20041683 Ver 1_Complete File_20041018

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November 10,2004
Halifax County
DWQ Project No. 041683
APPROVAL of 401 Water Quality Certification
Mr. James H. Trogdon, III, P.E. Division Engineer
NCDOT, Division 4
PO Box 3165
Wilson, NC 27895-3165
Dear Mr. Trogdon:
You have our approval, in accordance with the conditions listed below, for the following impacts for the purpose of
upgrading SR 1322 (Medoc State Park Road) in Halifax County.
Impact Locations Stream Impacts (Linear Feet) Riparian Buffer Impacts (Square Feet)
Site 1 (STA 81+00 -L) 16 4, 14 (2,593 Zone 1 + 1,621 Zone 2)
Site 2 (STA 96+35 -L) 16 4.,0 5 (2,494 Zone 1 + 1,561 Zone 2)
The project shall be constructed in accordance with your application dated received October 18, 2004. After
reviewing your application, we have decided that the stream impacts and riparian buffer impacts described are
covered by General Water Quality Certification Numbers 3404 and 3366. This certification corresponds to the
Nationwide Permit 14 and the Nationwide Permit 33 issued by the Corps of Engineers. This approval is also valid
for the Tar-Pamlico River Buffer Rules (15A NCAC 2B .0259). In addition, you should acquire any other federal,
state or local permits before you proceed with your project including (but not limited to) Sediment and Erosion
Control, Non-Discharge and Water Supply Watershed regulations. This approval will expire with the accompanying
404 permit, unless otherwise specified in the Water Quality Certification.
This approval is valid solely for the purpose and design described in your application (unless modified below).
Should your project change, you must notify the DWQ and submit a new application. If the property is sold, the
new owner must be given a copy of this Certification and approval letter, and is thereby responsible for complying
with all the conditions. If total wetland fills for this project (now or in the future) exceed one acre, or of total
impacts to streams (now or in the future) exceed 150 linear feet, compensatory mitigation may be required as
described in 15A NCAC 2H .0506 (h) (6) and (7). For this approval to remain valid, you must adhere to the
conditions listed in the attached certification.
1.) Upon completion of the project, the NCDOT shall complete and return the enclosed "Certification of
Completion Form" to notify DWQ when all work included in the 401 Certification has been completed. The
responsible party shall complete the attached form and return it to the 401/Wetlands Unit of the Division of
Water Quality upon completion of the project.
2.) All stormwater runoff shall be directed to sheetflow through stream buffers at nonerosive velocities, unless
approved otherwise by this certification.
3.) During the construction of the project, no staging of equipment of any kind is permitted in waters of the U.S., or
protected riparian buffers.
None hCarolina
Transportation Permitting Unit NatuCally
1650 Mail Service Center, Raleigh, North Carolina 27699.1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: htto://h2o.enr.state.nc.us/ncvvetlands
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
n_ r-.._I n___..•.. _:?.:nu:..-_•:.._ .-- 1-1 PL.....-AM not ?....• n ............... 0.......
4.) Riparian vegetation must be reestablished within the construction limits of the project by the end of the growing
season following completion of construction.
5.) The dimension, pattern and profile of the stream above and below the crossing should not be modified by
widening the stream channel or reducing the depth of the stream. Disturbed floodplains and streams should be
restored to natural geomorphic conditions.
6.) Any riprap used must not interfere with thalweg performance and aquatic life passage during low flow
conditions.
7.) All mechanized equipment operated near surface waters must be regularly inspected and maintained to prevent
contamination of stream waters from fuels, lubricants, hydraulic fluids, or other toxic materials.
8.) Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or adjacent to surface
waters is prohibited.
9.) The outside buffer, wetland or water boundary located within the construction corridor approved by this authorization shall
be clearly marked by orange fabric fencing prior to any land disturbing activities. Impacts to areas within the fencing are
prohibited unless otherwise authorized by this certification.
10.) There shall be no excavation from or waste disposal into jurisdictional wetlands or waters associated with this
permit without appropriate modification of this permit. Should waste or borrow sites be located in wetlands or
stream, compensatory mitigation will be required since it is a direct\impact from road construction activities.
11.) Pursuant to NCACI5A 2B.02593(6), sediment and erosion control devices shall not be placed in Zone 1 of any
Tar-Pamlico Buffer without prior approval by the NCDWQ. At this time, the NCDWQ has approved no
sediment and erosion control devices in Zone 1, outside of the approved project impacts, anywhere on this
project. Moreover, sediment and erosion control devices shall be allowed in Zone 2 of the buffers provided that
Zone 1 is not compromised and that discharge is released as diffuse flow.
