20060619 Ver 1_Complete File_20060505

Certificate of Completion
DWQ Project No. O (g - O (o 1 C? County:
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Applicant: NC,3'T Ja J- l i7
Project Name:
Date of Issuance of 401 Water Quality Certification: 5 / 5 /D (o
Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules,
and any subsequent modifications, the applicant is required to return this certificate to the
40] /Wetlands Unit, North Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh,
NC, 27699-1621. This form may be returned to DWQ by the applicant, the applicant's authorized
agent, or the project engineer. It is not necessary to send certificates from all of these.
Applicant's Certification
1, , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to
built within substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules, the approved plans and specifications, and other supporting materials.
Signature:
Date:
Agent's Certification
I, , hereby state that, to the best of my abilities, due care and
diligence wa, used in t "Ac observation of the construction such that the construction was observed to
built within substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules, the approved plans and specifications, and other supporting materials.
Signature:.-- Date: L ° o ?o Co
If this prgiect was designed by a Certified Professional
I, __ , as a duly registered Professional
(i.e., Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been
authorized to observe (periodically, weekly, full time) the construction of the project, for the
Permittee hereby state that, to the best of my abilities, due care and diligence was used in the
observation of the construction such that the construction was observed to built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans
and specifications, and other supporting materials.
Signature: Registration No.: Date:
?C)F W A,TF9Q Michael F. Easley, Governor
t
??G William G. Ross Jr., Secretary
c 1 7 North Carolina Department of Environment and Natural Resources
p Alan W. Klimek, P.E. Director
' Division of Water Quality
May 5, 2006
n DWQ# 06-0619
Stanly County
Mr. Barry Moose, P.E. MAY j O 7.006
NCDOT Division 10 DFI IR - VVAI0i QUALITY
716 West Main Street WETLANDS ANO STOOMWAIM ®WWCrt
Albemarle, NC 28001
APPROVAL of 401 Water Quality Certification with Additional Conditions
Dear Mr. Moose:
You have our approval, in accordance with the attached conditions and those listed below, to permanently
impact 12 linear feet (If) (culvert extension) of an unnamed tributary* to Long Creek in order to pave an
existing, unpaved secondary road as described in your application received by the Division of Water Quality
(DWQ) on April 12, 2006. The location of the project is State Road 1266 (City Lake Drive) in Stanly County.
After reviewing your application, we have determined that this project is covered by Water Quality General
Certification Number 3404. Please note that you should get any other federal, state or local permits before
proceeding with your project, including those required by (but not limited to) Sediment and Erosion Control,
Non-Discharge, and Water Supply Watershed regulations.
This approval is valid solely for the purpose and design that you described in your application (unless modified
below) and will expire with the associated USACE 404 permit unless otherwise specified in the Water Quality
Certification. Should your project change, you must notify the DWQ in writing and you may be required to
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 conditions. If total wetland fills for this project
(now or in the future) exceed one acre, or if 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 in the attached certification and those listed below:
1. The placement of culverts and other structures in waters, streams and wetlands must be below the elevation
of the streambed by one (1) 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 for low flow passage of water and
aquatic life, as well as prevent headcutting of the streams. Design and placement of culverts and other
structures including temporary erosion control measures shall be installed in such a manner that the original
stream profiles are not altered (i.e., the depth of the channel must not be reduced by a widening of the
streambed). Existing stream dimensions (including pattern and profile) are to be maintained above and
below locations of each culvert. The applicant may be required to provide evidence that the equilibrium has
been maintained, if requested in writing by the DWQ. If it is determined that complete burial of the
culvert would cause adverse affects to and/or destabilize the wetland, which is the stream origin,
DWQ will not require the complete burial of the culvert at the inlet end in the streambed.
2. Heavy equipment must be operated from the banks rather than in the stream channel, when possible, in
order to minimize sedimentation and reduce the likelihood of introducing other pollutants into the stream.
'No stream determination performed.
North Carolina Division of Water Quality 610 East Center Avenue, Suite 301
Intemet: %w N..ne\atet ualil?-org Mooresville, NC 28115
Phone [phone]
FAX [phone]
Noy thCarolm,
?atura!!y
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
Page 2
3. Temporary dewatering sites must be restored to pre-existing conditions unless more natural geomorphic
conditions can be provided.
4. No live or fresh concrete shall come into contact with waters of the state until the concrete has hardenec
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. 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.
7. All work shall be performed during low or normal flow conditions.
8. Discharging hydroseeding mixtures and washing out hydroseeders and other equipment in or adjacent t
surface waters is strictly prohibited.
9. Erosion and sediment control practices must utilize Best Management Practices (BMP) and be in full
compliance with all specifications governing the proper design, installation, and operation and maintenar
such BMP in order to protect surface water standards:
a. The design, installation, operation, and maintenance of the sediment and erosion control measu
must be such that they equal, or exceed, the requirements specified in the most recent version c
the North Carolina Sediment and Erosion Control Manual. The devices shall be maintained on s
construction sites, borrow pit sites, and waste pile (spoil) projects, including contractor-owned or
leased borrow pits associated with the project.
b. 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 Surf,
Mining Manual.
c. The reclamation measures and implementation of these measures must be in accordance with tl
requirements of the Sedimentation Pollution Control Act.
10. Sediment and erosion control measures shall not be placed in wetlands or waters to the maximum exter
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 30 days after the Division of Land Resource
released the project.
11. The North Carolina Department of Transportation (NCDOT) and its contractors and/or agents shall not
excavate, fill or perform mechanized land clearing at any time in the construction or maintenance of this
project within waters and/or wetlands, except as authorized by this Certification, or any modification to tf
Certification (e.g., no work shall occur outside of the footprint of the plans provided). In addition, there
be no excavation from or waste disposal into jurisdictional wetlands or waters associated with this
Certification without appropriate modification. If this occurs, compensatory mitigation may be required s
is a direct impact from road construction activities.
12. Upon completion of the project, the applicant shall complete and return the enclosed "Certificate of
Completion" form to notify DWQ when all work included in the 401 Certification has been completed. PIi
include photographs upstream and downstream of the structure to document correct installation.
13. Continuing Compliance. NCDOT shall conduct its activities in a manner so as not to contravene any sta
water quality standard [including any requirements for compliance with section 303(d) of the Clean Wate
and any other appropriate requirements of state and federal law.
Page 3
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 to include conditions
appropriate to assure compliance with such standards and requirements in accordance with 15 A NCAC
2H.0507(d). Before codifying the certification, DWQ shall notify NCDOT and the USACE, provide public
notice in accordance with 15A NCAC 2H.0503, and provide opportunity for public hearing in accordance with
15A NCAC 21-1.0504. Any new or revised conditions shall be provided to NCDOT in writing, shall be provided
to the USACE for reference in any permit issued pursuant to Section 404 of the Clean Water Act, and shall
also become conditions of the 404 Permit for the project.
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. 27699-6714. This certification and its conditions are final and binding unless
you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If
you have any questions, please telephone Polly Lespinasse in the Mooresville Regional Office at 704-663-
1699.
Sincerely,
i
for Alan W. Klimek, P. E.
Attachments
cc: Steve Lund, USACE Asheville Field Office
Sonia Gregory, DWQ Wetlands Unit
Central Files
File Copy

