20061320 Ver 1_Complete File_20060928

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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
September 28, 2006
Hyde County
DWQ Project No. 20061320
APPROVAL of 401 WATER QUALITY CERTIFICATION and TAR-PAMLICO BUFFER RULES with ADDITIONAL
CONDITIONS
Mr. Anthony Roper, P.E.
NCDOT, Division 1
113 Airport Drive Suite 100
Edenton, NC 27932
Dear Mr. Roper:
You have our approval, in accordance with the attached conditions and those listed below, for the following impacts:
Site Location Wetlands
acres Buffer Zone 1
(square ft Buffer Zone 2
(square ft Streams
linear ft
Silver Lake 0 505 1404 0
Net Total for Buffer 1909 square feet
Impacts
The project shall be constructed in accordance with your application dated August 16, 2006 for the purpose of a pipe
replacement and the construction of a pedestrian sidewalk on Ocracoke Island in Hyde County. 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 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 issued by the US
Army Corps of Engineers (this supercedes Condition 13 of General Certification 3494 issued December 31, 2004).
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 applicant 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 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.
3.) Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or adjacent to surface waters is
prohibited.
None Carolina
N. C. Division of Water Quality 943 Washington Square Mall Washington, N.C. 27889 Telephone [phone] Naturally
FAX [phone] Internet: www.ncwaterquality.org
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
4.) 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.
5.) No rock, sand or other materials shall be dredged from the stream channel except where authorized by this certification.
6.) 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.
7.) There shall be no waste disposal into jurisdictional wetlands or waters associated with this permit without appropriate
modification. 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.
8.) 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.
9.) 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.
10.) The use of rip-rap above the Normal High Water Mark shall be minimized. 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.
11.) Erosion and sediment control practices must be in full compliance with all specifications governing the proper
design, installation, 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.
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.) 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.
14.) All stormwater runoff shall be directed as sheetflow through stream buffers at nonerosive velocities, unless otherwise
approved by this certification.
15.) 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 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.
16.) All fill slopes located in jurisdictional wetlands shall be placed at slopes no flatter than 3:1.
17.) Placement of culverts and other structures in waters, streams, and wetlands shall 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 streambeds or banks, adjacent to or upstream and down stream
of the above structures. The applicant is required to provide evidence that the equilibrium is being maintained if
requested in writing by DWQ. If this condition is unable to be met due to bedrock or other limiting features encountered
during construction, please contact the NC DWQ for guidance on how to proceed and to determine whether or not a
permit modification will be required.
18.) The permittee and its authorized agents shall conduct its activities in a manner consistent with state water quality
standards (including any requirements resulting from compliance with §303(d) of the Clean Water Act) and any other
appropriate requirements of State and Federal law. If DWQ determines that such standards or laws are not being met
(including the failure to sustain a designated or achieved use) or that State or federal law is being violated, or that further
conditions are necessary to assure compliance, DWQ may reevaluate and modify this certification.
19.) 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.
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 Garcy Ward at [phone].
Sincer y,
for Alan W. K imek, P.E.
Attachment
cc: Wilmington District Corps of Engineers
Mr. Bill Biddlecome, US Army Corps of Engineers, Washington Field Office
Mr. Clay Willis, Division I Environmental Officer, NCDOT
Cathy Brittingham, DCM, 1638 Mail Service Center, Raleigh, NC 27699
Sonia Gregory, NCDWQ, Wetlands/401 Unit
Central Files
File Copy
Y
WQC #3494
GENERAL CERTIFICATION FOR PROJECTS ELIGIBLE FOR CORPS OF ENGINEERS
NATIONWIDE PERMIT NUMBERS 3 (MAINTENANCE),
4 (FISH AND WILDLIFE HARVESTING DEVICES AND ACTIVITIES),
5 (SCIENTIFIC MEASUREMENT DEVICES), 6 (SURVEY ACTIVITIES),
7 (OUTFALL STRUCTURES), 19 (25 CUBIC YARDS OF FILL), 20 (OIL SPILL CLEANUP). 22
(REMOVAL OF VESSELS), 25 (STRUCTURAL DISCHARGE),
30( MOIST SOIL MANAGEMENT FOR WILDLIFE), 32 (COMPLETED ENFORCEMENT
ACTIONS), 36 (BOAT RAMPS fIN NONWETLAND SITESI). REGIONAL PERMIT 197800056
(PIERS, DOCKS AND BOATHOUSES) AND REGIONAL PERMIT 197800125 (BOAT RAMPS)
AND RIPARIAN AREA PROTECTION RULES (BUFFER RULES)
This General Certification is issued in conformity with the requirements of Section 401, Public
Laws 92-500 and 95-217 of the United States and subject to the North Carolina Division of Water
Quality (DWQ) Regulations in 15 NCAC 2H, Section .0500 and 15 NCAC 2B .0200 for the
discharge of fill material to waters and wetland areas which are waters of the United States as
described in 33 CFR 330 Appendix A (B) (3, 4, 5, 6, 7, 19, 20, 22, 25, 30, 32, and 36) of the
Corps of Engineers regulations and Regional Permits 197800056 and 19780125 and for the
Riparian Area Protection Rules (Buffer Rules) in 15A NCAC 2B .0200. This Certification replaces
Water Quality Certification Number 3376 issued on March 18, 2002. This WQC is rescinded
when the Corps of Engineers re-authorizes any of these Nationwide or Regional Permits or when
deemed appropriate by the Director of the Division of Water Quality.