12.) Heavy equipment must be operated from the banks rather than in the stream channel in order to minimize
sedimentation and reduce the likelihood of introducing other pollutants into the stream.
13.) Placement of culverts and other structures in waters, streams, and wetlands must be placed below the elevation
of the streambed by one foot for all culverts with a diameter greater than 48 inches, and 20 percent of the
culvert diameter for culverts having a diameter less than 48 inches, to allow low flow passage of water and
aquatic life. Design and placement of culverts and other structures including temporary erosion control
measures shall not be conducted in a manner that may result in dis-equilibrium of wetlands or stream beds or
banks, adjacent to or upstream and down stream of the above structures. The applicant is required to provide
evidence that the equilibrium shall be maintained if requested in writing by DWQ.
14.) No live or fresh concrete shall come into contact with waters of the state until the concrete has hardened
15.) The presence of equipment in the channels must be minimized. Under no circumstances must 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.
16.) All work shall be performed during low or normal flow conditions.
17.) All fill slopes located in jurisdictional wetlands shall be placed at slopes no flatter than 3:1.
18.) A copy of this Water Quality Certification shall be posted on the construction site at all times. In addition, the
Water Quality Certification and all subsequent modifications, if any, shall be maintained with the Division
Engineer and the on-site project manager.
19.) For 16 linear feet of stream at Site 1 and 16 linear feet of stream at Site 2 being impacted due to site dewatering
activties, the site shall be graded to its preconstruction contours and revegetated with native vegetation.
20.) All protected riparian buffers impacted by the placement of temporary fill or clearing activities shall be restored
to the preconstruction contours and revegetated with native woody species upon completion of the project
construction. A post-construction as-built with the restoration activities included shall be submitted to the
DWQ no later than 60 days after the project is closed out by the Department of Transportation.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must
act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition that conforms
to Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, P.O. Box 27447,
Raleigh, N.C. 27611-7447. This certification and its conditions are final and binding unless you ask for a hearing.
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 contact Nicole Thomson at 919-715-3415.
nce ely,
gym'
Ian W. Klimek; P.E.
JEH/njt
Attachment
cc: Wilmington District, US Army Corps of Engineers
Mr. Eric Alsmeyer, US Army Corps of Engineers, Raleigh Field Office
Mr. Jamie Shern, Division 4 Environmental Officer, PO Box 3165, Wilson, NC 27895-3165
NC DWQ Raleigh Regional Office
Central Files
File Copy
c ACorrespondence\D W Q041683\110504wgc.doc
14
. STATE o
STATE of NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPETT
GOVERNOR SECRETARY
DIVISION 4
Mr. Mike Bell
U.S. Army Corps of Engineers
Washington Regulatory Field Office
Post Office Box 1000 D
Washington, North Carolina 27889-1000 OCT 1 8 2004
(Two Copies)
l;'tiU„EDSAt4D Si'O?i2R Q 1?ER GrTM'iR!`?'gl
Mr. John Hennessy
Wetlands/401 Unit
NC DENR Division of Water Quality
1650 Mail Service Center
Raleigh, NC 27699
(Seven Copies)
SUBJECT: Halifax County, Upgrade of Medoc State Park Road (SR 1322) from an
unpaved secondary road to a paved secondary road.
State Project Number: 4C.042008
Dear Sirs:
The North Carolina Department of Transportation (NCDOT) proposes to upgrade Medoc
State Park Road (SR 1322) from an unpaved to a paved secondary road to reduce future
maintenance needs and increase traffic safety. This activity will result in impacts to
streams due to the replacement and extension of crossline pipes to facilitate travel lane
and shoulder widening. The NCDOT anticipates that the pipe replacement activities will
be authorized under Nationwide Permit (NWP) 14 and, if needed, the dewatering
operations will be authorized under NWP 33. This application is also intended as request
for written authorization from the NC Division of Water Quality to replace the pipes
under General Water Quality Certificate # 3375 (NWP 14). The following information is
being provided to satisfy Nationwide Permit Condition 13 (Federal Register January 15,
2002) and Condition 1 of General Water Quality Certificate # 3375.