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STATE OF NORTH CAROLINA
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4PR 6?4'w'
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ASST?R (l
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY DIVISION OF HIGHWAYS W. LYNDo TIPPETT
GOVERNOR April 6, 2006 SKRUARY
North Carolina Division of Water Quality
401 Wetlands Certification Unit 606 19
2321 Crabtree Boulevard
Raleigh, NC 27604-2260
Subject: Secondary Road Improvements to SR 1266 (City Lake Drive), Stanly County.
WBS Element Number 10C.084032 (DWQ Minor Permit Fee $200.00)
Dear Sir or Madam:
The North Carolina Department of Transportation (NCDOT) proposes to upgrade SR 1266 (City
Lake Drive) in Stanly County. SR 1266 is an unpaved roadway that will be upgraded to a paved
roadway. The total project length is 1.28 miles.
Transportation and highway laws of North Carolina (G.S. 136-44.6, 136-44.7, 136-44.7A, 136-
44.8 and 136-44.9) require the NCDOT to develop annual work programs for construction and
maintenance of secondary roads. These general statutes specifically set forth requirements for
annual construction and paving of existing unpaved roads. Paving of these roads is performed in
priority order as established by the NCDOT for each unpaved road within a given county. This
number is based on characteristics of each road, including number of homes, schools, churches,
businesses, industries, recreational facilities, traffic counts, presence of school bus routes, and
value as a thoroughfare. SR 1266 is scheduled for paving in the 2005-2006 Secondary Roads
Construction Program.
Protected Species
The project has been reviewed for the presence of federally listed threatened and endangered
species. It has been determined that the construction of this project will not have an effect on any
federally listed species.
Impacts to Waters of the United States
This project cannot be completed without impacts to waters of the United States. The project lies
within the Yadkin River Basin (Hydrologic Unit # 03040105); affecting the drainage of an
unnamed tributary to Long Creek. There will be approximately 12 linear feet of stream impacts as
a result of the proposed roadway improvements.
716 West Main Street, Albemarle, NC 28001 9 [phone] • Fax [phone]

Y.

f.