The State of North Carolina certifies that the specified category of activity will not violate
applicable portions of Sections 301, 302, 303, 306 and 307 of the Public Laws 92-500 and 95-217
if conducted in accordance with the conditions hereinafter set forth.
Conditions of Certification:
These activities do not require written concurrence from the Division of Water Quality as
long as they comply with all conditions of this General Certification. If any condition in this
Certification cannot be met, application to and written concurrence from DWQ are
required. Also, Condition No. 8 is applicable to all streams in basins with riparian area
protection rules;
2. If the activity is associated with or in response to a Notice of Violation or an enforcement
action initiated by DWQ or the Division of Land Resources, this General Certification
requires application to and prior written concurrence from the Division of Water Quality;
That appropriate sediment and erosion control practices which equal or exceed those
outlined in the most recent version of the "North Carolina Sediment and Erosion Contro'
Planning and Design Manual' or the "North Carolina Surface Mining Manual" whichever is
more appropriate (available from the Division of Land Resources (DLR) in the DENR
Regional or Central Offices) shall be in full compliance with all specifications governing
the proper design, installation and operation and maintenance of such Best Management
Practices in order to assure compliance with the appropriate turbidity water quality
standard;
4. All sediment and erosion control measures placed in wetlands or waters shall be removed
and the natural grade restored within two months after the Division of Land Resources
has released the project;
5. If an environmental document is required, this Certification is not valid until a Finding of
No Significant Impact (FONSI) or Record of Decision (ROD) is issued by the State
Clearinghouse;
WQC #3494
6. Measures shall be taken to prevent live or fresh concrete from coming into contact with
waters of the state until the concrete has hardened;
7. Access roads constructed for any of. these permits shall be constructed so as to
minimize wetland fill as much as is practicable and shall be restored to grade
immediately after the project is completed. The site shall be re-vegetated with native
species which shall be in place within three months following construction or before
initiation of the next growing season;
8. In accordance with North Carolina General Statute Section 143-215.3D(e), any request
for written concurrence for a 401 Water Quality Certification must include the appropriate
fee. If a project also requires a CAMA Permit, one payment to both agencies shall be
submitted and will be the higher of the two fees;
9. Impacts to any stream length in the Neuse, Tar-Pamlico, Randleman and Catawba River
Basins (or any other river basins with Riparian Area Protection Rules [Buffer Rules] in
effect at the time of application) requires written concurrence from DWQ in accordance
with 15A NCAC 28.0200. Activities listed as "exempt" from these rules do no, need to
apply for written concurrence under this Certification. New development activities located
in the protected 50-foot wide riparian areas (whether jurisdictional wetlands o- not) within
the Neuse and Tar-Pamlico River Basins shall be limited to "uses" identified within and
constructed in accordance with 15A NCAC 2B .0200. All new development shall be
located, designed, constructed, and maintained to have minimal disturbance to protect
water quality to the maximum extent practicable through the use of best management
practices;
10. Placement of culverts and other structures in waters, streams and wetlands must be
placed below the elevation of the streambed to allow low flow passage of water and
aquatic life unless it can be shown to DWQ that providing passage would be impractical.