APPLICATION INFORMATION
Enclosed please find the Pre-construction Notification (PCN) Form and supporting
documentation for the above referenced project.
Post Office Box 3165, Wilson, North Carolina 27895-3165
Phone [phone] Fax [phone]
In accordance with North Carolina General Statute 143-215.3D(e) the following information is
being provided to facilitate payment of fees associated witli the appropriate Water Quality
Certificate:
• Certificates being requested: #3375 (NWP 14) and #3366 (NWP 33)
• Work Order Number : 4C.042008
• Amount of fee: $200
PROJECT INFOR1IATION
Road Name SR Number Project Length
(miles) Classification
Medoc State Park Rd. SR 1322 1.91 Rural
River Basin: DWQ
ID Water Quality
Designation % New Impervious
Surface
Tar-Pamlico 28-79-25-7 C NSW 0%
Buffer Rules Buffer Use Designation
Tar-Pamlico Allowable
Protected Species Mapped Historic
Present* Pro erties**
No No
* Seethe attached Endangered Species Review Sheet for further information: "Seethe
attached Historic Review Spreadsheet. If required, historic compliance work to be
scheduled and concurrence with HPO will be obtained.
PIPE REPLACEMENT INFORMATION
Site (Station) 81+00 -L- Map Status Shown on ssurvey only
Existing Pipe 36' Proposed 52'
Lengtli Length
Construction Low flow installation Dewatering ABC aggregate
Method Device*
Burial Depth 5" E/C Plan ASAP
Date
Construction ASAP Duration
Date
Impacts (ft.) 16'-piped; 0'-rip-rap protection ;20'-temporary
Special
Conditions
Restoration Within 15 working days of the of the pipe replacement all cofferdams will be
Plan entirely removed and natural stream contours will be restored and seeded.
Temporary silt screens placed in intermittent channels will be cleaned and removed
following vegetation establishment.
RCP = reinforced concrete pipe; CMP = Corrugated metal pipe; CMPA = Corrugated metal pipe arch; E/C
= Erosion control. *If needed.
Site (Station) 96+35 -L- Map Status Shown on topo only
Existing Pipe 36' Proposed 52'
Length Length
Construction Low flow installation Dewatering ABC aggregate
Method Device*
Burial Depth 5" E/C Plan ASAP
Date
Construction ASAP Duration
Date
Impacts (ft.) 16'-piped; 0'-rip-rap protection ;20'-temporary
Special
Conditions
Restoration Within 15 working days of the of the pipe replacement all cofferdams will be
Plan entirely removed and natural stream contours will be restored and seeded.
Temporary silt screens placed in intermittent channels will be cleaned and removed
following vegetation establishment.
RCP = reinforced concrete pipe; CMP = Corrugated metal pipe; CMPA = Corrugated metal pipe arch;
E/C = Erosion control. *If needed.
MINIMIZATION INFORMATION
Impacts will be minimized by strict enforcement of Best Management Practices for the protection
of surface waters and wetlands, restrictions against the staging of equipment in or adjacent to
waters of the US, and coordination (including a pre-construction meeting) with the Division
Environmental Officer.
MITIGATION INFORMATION
Stream mitigation is not anticipated, as the impacts to any individual stream do not exceed 150
feet. Wetland mitigation is not anticipated, as surfacing can be accomplished within the existing
roadway footprint.
If you have any questions or need any additional information, please contact Franz Enders at
[phone] or Jamie Shern at [phone]. Your time and effort are appreciated.
M ..;amen H. Tr64don III, P.E.
D i?ion Engineer, Division 4
cl Mr. James F. Shern, Division Environmental Officer
v Mr. Ronnie Keeter, Jr. P.E., District 1 Engineer
Mr. Bryant Bunn, P. E., NCDOT Division Maintenance Engineer
Mr. W. T. Bass IV, County Maintenance Engineer, Halifax
Mr. Billy Butler, Area Roadside Field Operations Engineer
Office Use Only' Form Version October 2001
0?
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
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 14, 33
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is. not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name: Mr. James H Tro_gdon 111, P F Division Engineer
Mailing Address: North Carolina Department of Transportation/Division 4
P.O. Box 3165
Wilson NC 27895-3165
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: itrogdonodot. state nc us
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: Mr. James Shern
Company Affiliation: Division Environmental Officer
Mailing Address: North Carolina Department of Transportation/Division 4
P.O. Box 3165
Wilson. NC 27895-3165
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: ifshern(a?dot state nc us
Page 5 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: SR 1322, Medoc State Park Road
2. T.I.P. Project Number or State Project Number (NCDOT Only): 4C.042008
3. Property Identification Number (Tax PIN): NA
4. Location
County: Halifax Nearest Town: Hollister
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): Take Exit 160 off I 95 and head
west on NC 561. After 10 miles turn left onto SR 1322.
