Bayboro. Take left on SR 1126 to proiect.
5. Site coordinates, if available (UTM or Lat/Long): UTM 18 321361E 3894673N
(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.) Reelsboro Quad
6. Describe the existing land use or condition of the site at the time of this application:Existing
gavel secondary road
7. Property size (acres):
8. Nearest body of water (stream/river/sound/ocean/lake): Upper Broad Creek
9. River Basin: Neuse
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
Page 4 of 12
10. Describe the purpose of the proposed work: Widen existing gravel road
11. List the type of equipment to be used to construct the project: Typical road construction
equipment.
12. Describe the land use in the vicinity of this project: Residential, Agricultural
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.
No previous permits have been issued.
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 additional permit requests are anticipated in the near future.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
Page 5 of 12
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Wetland Impacts Fill in 404 wetlands
Wetland Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(es/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
Area 1 Fill .005 Yes < 50' freshwater
Area 2 Fill .08 Yes <50' freshwater
Area 3 Fill .007 Yes <50' freshwater

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http -w%kw.fema.,ov.
*** 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: N/A
Total area of wetland impact proposed: .09 Acre
2. Stream Impacts, including all intermittent and perennial streams N/A
Pipe will not be replaced
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 seci

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions. etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usas.aov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
Page 6 of 12
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 p Waterbody
applicable) Type of Waterbody

(lake, pond, estuary, sound,
bay, ocean, etc.)

List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads,.etc.
4. Pond Creation N/A
If construction of a pond is proposed, associated wetland and stream impacts should be
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.
The fill area has been designed for a minimal amount of fill to allow for a safetv standard
for new secondary road constuction. Only the wetland area indicated will be impacted and
the new side ditches will be constructed to flow into a sediment basin and sheet flow over
vegetated uplands prior to entering the wetlands and not directly discharging into any
VIII. Mitigation
Page 7 of 12
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/ncwetlands/strms.,ide.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.
N/A
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
Page 8 of 12
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 hitp://h2o.enr.state.nc.us/wr2/index.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information: N/A
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 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 2B .0233
(Meuse), 15A NCAC 213 .0259 (Tar-Pamlico), 15A NCAC 2B :0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify V
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. Total disturbance will not exceed 40' linear from edge of road
Zone* Impact
(square feet) Multiplier Required
Mitigation
1 3 N/A
2 1.5 N/A
Total 750 N/A
* Zone I extends out 30 feet pedicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (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.
When adeauate upland is present in the existing! R/W new side ditches from the Proiect will
contain and transport stormwater toward wetlands or streams however the stormwater
will flow through a silt basin and over vegetated uplands prior to entering wetlands or the
stream bufffer area. A detail map is enclosed. When no upland exists to construct side
ditches stormwater will sheet flow over the vegetated road shoulder and into wetlands.
XII. 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.
N/A
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Page 10 of 12
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
Applicant/Agen i atur Date
(Agent's signa a is U lid 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 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 Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 11 of 12
r?
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: _59_Z A&_-_? _ Date: a

