20061832 Ver 1_Complete File_20061127

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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

November 27, 2006
Franklin County
DWQ Project No. 20061832
NC Hwy 58
State Project No. 5B.203511
APPROVAL of 401 WATER QUALITY CERTIFICATION and TAR-PAMLICO BUFFER AUTHORIZATION,
with ADDITIONAL CONDITIONS
Mr. Jon G. Nance, P.E., Division Engineer
NCDOT, Division 5
2612 North Duke Street
Durham, NC 27704
Dear Mr. Nance:
You have our approval, in accordance with the conditions listed below, for the following impacts for the purpose of
improving a culvert on NC 58 in Franklin County:
Stream Impacts in the Tar-Pamlico River Basin
Site Riprap Impact to Perennial
Stream linear ft Total Stream Impact
linear ft
1 16 16
Total 16 16
Total Stream Impact for Project: 16 linear feet.
Tar-Pamlico Riparian Buffer Impacts
Site Zone 1 murus = Zone 1 Zone 1 Buffer Zone 2 minus = Zone 2 Zone 2 Buffer
Impact Wetlands Buffers (not Mitigation Impact Wetlands Buffers Mitigation
(sq ft) in Zone 1 wetlands) Required (sq ft) in Zone 2 (not Required (using
(sq ft) (sq ft) (using 3:1 ratio) (sq ft) wetlands) 1.5:1 ratio)
s ft
1 866 0 866 N/A 0 0 0 N/A
Totals 866 0 866 0 0 0 0 0
* n/a = Total for Site is less than 1/3 acre and 150 linear feet of impact, no mitigation required
Total Buffer Impact for Project: 866 square feet.
The project shall be constructed in accordance with your application dated received November 22,2006. After
reviewing your application, we have decided that these impacts are covered by General Water Quality Certification
Number 3494. This certification corresponds to the Nationwide Permit 3 issued by the Corps of Engineers. This
approval is also valid for the Tar-Pamlico Riparian Buffer Rules (15A NCAC 2B. 0250). 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.
One
Transportation Perrni0ing Unit Alatimally
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] FAX [phone] / Internet: http://h2o.enr.state.nc.uslncweti Inds
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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
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 subnut 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 as well as those listed below.
Conditions of Certification:
1. All riparian buffers impacted by the placement of temporary fill or clearing activities shall be restored to the
preconstruction contours and revegated. Maintained buffers shall be permanently revegetated with non-woody
species by the end of the growing season following completion of construction. For the purpose of this condition,
maintained buffer areas are defined as areas within the transportation corridor that will be subject to regular DOT
maintenance activities including mowing. The area with non-maintained buffers shall be permanently revegetated,
with native woody species before the next growing season following completion of construction.
2. Pursuant to NCACI5A 2B.0259(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.
3. If concrete is used during construction, a dry work area should be maintained to prevent direct contact between
curing concrete and stream water. Water that inadvertently contacts uncured concrete should not be discharged to
surface waters due to the potential for elevated pH and possible aquatic life and fish kills.
4. 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.
5. The dimension, pattern and profile of the stream above and below the crossing should not be modified.
Disturbed floodplains and streams should be restored to natural geomorphic conditions.
6. Any rip-rap placed for stream stabilization shall be placed in stream channels in such a manner that it does not
impede aquatic life passage.
7. All work in or adjacent to stream waters shall be conducted in a dry work area. Approved BMP measures from
the most current version of NCDOT Construction and Maintenance Activities manual such as sandbags, rock berms,
cofferdams and other diversion structures shall be used to prevent excavation in flowing water.
8. Heavy equipment shall be operated from the banks rather than in the stream channel in order to minimize
sedimentation and reduce the introduction of other pollutants into the stream.
9. 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.
No??thCarolina
Transportation Permitting Unit ,?llfllCll??lf
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone]! FAX [phone] Internet http:l/h2o,enr.state.nc.uslncwetlands
An Equal Opportunity/Affirmative Action Employer - 50% Recycled110% Post Consumer Paper
F WATF Michael F. Easley, Governor
William G. Ross Jr., Secretary
\Q?'` QG North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
(Aw Division of Water Quality
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10. No rock, sand or other materials shall be dredged from the stream channel except where authorized by this
certification.
11. Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or adjacent to surface
waters is prohibited.
12. 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.
