20010279 Ver 1_Complete File_20010226

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Michael F. Easley
Governor
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Kerr T. Stevens
Division of Water Quality
April 11, 2001
Surry County
DWQ Project No. 010279
Bridge No. 64 on SR 1408
APPROVAL of 401 Water Quality Certification with Additional Conditions
Mr. Heath Slaughter, Division Environmental Officer
NCDOT Division 11
P.O. Box 250
North Wilkesboro, NC 28659
Dear Mr. Slaughter:
You have our approval, in accordance with the attached conditions and those listed below, to impact 50
linear feet of Roaring Fork Creek in order to replace Bridge No. 64 on SR 1408 in Surry County. The
project should be constructed in accordance with your application dated 15 February 2001. After
reviewing your application, we have decided that this fill is covered by General Water Quality
Certification No. 3289 corresponding to the U.S. Army Corps of Engineers Nationwide Permit Number
14. In addition, you should acquire any other federal, state or local permits before you proceed with your
project including (but not limited to) Sediment and Erosion Control, Non-Discharge and Water Supply
Watershed regulations. This approval will expire with the accompanying 404 permit unless otherwise
specified in the Water Quality Certification.
This approval is valid solely for the purpose and design described in your application (unless modified
below). Should your project change, you must notify the DWQ and submit a new application. If the
property is sold, the new owner must be given a copy of this Certification and approval letter, and is
thereby responsible for complying with all the conditions. If total wetland fills for this project (now or in
the future) exceed one acre, or of total impacts to streams (now or in the future) exceed 150 linear feet,
compensatory mitigation may be required as described in 15A NCAC 2H .0506 (h) (6) and (7). For this
approval to be valid, you must follow the conditions listed in the attached certification and any additional
conditions listed below.
1. In-stream work and land disturbance within the 25-foot wide buffer zone are prohibited during the
trout spawning season of October 15 through April 15, or as otherwise determined by the North
Carolina Wildlife Resources Commission, to protect the egg and fry stages of trout from
sedimentation during construction.
2. 'Storm water should be directed to buffer areas or retention basins and should not be routed directly
into streams.
3. Sedimentation and Erosion Control Guidelines for Sensitive Watersheds (15A NCAC 4B .0024) must
be implemented prior to any ground-disturbing activities to minimize impacts to downstream aquatic
resources. Temporary or permanent herbaceous vegetation should be planted on all bare soil within 5
days of ground-disturbing activities to provide long term erosion control.
4. The culvert required for this project shall be installed in such a manner that the original stream profile
is not altered (i.e. the depth of the channel should not be reduced by a widening of the streambed).
Existing stream dimensions are to be maintained above and below locations of culvert extensions.
5. All work shall be performed during low flow conditions.
North Carolina Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
919-733-1786 (phone), 919-733-6893 (fax), http://h2o.enr.state.nc.us/ncwedands/
Page 2 of 2 _
6. All mechanized equipment operated near surface waters should be regularly inspected and maintained
to prevent contamination of stream waters from fuels, lubricants, hydraulic fluids, or other toxic
materials.
7. The presence of equipment in the channels must be minimized. Under no circumstances should rock,
sand or other materials be dredged from the wetted stream channel under authorization of this permit,
except in the immediate vicinity of the culverts.
8. Mowing of existing vegetated buffers is strongly discouraged, so that they may be utilized for storm
water sheet flow.
9. Use of rip-rap for bank stabilization is to be minimized; rather, native vegetation is to be planted
when practical. If necessary, rip-rap should be limited to the stream bank below the high water mark,
and vegetation should be used for stabilization above high water.
10. Rock silt screens at culvert outlets should be removed at project completion.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory
hearing. You must act within 60 days of the date that you receive this letter. To ask for a
hearing, send a written petition which conforms to Chapter 150B of the North Carolina General
Statutes to the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, N.C.
27699-6714. This certification and its conditions are final and binding unless you ask for a
hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water
Act. If you have any questions, please telephone John Dorney at 919.733.1786.