Applicant/Owner- MC r
I
ti
t _
County: t es -
N
S
nves
or:
ga tate: _
Do Normal Circumstances exist on the site? Ye No Community ID: _Y
Is the site significantly disturbed (Atypical Situation)? Yes Q Transect ID:
Is the area a potential Problem Area? Yes IQ Plot ID:
(If needed, explain on reverse.)
VEGETATION
Dominant Plant Species Stratum Indicator Dominant Plant Species Stratum Indicator
1..k.. b. I- -4.4 s 34-y A4.3 » 9.- - - -
2. N. ?. ?..?.... _ ?_ dr, 50
v
? 10. - -- -
3. ?wt? ls.+c 4.? N!X _ -_ ,
J
7"?'?i lie. 3• d 11. --- - -
-
5.- 13.-
6.- -- --- --- 14.- - - - -
7.
--- --- - 15.
-
-- -
8.
---
- - --- ----
----
16.
-
- -
- -- --
Percent of Dominant Species that are OBL. FACW or FAC
(excluding FAG-). ?j
!!!0---------------------------------
Remarks: U1Tvw-w;:) V P.? .
11 S l /'"'?
HYDROLOGY
- Recorded Data (Describe in Remarks):
- Stream, Lake, or Tide Gauge
_ Aerial Photographs
Other
-LNo Recorded Data Available Wetland Hydrology Indicators:
Primary Indicators:
_ Inundated
- Saturated in Upper 12 Inches
_ Water Marks
_ Drift Lines
_ Sediment Deposits
Field Observations: - Drainage Patterns in Wetlands
Secondary Indicators (2 or more required):
Depth of Surface Water. (in.) _ Oxidized Root Channels in Upper 12 Inches
Water-Stained Leaves
Depth to Free Water in Pit: > ?a (in.) _
- Local Soil Survey Data
•? _ FAC-Neutral Test
Depth to Saturated Soil: (in.) - Other (Explain in Remarks)
Remarks: 1470t6 /*7v t 6 N? ??-'
B2 Appendix B Blank and Example Data Forms
SOILS
Map Unit Name ,//_ ?- /
(Series and P ase):? _ I?? Sq,Np(i? rainage Class: -?
Taxonomy( u J?p ±?_ __ ?R ?e tJ O!J?? (( Field Observations
-??- '-- --?- Confirm Mapped Type? Yes No
Profile D ription*
Depth Matrix Color Mottle Colors Mottle Abundance/ Texture, Concretions,
finChej) Horizon' (Munsell Moist) (Munsell Moist Size/Contrast Structure. etc.
Hydric Soil Indicators:
- Histosol Concretions
- Histic Epipedon - High Organic Content in Surface Layer in Sandy Soils
- Sulfidic Odor Organic Streaking in Sandy Soils
Aquic Moisture Regime - Listed on Local Hydric Soils List
Reducing Conditions Listed on National Hlydric Soils List
- Gleyed or Low-Chroma Colors - Other (Explain in Remarks)
Remarks: VJ e4jet4 , $0645 Gty-e- eV 0 +
WETLAND DETERMINATION
Hydrophytic Vegetation Present? ® No (Circle) (Circle)
Wetland Hydrology Present? Yes
Hydric Soils Present? Yes ? Is this Sampling Point Within a Wetland? Yes IPo
Remarks: t, )U-A", CA-Y" 101v?d c?ft-vS e"'G- IvO
Approved by HQUSACE 3/92
Appendix B Blank and Example Data Forms B3
itieN'd°
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)
Project/Site: - SW // Co Date:
d?

Applicant/Owner: Lt1 p7 ._
County: /. ?&
Investigator: - ?gy .f o n?j ?? State: 1y •C'-. `
Do Normal Circumstances exist on the site? No Community ID:
Is the site significantly disturbed (Atypical Situation)? Yes Transect ID:
Is the area a potential Problem Area? Yes o Plot ID:
If needed, explain on reverse.
VEGETATION
D minant Plant ecies Stratum Ind' for Dominant Plant Species Stratum Indicator

__-
10.
3. XCII.4 • ? +^-"?_ i rites 3• ° 11. - -
-

6. [Nv s 4?/Qrar4w.i(t ?{???t[_?• • 14. - -- ---

8. ------ ---- - 16.- ?-
Percent of Dominant Species that are OBL. FACW or FAC
(excluding FAC-).
------------ ---------------------------
Remarks:
HYDROLOGY
- Recorded Data (Describe in Remarks):
_ Stream, Lake, or Tide Gauge
_ Aerial Photographs
Other
,NZNo Recorded Data Available Wetland Hydrology Indicators:
Primary Indicators:
Inundated
?;e turated in Upper 12 Inches
_ Water Marks
_ Drift Lines
- Sediment Deposits
Field Observations: - Drainage Patterns in Wetlands
Secondary Indicators (2 or more required):
Depth of Surface Water: (in.) O)Wi ized Root Channels in Upper 12 Inches
eUVat tained Leaves
Depth to Free Water in Pit: (in.) _ ocal Soil Survey Data

,` _ FAC-Neutral Test
(in.)
Depth to Saturated Soil: 3 - Other (Explain in Remarks)
Remarks:
B2 Appendix B Blank and Example Data Forms
SOILS
Map Unit Name
ri
(S
d Ph
es an
e
ase):
o Drainage Class: _

Taxonomy (Subgroup): ?lz
- Field Observations
veyt Ou V Z°- Confirm Mapped Type? Yes No
----
Profile Description-
Depth Matrix Color
(inches) Horizon (Munsell Moist) ( Mottle Colors Mottle Abundance/ Texture, Concretions,
M
l
unse
l Moist) Size/Contrast Structure- et
o -iA o
Hydric Soil Indicators:
Histosol Concretions
- Hlistic don - High Organic Content in Surface Layer in Sandy Soils
Sulfdic Odor
AAvtc Moisture Regime
Re cin
Conditions O is Streaking in Sandy Soils
=-Lis ed on Local Hydric Soils List
g isted on National Hydric Soils List
)eyed or Low-Chroma Colors - Other (Explain in Remarks)
Remarks:
WETLAND DETERMINATION
Hydrophytic Vegetation Present? No (Circle) (Circle)
Wetland Hydrology Present? No
Hydric Soils Present? es No Is this Sampling Point Within a Wetland? Ye,, No
Remarks:
Approved by HQUSACE 3/92
Appendix B Blank and Example Data Forms B3

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