Design and placement of culverts and other structures including temporary erosion control
measures shall not be conducted in a manner that may result in dis-equilibrium of
wetlands or stream beds or banks, adjacent to or upstream and down stream of the above
structures. The applicant is required to provide evidence that the equilibrium shall be
maintained if requested in writing by DWQ. Additionally, when roadways. causeways or
other fill projects are constructed across FEMA-designated floodways or wetlands,
openings such as culverts or bridges must be provided to maintain the natura' hydrology
of the system as well as prevent constriction of the floodway that may result it
destabilization of streams or wetlands. If more than 150 linear feet of additional stream is
filled, culverted, rip-rapped, relocated, excavated or dredged as a result of.this permit,
then an application to DWQ is needed and compensatory mitication may be required;
11. Additional site-specific conditions may be added to projects for which written concurrence
is required or requested under this Certification in order to ensure compliance with all
applicable water quality and effluent standards;
12. Applications for riprap groins proposed in accordance with 15A NCAC 07H .1401 (NC
Division of Coastal Management General Permit for construction of Wooden and Riprap
Groins in Estuarine and Public Trust Waters) must meet all the specific conditions for
design and construction specified in 15A NCAC 07H .1405.
13. Concurrence from DWQ that this Certification applies to an individual project shall expire
three years from the date of the cover letter from DWQ or on the same day as the
expiration date of these corresponding Nationwide and Regional General Permits,
whichever is sooner;
V?
WQC #3494
14. Projects with any impacts to streams, wetlands, and/or waters that have received a Notice
of Violation from the Division of Land Resources and/or the Division of Water Quality are
required to submit a complete application and receive written concurrence to use this
'Certification regardless of the proposed impact amount to streams, wetlands, and waters.
15. When written concurrence is required, the applicant is required to use the most recent
version of the Certification of Completion form to notify DWQ when all work included in the
401 Certification has been completed;
16. Standard Erosion and Sediment Control Practices:
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:
a. 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. 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. Reclamation measures and implementation must comply with the reclamation in
accordance with the requirements of the Sedimentation Pollution Control Act.
e. Sufficient materials required for stabilization and/or repair of erosion control
measures and stormwater routing and treatment shall be on site at all times.
17. No Impacts Beyond those in Application
No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or riparian areas
beyond the footprint of the impacts depicted in the Pre-construction Notification. All
construction activities, including the design, installation, operation, and maintenance of
sediment and erosion control Best Management Practices, shall be performed so that no
violations of state water quality standards, statutes, or rules occur.
18. No Sediment and Erosion Control Measures in Wetlands
Sediment and erosion control measures shall not be placed in wetlands or waters to the
maximum extent practicable. If placement of sediment and erosion control devices in
wetlands and waters is unavoidable, they shall be removed and the natural grade restored
within six months of the date that the Division of Land Resources or locally delegated
program has released the project.
Non-compliance with or violation of the conditions herein set forth by a specific fill project shall
result in revocation of this Certification for the project and may result in criminal and/or civil
penalties.
The Director of the North Carolina Division of Water Quality may require submission of a formal
application for Individual Certification for any project in this category of activity if it is determined
that the project is likely to have a significant adverse effect upon water quality including state or
WQC #3494
federally listed endangered or threatened aquatic species or degrade the waters so that existing
uses of the wetland or downstream waters are precluded.
Public hearings may be held for specific applications or group of applications prior to a
Certification decision if deemed in the public's best interest by the Director of the North Caroling
Division of Water Quality.
Effective date: 31 December 2004
DIVISION OF WATER QUALITY
By
4?", Kit;ak
Alan W. Klimek, P.E.
Director
WQC # 3494
If
4
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
GOVERNOR
LYNDO TIPPETT
SECRETARY
August 16, 2006
U. S. Army Corps of Engineers
Regulatory Field Office
Post Office Box 1000
Washington, N.C. 27889-1000
08_132
Attention: Bill Biddlecome
Subject: Request for a NW 3 permit for a pipe replacement and a DWQ Buffer Certification for the
construction of a multi-use pedestrian sidewalk on NC 12 in Ocracoke Village, Hyde County.
The North Carolina Department of Transportation request a NW 3 permit for the replacement of a
pipe that is being done in conjunction with the construction of a multi-use pedestrian sidewalk in Ocracoke
Village. The existing pipe is 48'x 18" CMP and will be replaced with a 48' x 18" CMP. The existing pipe
is failing and needs to be replaced. The pipe is located approximately 0.37 miles from the start of the
project. NCDOT also request a Buffer Certification from NCDWQ for the construction of the multi-use
pedestrian sidewalk, which portions of are inside Zone 1 and 2 of the Tar-Pamlico buffer area. The
proposed sidewalk will parallel the existing road alignment and be contiguous with the existing road
surface. The sidewalk is proposed to be approximately three feet wide on both sides of NC 12 starting
approximately 600' east of SR 1328 (Silver Lake Road) and continuing for 0.44 miles. The sidewalk will
have a gravel base and concrete surface. There are no wetland impacts associated with this project and a
total of 1,909 sq. ft. of Riparian Buffer impacts. A PCN form, permit drawings, and a site location map are
included with this letter. If you need any additional information or have any questions concerning this
project please call me at 252482-7977.