Sincerely,
Attachment
1
T
cc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
NCDWQ Winston-Salem Regional Office
Central Files
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY P. O. Box 25201, Raleigh, NC 27611-5202 LYNDO TIPPETT
GOVERNOR PHONE: [phone] SECRETARY
February 15, 2001
Mr. Eric Alsmeyer
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls of Neuse Road, Suite 120
Raleigh, NC 27615
Subject: Nationwide Permit #14
Bridge #64 on SR 1408
Surry County, North Carolina
Dear Mr. Alsmeyer:
010279
The North Carolina Department of Transportation, Bridge Maintenance Unit, proposes to replace
the existing substandard bridge #64 on SR 1408 (Ramey Creek Road) with three (3) lines of 142"
x 91" CSPA. Please note that all three lines can be laid on the same elevation (1' below
streambed) without widening the existing stream channel. Due to the proposed work, we are
requesting a 404 Nationwide Permit # 14.
The current bridge crosses Roaring Fork Creek (DEM Class - WS II, Trout). A stringent erosion
and sedimentation control plan will be implemented and maintained during the project
construction and every effort will be made to complete this project in a timely manner.
Attached is a Preconstruction Notification Form, plan sheet with proposed erosion control
measures, CSPA information, a marked county map, a marked topography map and photographs.
By copy of this letter, it is requested that Mr. Ron Linville, Mountain Region Coordinator, with
the North Carolina Wildlife Resources Commission comment directly to you concerning the 404
Nationwide Permit application with a copy sent to me.
By copy of this letter, I am forwarding seven (7) copies of this application package to Cynthia
Van Der Wiele, NCDENR, Division of Water Quality, 401/Wetland Unit, for her review. A
$200.00 check is enclosed for the 401 certification processing fee. It is requested that any
comments related to the 401 certification be forwarded directly to the Corps with a copy sent to
me.
m?
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P. O. BOX 250, N. WILKESBORO, NC 28659
PHONE [phone] FAX [phone]
Mr. Eric Alsmeyer
Bridge #64 on SR 1408
Page 2
February 15, 2001
We would like to begin construction as soon as possible. If further information is required, please
let me know. Your early review and consideration will be greatly appreciated.
Sincerely,
.
Heath Slaughter
Division Environmental Officer
Enclosures
cc: Ron Linville, Western Piedmont Region Coordinator, NCWRC
Renee Gledhill-Earley, Environmental Review Coordinator, NCDCR
Cynthia Van Der Wiele, Division of Water Quality (7 copies)
Brian Cole, U. S. Fish and Wildlife Service
R. C. McCann, PE, Division Engineer
Heath Slaughter, Division Environmental Officer
Neil Trivette, Area Roadside Environmental Engineer
Dennis Bennett, Bridge Maintenance Engineer
ofjj ci
0
DWQ ID: _ CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) 14
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1. NOTIFICATION TO THE CORPS OF ENGINEERS
2. APPLICATION FOR SECTION 401 CERTIFICATION
3. COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE FIELD
OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7)
COPIES MUST BE SENT TO THE NC DIVISION OF WATER QUALITY,
ATTN: JOHN DORNEY, 4401 REEDY CREEK ROAD, RALEIGH, NC
27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: NC DEPARTMENT OF TRANSPROTATION
2. MAILING ADDRESS: PO BOX 250
SUBDIVISION NAME N/A
CITY: North Wilkesboro STATE: NC ZIP CODE: 28659
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
Bridge #64 on SR 1408 (Ramey Creek Road), Surry County.
3. TELEPHONE NUMBER: (HOME) _ (WORK) [phone]
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
Heath Slaughter, Division Environmental Officer
PO BOX 250
North Wilkesboro, NC 28659
[phone]
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Surry - NEAREST TOWN: Low Gap
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) From I-77, turn west on
NC 89, turn left on SR 1338, turn right on SR 1408.
6. IMPACTED OR NEAREST STREAM/RIVER: Roaring Fork Creek
RIVER BASIN: Yadkin
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES ® NO ? IF YES, EXPLAIN: DEM Classification: WS II, Trout.