Wetland Impacts
There are no wetland impacts that will result from the construction of this project. Potential
impacts will be avoided by realigning City Lake Drive.
Stream Impacts
Table 1 includes information related to site number, stream name, existing pipe length (ft),
existing pipe width (in), proposed replacement or extended pipe length (ft) and width (in).
Tah1p t _ gtream impacts due to imnrovements to SR 1221 (Frog Pond Road)
Site Existing Existing Proposed Proposed
No. Stream Name Length Width Length Width
feet inches feet inches
Sta. UT to Long Creek/Long 24 12 36 18
19+80 Lake
Note: "U'P' refers to unnamed tributary.
Avoidance/Minimization
SR 1266 has been realigned to the north side of the existing right-of-way near Station 19+80,
thereby eliminating possible wetland impacts in this area. The proposed road shoulders for this
project have been reduced to a 2:1 slope in an effort to further minimize unnecessary impacts.
Surface waters not affected by this project will be protected from unnecessary encroachment. No
staging of construction equipment or storage of construction supplies will be allowed in or near
wetlands or surface waters. Best Management Practices for the protection of wetlands and
surface waters will be enforced during all phases of project construction. Continued coordination
will occur between maintenance forces and the Division Environmental Supervisor during
construction in an effort to minimize impacts to jurisdictional sites.
Summary
The purpose of this letter is to request authorization to construct the proposed project under a
Section 401 Water Quality Certificate (WQC) No. GC3404. We have enclosed seven copies of
the pre-construction notification package for dissemination and review.
If you have any questions or need any additional information concerning this project, please feel
free to contact Mr. Larry Thompson, Division Environmental Supervisor, at [phone].
Sincerely,
Barry Mo se, PE
Division Engineer
BSM/LBT
cc: Ms. Polly Lespinasse, NCDWQ
Ms. Marella Buncick, USFWS
Ms. Marla Chambers, NCWRC
Mr. Ritchie Hearne, DE
Ms. Ranette Davis, CME
Mr. Larry Thompson, DEO
Area Field Operations Unit
SR 1266 (City Lake Drive)
Stanly County
Office Use Only' Form Version March 05
USACE Action ID No. DWQ No. 2 Q 0 R 0 F 1 9
(If anv particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. 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: Nationwide 14
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: ?
If your project is located in any of North 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
Owner/Applicant Information
Name:
Mailing Address: 10' Highway Division
716 West Main Street
Albemarle N.C. 28001
Telephone Number: [phone] Fax Number: [phone]
E-mail Address:
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: Barry Moose
Company Affiliation: N.C. Department of Transportation
Mailing Address: 10th Highway Division
716 West Main Street
Albemarle N.C. 28001
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: bmoose@dot state nc us
Page] of 9
SR 1266 (City Lake Drive)
Stanly County
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 l l 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 fiill-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 1266 (City Lake Drive)
2. T.I.P. Project Number or State Project Number (NCDOT Only):
Property Identification Number (Tax PIN):
4. Location
County: Stanly County Nearest Town: Albemarle
Subdivision name (include phase/lot number):
Directions to site (include road numbers/names, landmarks, etc.): From the intersection of
US 52 and NC 73 in Albemarle travel north on NC 73 2.1 miles to City Lake Drive which is
located on your left. City Lake Drive is on the NW side of Long Lake
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): 35°20'34.90" ON 80°14'49.31 °W
6. Property size (acres): N
7. Name of nearest receiving body of water: Long Creek/Lake
8. River Basin: Yadkin (Hydrologic Unit 03040105)
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps .)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Rural residential with some agricultural uses.
Page 2 of 9
SR 1266 (City Lake Drive)
Stanly County
10. Describe the overall project in detail, including the type of equipment to be used: City Lake
Drive is an unpaved secondary road that is scheduled to be paved in the 2005-2006
Secondary Road Program There are two jurisdictional streams that cross City Lake Drive,
one has been previously authorized under a separate PCN and one crossing that has prompted
this request for a permit authorization The stream is located at Sta. 19+80 in the attached
plan sheets The project area will be cleared as needed and followed by the erosion control
plan implementation The proposed pipe replacement will be completed utilizing typical
construction equipment such as track hoe dump truck boom truck and hand tools.
11. Explain the purpose of the proposed work: Due to the adjacent wetland area the roadway
will be realigned near Sta 19+80 to avoid unnecessary impacts The existing 12 inch RCP
will need to be replaced with a longer 18 inch RCP to accommodate the road alignment and
sufficient road shoulder.
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 There is a bridge located at Sta 66+20 that was previously permitted by
the USACE (Action ID 200330758 - extended to March 18, 2007) and the NCDWQ (DWQ
Project Number 030596). This bridge should be replaced sometime prior to beginning the
secondary road improvements
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.
There are no future permit requests anticipated for this project '
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. 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.
Page 3 of 9
SR 1266 (City Lake Drive)
Stanly County
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.
1. Provide a written description of the proposed impacts: There will be 12 feet of permanent
impacts associated with this project
2. Individually list wetland impacts. Types of 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.
Wetland Impact