13. The outside buffer, wetland or water boundary located within the construction corridor approved by this
authorization shall be clearly marked by highly visible fencing prior to any land disturbing activities. Impacts to
areas within the fencing are prohibited unless otherwise authorized by this certification.
14. Upon completion of the project, the NCDOT Division Engineer shall complete and return the enclosed
"Certification of Completion Form" to notify DWQ when all work included in the 401 Certification has been
completed.
15. Native riparian vegetation must be reestablished within the construction limits of the project by the end of the
growing season following completion of construction.
16. There shall be no excavation from, or waste disposal into, jurisdictional wetlands or waters associated with this
permit without appropriate modification. Should waste or borrow sites be located in wetlands or streams,
compensatory mitigation will be required since that is a direct impact from road construction activities.
17. Erosion and sediment control practices must be in full compliance with all specifications governing
the proper design, installation and operation and maintenance of such Best Management Practices in
order to protect surface waters standards:
a. The erosion and sediment control measures for the project must be designed, installed, operated, and
maintained in accordance with the most recent version of the North Carolina Sediment and Erosion
Control Planning and Design Manual.
b. The design, installation, operation, and maintenance of the sediment and erosion control measures
must be such that they equal, or exceed, the requirements specified in the most recent version of the
North Carolina Sediment and Erosion Control Manual. The devices shall be maintained on all
construction sites, borrow sites, and waste pile (spoil) projects, including contractor-owned or leased
borrow pits associated with the project.
c. For borrow pit sites, the erosion and sediment control measures must be designed, installed, operated,
and maintained in accordance with the most recent version of the North Carolina Surface Mining
Manual.
d. The reclamation measures and implementation must comply with the reclamation in accordance with
the requirements of the Sedimentation Pollution Control Act.
18. Sediment and erosion control measures shall not be placed in wetlands or waters unless otherwise approved by
this Certification. If placement of sediment and erosion control devices in wetlands and waters is unavoidable, they
shall be removed and the natural grade restored upon completion of the project.
N nUiCarolina
Transportation Permitting Unit afura!!?
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] FAX [phone] Internet: htti)://h2o.enr.state.nc.us/ncwetlands
An Equal OpportunitylAffirmative Action Employer- 50% Recycled/10% Post Consumer Paper
W A T ?R?G
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tvlichael 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
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, 6714 Mail Service
Center, Raleigh, N.C. 27699. 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 Rob Ridings at (9190 733-9817.
S' cerel ,
7 > G
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L"Alan W. Klimek, P.E.
Attachments (General Certification and Certificate of Completion form)
cc: Chris Murray, Division 5 Environmental Officer
Eric Alsmeyer, US Army Corps of Engineers, Raleigh Field Office
Travis Wilson, NC Wildlife Resources Commission
DWQ Raleigh Regional Office copy
File Copy
NojtliCarolina
Transportation Permitting Unit Aaturallf
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] FAX [phone]Internet http•l/h2o.enr.state.nc.us/ncwetlands
An Equal Opportunity/Affirmative Action Employer-50% Recycled/10% Post Consumer Paper

e
(i'av-22-2006 11:20 From-DIV 5
919-560-33T1 T-6T3 P.001 F-669
NCDOT - DIVISION FIVE
NOV 2 0 2006
Z""K_L WATER Q !F +!? rY
D_rj"?-
2 JJ
?NETIASJDS AND
To: Rob Ridings, NCDENR-DWQ
Phone: [phone]
Fax phone: [phone]
CC:
Date: 11/22/06
Number of pages including cover sheet:
From: Chris Murray
NCDOT - DIVISION 5
2612 N. DUKE STREET
DURHAM, NC 27704
Phone: [phone]
Fax phone: [phone]
REMARKS; ? Urgent
Rob,
® For your review ? Reply ASAP 0 Please comment
Please find permit application to conduct maintenance activities at a culvert on NC 58
conveying Deer Branch in Franklin County. A recent inspection of the structure indicated that
water flow has undermined a wing wall located at the inlet of the culvert and is starting to
undermine the floor of the culvert at the outlet of the culvert. A large blow hole has also formed
in the streambed at the outlet of the structure. The NCDOT proposes to conduct stabilization
activities at the site to prevent a catastrophic failure of the structure.