5. Site coordinates, if available (UTM or Lat/Long):Hollister Quad Map: 36.2720N 77.8888W;
36.2760N 77.7902W
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application: Rural,
timber
7. Property size (acres): N
8. Nearest body of water (stream/river/sound/ocean/lake): UT to Bear Swamp (DWQ ID #
28-79-25-7 C NSW) Little Fishing Creek (DWQ 1D # 28-79-25 C NSW)
9. River Basin:-Tar-Pamlico
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at littp•//112o.eiir.state.nc.us/admin/maps/.)
Page 6 of 12
10. Describe the purpose of the proposed work: Road grading drainage base paving and
erosion control to bring existing gravel read in compliance with standard safety design
specifications
11. List the type of equipment to be used to construct the project: Heavy construction
equipment (backhoe excavator, dump truck bulldozer, grader)
12. Describe the land use in the vicinity of this project: Rural timber
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.
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application:
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate slieet.
1. Wetland Impacts
Page 7 of 12
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***

* 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://www.fema.rov.
*** 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: NA
Total area of wetland impact proposed: NA
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact Length of Average Width Perennial or
Site Number Type of Impact* Impact Stream Name** of Stream Intermittent?
indicate on ma linear feet Before Impact (please secif
81+00 -L- 24" RCP 16 UT to Bear Swamp 4 feet Intermittent
96+35 -L- 24" RCP 16 UT to Bear Swamp 4 feet Intermittent
* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associaicd 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 U"I (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.uses.eov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapgucst.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 32
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
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, dredgmg,
flooding, drainage, bulkheads, etc.
4. Pond Creation
Page 8 of 12
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.
All wetlands or surface waters not affected by the project will be protected from unnecessary
encroachment No staging of constriction equipment will be allowed in or near wetlands or
waters of the U.S. Strict enforcement of sedimentation and erosion control Best Management
Practices for the protection of wetlands and surface waters will be enforced during project
construction.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 21-1 .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
Pennits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic enviromnent 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
Page 9 of 12
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
littp•//h2o.enr.state.ne.us/ncwet]ands/strnigide.html.
IX.
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
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•//1,20 enr st.ite.nc.iis/wg2/index.lit,n. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
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
Page 10 of 12
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 ?
Y. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 213 .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify Tar-Pamlico )?
Yes ® No ? If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet) Multiplier Required
Mitigation
1 5087 3
2 3182 1.5
Total 8269
* Zone I extends out 30 feet perpendicular 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.
Page 11 of 12
XI.
XII.
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.
Temporary dewatering and all appropriate best management practices for sediment and erosion
control will be implemented during pipe replacement
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
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).
?b
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(Agelature is vali AoTii?f an authorization letter from the applicant is
d.)
Page 12 of 12

O
5X2X2 -RIPARIAN BUFFER ZONE -
N 2° ll' 50.0" W
PROP RrW

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PROP WW
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Legend
F-1 Str-eam-. 161 f
? Wet I andg Osf Oac
® Zone I. 2593sf 0.060ac
EjZone 2. 1621 sf 0. 037ac
IMPACT MAP
COUNTY-. Halifax
SCALE -. 1 " = 50'
-=- S I TE-. 81 +00 - U -
Franz Enders 6/3/04

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MEDOC MT.
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RIPARIAN BUFFER ZONE, N 2' II d' 50.0" W
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6X2X2 BLUE LINE
36.2760'N 4X2X2
77.89021Y
NC STATE PARK
MEDOC MT.
Legend
F-1 Stream: 161 f
? Wet I and: Osf Oac
? Zone l : 2494sf 0. 057ac
Zone 2: 1561 sf 0. 036ac
IMPACT MAP
COUNTY: Halifax
SCALE: l " = 50'
?-? S I TD 96 + 35 - L -
Eranz Enders 6/ 3/ 04
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Projection is UTM Zone 18 NAD83 Datum G=-1.711
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C p U N T Y
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SOIL SURVEY SHEET # 8(0
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