Sincerely,
Anthony Roper, PE
Division One Engineer
Jam=
k
Clay Willis
Division One Environmental Officer
Cc:Garcy Ward, DWQ
Sonia Gregory, DWQ
Proposed pedestrian sidewalk in Ocracoke in Hyde County.
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Office Use Only: O O 3 Version April 2001
2 6 1 2 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
1. Check all of the approval(s) requested for this project:
® Section 404 Permit
? Section 10 Permit
® 401 Water Quality Certification
® Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: NW 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 Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
II. Applicant Information
1. Owncr/Applicant Information
Name: Clay Willis, NC DOT Division One Environmental Officer
Mailing Address: 113 Airport Dr. Suite 100 Edenton, NC 27932
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: Tewillisndot.state.ne.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: N/A
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
Page 3 of 12
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
Name of project: Multi-use pedestrian sidewalk adjacent to NC 12, Ocracoke Island, Hyd
County
2. T.I.P. Project Number (NCDOT Only): WBS element # 33906.1.1
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Hyde County Nearest Town: Ocracoke
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): Take NC 12 south to Ocracoke.
The project will start approximately 600' east of SR 1328 (Silver Lake Road) and continue
for approximately 0.44 miles. Pipe Replacement will be approximately 0.37 miles from the
start of the project.
5. Site coordinates, if available (UTM or Lat/Long): 35.1152777 N 75.9847222 W
(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:
Commercial. residential area.
7. Property size (acres): 0.5 acres
8. Nearest body of water (stream/river/sound/ocean/lake): Silverlake (adjacent to Pamlico
Sound).
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 http://l12o.enr.stite.ilc.us/admiii/i-naps/.)
Page 4 of 12
10. Describe the purpose of the proposed work: To construct multi-use pedestrian sidewalks
approximately 3 feet wide on both sides of NC 12 in Ocracoke Village starting
approximately 600' east of SR 1328 (Silver Lake Road) and continuing for approximately
0.44 miles. NCDOT is also proposing to replace a failing pipe(48' x 18" CMP) with a
proposed pipe of 48' x 18" CMP approximately 0.37 miles from the start of the project.
11. List the type of equipment to be used to construct the project: backhoe, excavator, paving
equipment and dump trucks.
12. Describe the land use in the vicinity of this project: residential, commercial
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 pen-nits,
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
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application: None
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying, site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 5 of 12
1. Wetland Impacts None
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, till,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year tloodplains 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 Ccntcr at 1-800-358-9616, or
online at littp://www.fema.g
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwatcr marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: None
Total area of wetland impact proposed: None
2. Stream Impacts, including all intermittent and perennial streams: None
Stream Impact
Site Number
indicate on ma)
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
(please s ecif )

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and atler, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditch ing/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.uNgS.VOV. Several intcmct sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
w),%'w.mapgc uest. com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: N/A
Page 6 of 12
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact Area of
Name waterbody Type of Waterbody
Site Number Type of Impact* Impact
(if f applicable) (lake, pond, estuary, sound,
(indicate on ma) acres bay, ocean, etc.)

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: till, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation N/A
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local storrnwater requirement, etc.): N/A
Size of watershed draining to pond: N/A Expected pond surface area: N/A
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.
Unurade to the nine is on existine alienment. The existing nine size and the proposed pipe
size are the same. The multi-use sidewalk is to allow for safer travel by pedestrians on Ocracoke
Island. BMP's will be in place to reduce impacts to adjacent water bodies and wetlands.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
Page 7 of 12
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
littp://112o.cnr.state.nc.us/iicwctlaiids/strmi,iide.litml.
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 casement, 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 htttr.//h2o.etir.state.nc.ush+rp/index.htm. 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): None
Amount of buffer mitigation requested (square feet): None
Amount of Riparian wetland mitigation requested (acres): None
Amount of Non-riparian wetland mitigation requested (acres): None
Amount of Coastal wetland mitigation requested (acres): None
Page 8 of 12
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ® No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 213 .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify, )?
Yes ® No ? If you answered "yes", provide the following infonnation:
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
1 505 3 N/A
2 1404 1.5 N/A
Total 1909 N/A
Lone I extends out 3U feet perpendicular from near bank of channel; Lone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 9 of 12
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 213 .0242 or.0260.
N/A
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Impervious surface area will increase by 0.22 acres.
XII. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
None
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (I 5A 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). -
11116
Applicant/Agent's Signatur Da e
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 10 of 12
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