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO X
(c) IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? N/A
8. (a) HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ? NO X IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION):
(b) ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES ? NO X IF YES, DESCRIBE ANTICIPATED WORK:
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: Approximately 0.2 acres in
permitted areas.
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
0 Acres
10. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: EXCAVATION:
FLOODING: OTHER :
DRAINAGE_ TOTAL ACRES TO BE IMPACTED:
(b) (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: _ FT AFTER:- FT
WIDTH BEFORE (based on normal high water contours): _ FT
AVERAGE DEPTH BEFORE: FT AFTER FT
(b) (2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: _ PLACEMENT OF PIPE IN CHANNEL: X
CHANNEL EXCAVATION: _ CONSTRUCTION OF A DAMIFLOODING:
OTHER: Replacing existing bridge with 3 lines of 142" x 91" CSPA.
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? N/A WHAT IS THE EXPECTED POND SURFACE AREA? N/A
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 81/2 BY 11 DRAWINGS ONLY)
Replacing existing bridge with 3 lines of 142" x 91" CSPA.
13. PURPOSE OF PROPOSED WORK: Improvement of existing stream crossing.
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
N/A
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY FEDERALLY
LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL
HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: By copy of this application.
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA,
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED By copy of this
application.
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF PUBLIC
(STATE) LAND? YES ® NO E] (IF NO, GO TO 18)
(a) IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES ? NO
(b) IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ? NO ?
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO
WETLANDS:
(a) WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES, AND
PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, AND 38).
ALL STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON
THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OF 1 INCH EQUALS 100 FEET
OF THEIR EQUIVALENT.
(b) IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY
PRODUCT.
(c) IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEETS
RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
(d) ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
(e) WHAT IS LAND USE OF SURROUNDING PROPERTY?
(o IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
I. ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2. EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF WATER QUALITY
CERTIFICATION, AND
3. (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM,
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'401 ISSUED' r
3 2 %Q01
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY P. 0. Box 25201, Raleigh, NC 27611-5202 LYNDO TIPPETT
GOVERNOR PHONE: [phone] SECRETARY
February 15, 2001
Mr. Eric Alsmeyer
U. S. Army Corps of Engineers
Raleigh Regulatory Field Office "910279
Falls of Neuse Road, Suite 120
Raleigh, NC 27615
Subject: Nationwide Permit #14
Bridge #64 on SR 1408
Surry County, North Carolina
Dear Mr. Alsmeyer:
The North Carolina Department of Transportation, Bridge Maintenance Unit, proposes to replace
the existing substandard bridge #64 on SR 1408 (Ramey Creek Road) with three (3) lines of 142"
x 91" CSPA. Please note that all three lines can be laid on the same elevation (1' below
streambed) without widening the existing stream channel. Due to the proposed work, we are
requesting a 404 Nationwide Permit #14.
The current bridge crosses Roaring Fork Creek (DEM Class - WS II, Trout). A stringent erosion
and sedimentation control plan will be implemented and maintained during the project
construction and every effort will be made to complete this project in a timely manner.
Attached is a Preconstruction. Notification Form, plan sheet with proposed erosion control
measures, CSPA information, a marked county map, a marked topography map and photographs.
By copy of this letter, it is requested that Mr. Ron Linville, Mountain Region Coordinator, with
the North Carolina Wildlife Resources Commission comment directly to you concerning the 404
Nationwide Permit application with a copy sent to me.
By copy of this letter, I am forwarding seven (7) copies of this application package to Cynthia
Van Der Wiele, NCDENR, Division of Water Quality, 401/Wetland Unit, for her review. A
$200.00 check is enclosed for the 401 certification processing fee. It is requested that any
comments related to the 401 certification be forwarded directly to the Corps with a copy sent to
me.
? -n
C--)
rn
? m
rn?
P. 0. BOX 250, N. WILKESBORO, NC 28659
PHONE [phone] FAX [phone]
Mi. Eric Alsmeyer
Bridge #64 on SR 1408
Page 2
February 15, 2001
We would like to begin construction as soon as possible. If further information is required, please
let me know. Your early review and consideration will be greatly appreciated.