Site Number
(indicate on map)

Type of Impact Type of Wetland

(e.g., forested, marsh,
herbaceous, bog, etc.) Located within
100-year
Floodplain
es/no Distance to
Nearest
Stream
linear feet Area of
Impact
(acres)

Total Wetland Impact (acres)
3. List the total acreage (estimated) of all existing wetlands on the property: N/A
4. 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
Number
indicate on ma
Stream Name
Type of Impact
Perennial t?
Intermittent. Average
Stream Width
Before Impact- Impact
Length
linear feet Area of
Impact
acres
Sta. 19+80 UT to Long Creek 36' X 18" Perennial 1' 12' .0003

Total Stream Impact b length and acreage)
0003
Page 4 of 9
SR 1266 (City Lake Drive)
Stanly County
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, dredging, flooding, drainage, bulkheads, etc
Open Water Impact
Site Number
(indicate on ma Name of Waterbody
(if applicable)
Type of Impact Type of Waterbody
(lake, pond, estuary, sound, bay,
ocean, etc. Ime act
pact
acres
N/A

Total Open Water Impact (acres)
6. List the cumulative impact to all Waters of the U.S. resultin from the ro'ect.
Stream Impact (acres): .0003
Wetland Impact (acres): N/A
Open Water Impact (acres): N/A
Total Impact to Waters of the U.S. (acres) .0003
Total Stream Impact (linear feet): 12
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.
8. 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.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Current land use in the vicinity of the pond:
Size of watershed draining to pond: Expected pond surface area:
Page 5 of 9
SR 1266 (City Lake Drive)
Stanly County
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts. The road will be shifted near
Sta 19+80 to avoid wetland impacts Any streams and adjacent wetlands will be protected from
unnecessary encroachment The staging of construction equipment will not be allowed in or near
the streams and wetland located on this project. Strict enforcement of the sedimentation and
erosion control best management practices for the protection of wetlands and surface waters will
be enforced during, all phases of project construction
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 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
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 Work in North Carolina, available at
http?Hh2o.enr.state.nc.us/ncwetlands/strm-v,ide.litiiil.
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,
Page 6 of 9
SR 1266 (City Lake Drive)
Stanly County
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.
Any requests received for mitigation will be routed through the NC Ecosystem Enhancement
Pro cram.
2. 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 http://h2o enr.state.nc.us/wrp/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):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
IX. Environmental Documentation (required by DWQ)
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
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 (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.
Page 7 of 9
SR 1266 (City Lake Drive)
Stanly County
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 213 .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify )? Yes ? No
2. If "yes", 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 Multiplier Required
(square feet) Mitigation
3 (2 for Catawba)
1.5
Total I I I
* Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone I.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration / Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 213.0242 or.0244, or.0260.
XI. Stormwater (required by DWQ)
Describe impervious acreage (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. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level.
The Dronosed Davement width is 20 feet. The existing gravel base is twenty feet wide, and wider
in some sections There will not be an increase in impervious area as a result of this project
being constructed
XII. Sewage Disposal (required by DWQ)
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 (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
Page 8 of 9
SR 1266 (City Lake Drive)
Stanly County
XIV. 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://h2o.enr.state.ne.us/ncwetlands. If no, please provide a short narrative description:
This grade is necessary due to the widening and paving of SR 1266 ( City Lake Drive) and
will have no direct affect on development
XV. 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).
1/6,
Applicant/)
(Agent's signature i
ss Signature 4F or Date
only if an authorization letter from the applicant is provided.)
Page 9 of 9
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Name: ALBEMARLE Location: 035' 21'03.6" N 080° 14' 26.21" W
Date: 4/6/2006 Caption: Stanlv Countv
Scale: 1 inch equals 1000 feet SR 1266 (City Lake Drive)
Copyright (C) 1998, Maptech, Inc.
Stanly County
SR 1266 Wity Lake Drive
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Legend
p permit site

Prepared by:
North Carolina
Department of Transportation
L B. Thompson
Environmental Unit, Division 10
Date: April 6, 2006, 2006
This map Is Intended for Internal DOT use only.
For all other us", no warranties of any sort,
Including accuracy, fitness, or merchantability
accompany this product.
GGl
0 410 820 1,640 2,460 3,280

SR 1266 City Lake Drive
(Stanly County)

Inlet on City Lake Drive
(Sta. 19+80)

Road Way View Looking S/SW
(Sta. 19+80)
SR 1266 City Lake Drive
(Stanly County)
Outlet on City Lake Drive
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