Thanks,
Chris Murray
Div. 5 Environmental Supervisor
NOV-22-2006 WED 10:06 TEL:[phone] NAME:DWO-WETLANDS
P. 1
N.7Y-22-2006 11:20 From-DIV 5 919-560-3371 T-673 P.002 F-663
D-. HAJ6
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STATE of NORTH CAROLINA
DEPARTNENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPETT
GOVERNOR SECRETARY
November 22, 2006
U.S. Army Corps of Engineers
Raleigh Regulatory Field Office G QG?" I
6508 Falls of the Neuse Road, Suite 120
Raleigh, NC 27609
NO V 2 2 2006
Attention: Mr. Eric Alsmeyer
NCDOT Coordinator
IYETLANDSANDSTMt W11ERBfZAmh
Subject: Maintenance activities associated with a culvert on NC 58 conveying Deer
Branch in Franklin County. WBS Element No. 5B.203511
Dear Sir:
The North Carolina Department of Transportation (NCDOT) maintains a single-barrel
culvert conveying Deer Creek on NC 58 in Franklin County (Figures 1 and 2). A recent
inspection of the structure indicated that water flow has undermined a wing wall located
at the inlet of the culvert and is starting to undermine the floor of the culvert at the outlet
of the culvert. A large blow hole has also formed in the streambed at the outlet of the
structure. The NCDOT proposes to conduct stabilization activities at the site to prevent a
catastrophic failure of the structure.
Impacts to Waters of the United States
The stabilization activities at the site will result in impacts to Deer Branch (NCDENR-
DWQ Index No. 28-78-145, Best Usage Classification C NSW, HUC 03020,101) in the
Tar-Pamlico River Basin. The following activities are proposed at the site to stabilize the
structure (Figure 3):
1. Install Class II rip rap in the stream in front of the culvert floor and wing wall
(south bank only) of Deer Branch at the inlet of the structure.
2. Stabilize eight linear feet of Deer Branch along the south bank at the inlet of
the structure.
3. Install Class 11 rip rap in the stream in front of the culvert floor and wing walls
at the outlet of the structure. The rip rap will not extend above the ordinary high
water mark at this location.
4. Stabilize eight linear feet of Deer Branch along the north and south banks at the
outlet of the structure.
Division 5, 2612 N. Duke Street, Durham, NC 27704
Phone: [phone] Fax: [phone]
NOU-22-2006 WED 10:06 TEL:[phone]e93 NAME:DWO-WETLANDS P. 2
Nov-22-2006 11:20 From-DIV 5
2
Riparian Buffer
919-560-3371 T-673 P.003/017 F-668
The proposed project involves impacts to a stream that is subject to the Tar-Pamlico
River Buffer Rules. Deer Branch is depicted on the most recent version of the
Centerville (USGS, 1978) topographic quadrangle (Figure 1) and the Soil Survey of
Franklin County (USDA-NRCS, 2004) (Figure 2). Impacts to buffers adjacent to Deer
Branch total 866 fe in Zone I and 0 ft2 in Zone 2. All practicable measures to minimize
impacts within buffer zones associated with construction of the project were followed.
According to the buffer rules, the protection of the stnicture is listed as an
ALLOWABLE activity. Temporary erosion control measures will be placed within the
permitted footprint of this project.
Waters of the U.S. Mitigation
Avoidance:
Permanent impacts to Deer Branch from the proposed construction cannot be avoided due
to the nature of the project.
Minimization:
The proposed impacts have been minimized as much as possible.
Compensatory Mitigation:
Compensatory mitigation will be provided at the request of the regulatory agencies.
Protected Species
Plants and animals with federal classifications of Endangered, Threatened, Proposed
Endangered and Proposed Threatened are protected under provisions of Section 7 and
Section 9 of the ESA. As of November 2006, there are three federally protected species
listed for Franklin County. They include dwarf wedgemussel (Alasmidonta heterodon),
Tar spinymussel (Elliptio steinstansana), and Michaux's sumac (Rhus 7nichauxii). The
roadway shoulders along NC 58 are heavily maintained, eliminating the possibility for
Michaux's sumac to exist in this area. Additionally, a review of the Natural Heritage
Program database (last updated September 2006) revealed no occurrences of Michaux's
sumac within the project area. Therefore, based on lack of suitable habitat observed
during the September 20, 2006 site visit and the NHP database review, a biological
conclusion of No Effect has been rendered for this species.