Sincerely,
G' 'Au
Heath Slaughter
Division Environmental Officer
Enclosures
cc: Ron Linville, Western Piedmont Region Coordinator, NCWRC
Renee Gledhill-Earley, Environmental Review Coordinator, NCDCR
Cynthia Van Der Wiele, Division of Water Quality (7 copies)
Brian Cole, U. S. Fish and Wildlife Service
R, C. McCann, PE, Division Engineer
Heath Slaughter, Division Environmental Officer
Neil Trivette, Area Roadside Environmental Engineer
Dennis Bennett, Bridge Maintenance Engineer
.a
V
DWQ ID: _ CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #) 14
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1. NOTIFICATION TO THE CORPS OF ENGINEERS
2. APPLICATION FOR SECTION 401 CERTIFICATION
3. COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE FIELD
OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7)
COPIES MUST BE SENT TO THE NC DIVISION OF WATER QUALITY,
ATTN: JOHN DORNEY, 4401 REEDY CREEK ROAD, RALEIGH, NC
27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: NC DEPARTMENT OF TRANSPROTATION
2. MAILING ADDRESS: PO BOX 250
SUBDIVISION NAME N/A
CITY: North Wilkesboro STATE: NC ZIP CODE: 28659
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
Bridge 964 on SR 1408 (Ramey Creek Road), Surry County.
3. TELEPHONE NUMBER: (HOME) _ (WORK) [phone]
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER
Heath Slaughter, Division Environmental Officer
PO BOX 250
North Wilkesboro, NC 28659
[phone]
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Su_yrr - NEAREST TOWN: Low Gap
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) From I-77, turn west on
NC 89, turn left on SR 1338, turn right on SR 1408.
6. IMPACTED OR NEAREST STREAM/RIVER: Roaring Fork Creek
RIVER BASIN: Yadkin
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-II)? YES ® NO E] IF YES, EXPLAIN: DEM Classification: WS 11, Trout.
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO X
(c) IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION? N/A
8. (a) HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ? NO X IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION):
(b) ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES ? NO X IF YES, DESCRIBE ANTICIPATED WORK:
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: Approximately 0.2 acres in
permitted areas.
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
0 Acres
10. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: EXCAVATION:
FLOODING: OTHER :
DRAINAGE_ TOTAL ACRES TO BE IMPACTED:
(b) (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: _ FT AFTER.- FT
WIDTH BEFORE (based on normal high water contours): _ FT
AVERAGE DEPTH BEFORE: FT AFTER FT
(b) (2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: _ PLACEMENT OF PIPE IN CHANNEL: X
CHANNEL EXCAVATION: _ CONSTRUCTION OF A DAM/FLOODING:
OTHER: Replacing existing bridge with 3 lines of 142" x 91" CSPA.
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? N/A WHAT IS THE EXPECTED POND SURFACE AREA? N/A
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 81/2 BY 11 DRAWINGS ONLY)
Replacing existing bridge with 3 lines of 142" x 91" CSPA.
13. PURPOSE OF PROPOSED WORK: Improvement of existing stream crossing.
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
N/A
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY FEDERALLY
LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL
HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: By copy of this application.
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA,
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED By copy of this
application.
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF PUBLIC
(STATE) LAND? YES ® NO ? (IF NO, GO TO 18)
(a) IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES ? NO
(b) IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ? NO ?
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO
WETLANDS:
(a) WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES, AND
PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, AND 38).
ALL STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON
THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OF 1 INCH EQUALS 100 FEET
OF THEIR EQUIVALENT.
(b) IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY
PRODUCT.
(c) IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEETS
RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
(d) ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
(e) WHAT IS LAND USE OF SURROUNDING PROPERTY?
(0 IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
1. ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2. EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF WATER QUALITY
CERTIFICATION, AND
3. (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM,
OWNER'S/AGENTS gd-NATURE
'-?/is/o/
DATE
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
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