Alderman Environmental Services conducted a mussel survey at the site on August 24,
2004 as part of a much larger NCDOT Moving Ahead project involving the widening of
NC 58 in Franklin and Warren Counties (see attached report). No mussels were observed
at the culvert crossing of Deer Brunch during the 1.0 person hour survey. However, the
following Biological Determination was provided for the site: "If HQW protection
measures are implemented throughout all phases of the project development within the
watershed, then "may affect, not likely to adversely affect the Tar River spinymussel or
dwarf wedgemussel." The NCDOT has requested concurrence with these findings in a
letter forwarded to the USFWS on November 21, 2006.
NOV-22-2006 WED 10:06 TEL:[phone] NAME:DWO-WETLANDS P. 3
Nov-22-2006 11:20 From-DIY 5 919-560-3371 T-673 P-COVO1T F-658
Summary
The NCDOT proposes to conduct stabilization activities to prevent a catastrophic failure
of the structure that conveys Deer Branch on NC 58 in Franklin County. Application is
hereby made for a Department of the Army Section 404 Nationwide Permit (NWP) 3 and
NCDENR-DWQ Section 401 Water Quality Certification (WQC) No. ,!? and riparian
buffer authorization for above-described activities. An automated payment procedure has
been implemented between the NCDOT and NCDEI\R-DWQ. This procedure will
enable the Division to apply for the 401 WQC without submitting a check for this permit
application. This procedure will provide payment to the rCDENR-DWQ by charging the
permit application fee of $200.00 directly to the appropriate NCDOT `C'BS Element No.
58.203511. A pre-construction notification and permit drawing are attached with this
request. If you have any questions or need additional information, please contact Mr.
Chris Murray at [phone].
Si. J. ally Bowman, P E.
Division Engineer
cc: Mr. Rob Ridings, NCDENR-DWQ
Ms. Katie Simmons, NCDOT
Mr. Dallie Bagwell, NCDOT
Mr. Earl Bell, NCDOT
NDU-22-2006 WED 10:06 TEL:[phone] NAME:DWQ-WETLANDS P. 4
Nov-22-2006 11:21 From-DIV 5 919-560-3371 T-673 P•005/017 F-668
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Nov-22-2006 11:21 From-DIV 5 919-560-3371 T-673 P•006/017 F-666
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NOV-22-2006 WED 10:07 TEL:[phone] NAME:DWO-WETLANDS P. 6
Nov-22-2006 11:23 From-DIV 5 919-560-33TI T-6T3 P-007/01T F-663
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NOV-22-2006 WED 10:09 TEL:[phone] NAME:DWO-WETLANDS P. 7
Nov-22-2006 11:23 From-DIV 5
919-560-3371 T-673 P.008/017 F-668
c:Tjo=o= uM Sct rQA1murrmy 4V Donma=IN PK Lpas=CGCNj 157
NOV-22-2006 WED 10:09 TEL:[phone] NAME:DWO-WETLANDS P. 8
Photograph 1. View of undermined wing wall at inlet of culvert.
Nov-22-2006 11:23 From-DIV 5
919-560-3371 T-673 P.009/017 F-668
Photograph 2. View of culvert floor at outlet of structure. Note flow of water exiting the
structure.
NOV-22-2006 WED 10:09 TEL:[phone] NAME:DWO-WETLANDS P. 9
C:lpoaxrwn? aa1 sd;xa??nuRUyti "y Q?CCS?or?:uy PicII?ros10D3rioSCN 11 s3
Nov-22-2006 11:24 From-DIV 5
919-560-33T1 T-6T3 P.010/01T F-668
Office Use Only: Form Version March 05
0 0 (o
USACE Action ID No. DWQ No.
(if any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
® 401 Water Quality Certification ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 3
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 Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: ?
5. If your project is located in any of'Nlorth Carolina's twenty coastal counties (listed on page
4), and the project is within a North. Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name:NCDOT Division 5, J. Wally Bowman, P.E._(Division Engineer
Mailing Address: 2612 N. Duke St.. Durham. NC 27704
Telephone Number: [phone] Fax Number:_(919) 560-3371
E-mail Address: Wbowman(H-Mot. state. n c.us
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name: -
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 1 of 9
NOO-22-2006 WED 10:10 TEL:[phone] NAME:DWO-WETLANDS P. 10
Nov-22-2006 11:24 From-DIY 5
IIl. Project Information
919-560-3371 T-673 P-011/017 F-668
Attach a vicinity map clearly showing the location of the properry 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 NItCS 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: Proposed maintenance activities with a culvert on NC 58 conveying Deer
Branch in Franklin County.
2. T.I.P. Project Number or State Project Number (NCDOT Only):
NCDOT WBS Element No. 58.203511
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Franklin Nearest Town: Louisburg
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers/names, landmarks, etc.): From Louisburg,
travel northeast on NC 561, turn ri_ght and travel south on NC 58 to project site. _
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum):
Site 1 36.1"4 ON 78.1013°W
6. Property size (acres). approximately 0.2 acres
7. Name of nearest receiving body of water: Deer Branch
8. 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 httI2://h2o.enT.state.ne.us/admin/maps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Existing land uses along NC 58 are primarily nnnl and
forested.
Page 2 of 9
NOU-22-2006 WED 10:10 TEL:[phone] NAME:DWQ-WETLANDS P. 11
Nov-22-2006 11:24 From-DIV 5
919-560-3371 T-673 P.012/017 F-668
10. Describe the overall project in detail, including the type of equipment to be used: The
North Carolina Department of Transportation (NCDOT) proposes to conduct maintenance
activities at a culvert on NC 58 cone ing Deer Branch. Equipment may include excavator,
backhoe, bulldozer, grader, and crane.
11. Explain the purpose of the proposed work: The purpose of the project is to conduct
maintenance activities at the culvert to prevent a catastrophic failure.
IV. Prior Project History
V. 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. None available.
VI. 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.
NIA
VII. 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 trap all impacts to
wetlands, open water, and stream channels associated with the project. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts are proposed to these systems.
Wetland and stream evaluation and delineation forms should be included as appropriate.
Photographs may be included at the applicant's discretion. If this proposed impact is strictly for
wetland or stream mitigation, list and describe the impact in Section VIII below. If additional
space is needed for listing or description, please attach a separate sheet.
Provide a written description of the proposed impacts: Constrnction of the project will result in
16 linear feet existinp, channel impacted.
Page 3 of 9
NOV-22-2006 WED 10:10 TEL:[phone] NANE:DWQ-WETLANDS P. 12
Nov-22-2006 11:24 From-DIV 5
919-560-3371 T-673 P.013/017 F-668
Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For darns,
se arately list impacts due to both structure and flooding.
Wetland Impact Type of Wetland Located within Distance to Area of
Site Number Type of Impact (e.g., forested, marsh, 100-year
Floodplain Nearest
Stream Impact
(acres)
(indicate on trap) herbaceous, bog, etc.) es/no linear feet

Total Wetland Impact (acres)
2. List the total acreage (estimated) of all existing wetlands on the property: Approx. 0.1 ne
3. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, 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. To calculate acreage, multiply length X width, then divide by 43,560.

Stream Impact
Perennial or Average
Stream ?Vtdth Impact
Length
Area of
Number Stream Name Type of Impact Intermittent? Before Impact (linear Impact
(indicate on map) feet (acres)
Site 1 Deer Branch Stabilization Perennial 12 feet 16 ft X0.01 ac
Total Stream Impact (by length and acreage) 16 ft <0,01 stc
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, drednin , flooding, drainage, bulkheads, etc.
Open Water Impact Name of Waterbody Type of Waterbody Area of
Site Number
( applicable) Type of Impact (lake, pond, estuary, sound, bay, Impact
indicate on ma ocean, etc. acres

Total Open Water Impact (acres)
List the cumulative impact to all Waters of the U.S. resulting from the proiect:
Stream Im act acres): <0.01 ac
Wetland Impact (acres): NONE
Open Water Impact (acres): NONE
Total Impact to Waters of the U.S. (acres) <0.01 ac
Total Stream Impact (linear feet): 16 feet
6. Isolated Waters
Do any isolated waters exist on the property? ? Yes ®No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.
Page 4 of 9
NOV-22-2006 WED 10:10 TEL:[phone] NAME:DWO-WETLANDS P. 13
Nov-22-2006 11:24 From-DIV 5
919-560-3371 T-673 P.014/017 F-668
Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): N/A
Current land use in the vicinity of the pond: N/A.
Size of watershed draining to pond: N/A Expected pond surface area: N/A
VIII. 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
i were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
Avoidance:
Construction of the project cannot avoid impacts To waters of the United States.
Minimization:
NCDOT will implement best management practices for the protection of surface waters in
accordance with the most recent version of the "North Carolina Sediment and Erosion Control
Planning and Design Manual" and Desiun Standards in Sensitive Waters during design and
constroction phases of the project. All efforts have been made to minimize impacts to Waters of
the United States. Only the amount of fill necessary to stabilize the stnicture have been proposed
at the site.
IX Mitigation
i
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 January 15, 2002, 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
page 5 of9
NOV-22-2006 WED 10:10 TEL:[phone] NAME:DWO-WETLANDS P. 14
.v, r. vioiations (required by DWQ)
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
XV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes
If yes, please submit a qualitative or quantitative cumulative impact analysis acc No ordance nc with
the most recent North Carolina Division of Water Quality policy
h_ "://h2o.enr.state_nc us/ncwetlands. If no, please provide a short narrative des nption ebsite at
Nov-22-2006 11:25 From-DIV 5 919-560-3371 T-673 P.016/017 F-668
XI. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
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.
1. Will the project impact protected riparian buffers identified within I SA NCAC 2B .0233
(Meuse), 15A NCAC 2B.0259 (Tar-Pamlico), I SA NCAC 02B.0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify __ )? Yes ® No ?
Nov-22-2006 11:25 From-DIV 5 919-560-3371 T-673 P.015/017 F-668 arian buffers.
applying the
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 5 an
for U'SACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
the
An applicant may also choose to review the current guidelines for stream restoration in DWQ's Le-oposed nt into the
Draft Technical Guide for Stream Work in North Carolina, available at ent
lrttp://h2o.etnr.state.ne.us/ncwetlands/strmgide.htmi. as identified
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, ite. Discuss
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a description stream from
of the current site conditions and proposed method of construction. Please attach a separate
sheet if more space is needed. calculations
Mitigation for the nroiect_will _be provided if requested by the regulatorv acencies. icre_ existing
surface is
1. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For ischarge) of
additional information regarding the application process for the NCEEP, check the NCEEP
website at http://h2o.enr.state.nc.tiS/wm/index.htrn. If use of the NCEEP is proposed, please acility.
check the appropriate box on page five and provide the following information:
Amount of stream mitigation requested (linear feet): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
P. 16
M Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ® No ?
2. 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
3. If yes, has the document review been finalized by the State Clearinghouse? If so, please
i attach a copy of the NEPA or SEPA final approval letter. Yes ? No ?
Page 6 of 9
NOV-22-2006 WED 10:11 TEL:[phone] NAME:DWO-WETLANDS
P. 15

Nov-22-2006 11:25 From-DIV 5 919-560-3371 T-673 P.015/01T F-668
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 NCEEP 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 `York in North Carolina, available at
liTtp:/ih2o,ear.state.nc.us/ncwetland,,/strmrride.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.
Mitigation for the project will be provided if requested h the regulatory agencies.
I . Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at h"p:/A12o.enr.state.nc.tiLIM/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:
Amount of stream mitigation requested (linear feet): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): NIA
Amount of Coastal wetland mitigation requested (acres): N/A
X. Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ® No ?
2. 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
3. If yes, has the document review been finalized by the State Clearinghouse? If so, please
i attach a copy of the NEPA or SEPA final approval letter. Yes ? No ?
Page 6 of 9
NOV-22-2006 WED 10:11 TEL:[phone] NAME:DWO-WETLANDS P. 15
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999- 110/910'd E19-1 ILEE-099-818 5 A10-waiA 9Z:Il 900Z-Zl-AON
Nov-22-2006 11:25 From-DIY 5
:SIV. Violations (required by DWQ)
919-560-3371 T-673 P.017/017 F-668
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 21
XV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ? No
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
http://h?o.enr.state.nc.us/newetlands. If no, please provide a short narrative description:
This maintenance project will not result in additional development.
XVI. 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).
///?/o C.
applicant/Agent's Signature Date
signature is valid only if an authori2ation letter from the applicant is provided.)
Page 8 of 9
NOV-22-2006 WED 10:11 TEL:[phone] NAME:DWQ-WETLANDS P. 17