20050013 Ver 1_Complete File_20060207

OF W ATFR(`? _? /1? Michael F. Easley, Governor
\O? PG ? 1 William G. Ross Jr., Secretary
?` r?.rth Carolina Department of Environment and Natural Resources
? FEB U 7 Alan W. Klimek, P.E. Director
20n6 Division of Water Quality
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DWQ Project No.: UJIUOZ-3 County:
Applicant: NCDOT
Project Name: S /// r sn ?-
Date of Issuance of 401 Water Quality Certification:

Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer
Rules, and any subsequent modifications, the applicant is required to return this certificate to the
401/Wetlands Unit, North Carolina Division of Water Quality, 1650 Mail Service Center, Raleigh, NC,
27699-1650. This forni 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
I, Joel 13. Setzer, P.F,., 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 be built within substantial
ty Certification and Buffer Rules, the approved plans and
ali
compliance and intent of f64
specifications, and otl r s.
Signature: Date:
Agent's Certifi tion
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 be
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:
If this project 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 Permitee 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 be 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:
NA
tJzbff :t
North Carolina Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
919-733-1786 (phone), 919-733-6893 (fax), http://h2o.enr.state.nc.uslncwetlands/
of wA rF9
f
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
February 2, 2005
Graham County
DWQ Project No. 050013
NCSR 1111 (Poison Branch Road)
APPROVAL of 401 Water Quality Certification with Additional Conditions
Mr. J. B. Setzer, P.E.
Division Engineer
N C Department of Transportation
253 Webster Road
Syiva, North Carolina 28779
Dear Mr. Setzer:
FEB 7 2005
DENR - WATER QUALITY
% ETLIVIDS MD STORMWATER BRANCH
You have our approval, in accordance with the attached conditions and those listed below, to impact 177 linear feet of two
(2) unnamed tributaries to Poison Branch (63 linear feet of new culvert and eliminate 114 linear feet of roadside seep), in
order to make improvements to NCSR 1111 in Graham County. The project should be constructed in accordance with
your application dated December 21, 2004 (received January 3, 2005), including the environmental comments made in the
application letter. After reviewing your application, we have decided that this fill is covered by General Water Quality
Certification No. 3404, corresponding to the U.S. Army Corps of Engineers Nationwide Permit Number 14. In addition,
you must acquire any other federal, state or local permits before you proceed with your project including (but not limited
to) Sediment and Erosion Control, Non-Discharge and Water Supply Watershed regulations. This approval will expire
with the accompanying 404 Permit unless otherwise specified in the Water Quality Certification.
This approval is valid solely for the purpose and design described in your application (unless modified below). Should
your project change, you must notify the DWQ in writing 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 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 be valid, you must follow the conditions listed in the attached certification and any
additional conditions listed below.
1. 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 Afanual.
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 Sn.nfaceAlining.Hanual.
0,C
Nor-tltCarolina
Jl atamlly
North Carolina Division of Water Quality 2090 U.S. Highway 70 Swannanoa, NC 28778 Phone [phone] Customer Service
Internet: h2o.enrstate.nc.us FAX [phone]
An Equal Opportunity/Affirmative Action Employer
Mr. J. B. Setzer, P.E.
February 2, 2005
Page Two
d. Any reclamation measures and implementation must comply with the reclamation in accordance with the
requirements of the Sedimentation Pollution Control Act.
2. 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 Preconstruction Notice Application. 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.
3. 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 Quality has released the project.
4. In-stream work and land disturbance within the 25-foot buffer zone are prohibited during the trout-spawning season of
October 15 through April 15 to protect the egg and fry stages of trout from off-site sedimentation during construction
of the roadway.
5. Adequate sediment and erosion control measures should be implemented prior to any ground disturbing activities to
minimize impacts to downstream aquatic resources. Temporary or permanent herbaceous vegetation should be
planted on all bare soil within 15 days of ground disturbing activities to provide long-term erosion control. Erosion
control mating should be used in conjunction with appropriate seeding on disturbed soils in steep slope and riparian
areas. Matting should be secured in place with stables or wherever possible, live stakes of native trees. Tall fescue
should not be used in riparian areas. Riparian vegetation must be reestablished within the construction limits of the
project by the end of the growing season following completion of construction.
6. Culverts that are less than 48-inch in diameter should be buried to a depth equal to or greater than 20% of their size to
allow for aquatic life passage. Culverts that are 48-inch diameter or larger should be buried at least 12 inches below
the stream bottom to allow natural stream bottom material to become established in the culvert following installation
and to provide aquatic life passage during periods of low flow. This may require increasing the size of the culvert to
meet flow conveyance requirements. If any of the existing pipes are perched, they shall be removed and replaced, and
re-installed correctly, unless demonstrated that this is topographically unfeasible.
7. Rock check dams at culvert outlets should be removed at the project completion to avoid impeding the movement of
aquatic life.
8. The dimension, pattern and profile of the stream, above and below the culverts, should not be modified by widening
the stream channel or reducing the stream depth. Disturbed floodplains and streams should be restored to natural
geomorphic conditions.
9. Stormwater shall be directed to vegetated buffer areas, grass lined ditches or other means appropriate to the site for
the purpose of pre-treating stormwater runoff, and must not be routed directly into streams. Mowing of existing
vegetated buffers is strongly discouraged, so that they may be utilized for stormwater diffuse flow.
10. Removal of vegetation at the stream crossing and adjacent to streams should be minimized. Native trees and shrubs
(e.g. Rhododendron, dog hobble, willows, alders, sycamores, dogwoods, black walnut and red maple) should be
planted along the streambank to reestablish the riparian zone and to provide long-term erosion control in the vicinity
of the road crossing and along the streams within dedicated rights of way.
11. Any riprap placed for bank stabilization should be limited to the streambank below the high water mark, and
vegetation should be used for stabilization above the high water elevation. Riprap should not be place in stream
channels in such a manner that it impedes aquatic life passage.
12. Heavy equipment must be operated from the banks rather than in the stream channel in order to minimize
sedimentation and to reduce the likelihood of introducing other pollutants into the stream.
13. 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.
14. Excavation of the stream crossings and relocations should be conducted in the dry, if possible. Sandbags, cofferdams,
flexible pipe or other diversion structures should be used to minimize excavation in flowing water.
15. If concrete is used during culvert construction (e.g., headwalls), 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 fish kills.
16. Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or adjacent to surface waters is
strictly prohibited.

Mr. J. B. Setzer. P.E.
February 2, 2005
Page Three
17. The presence of equipment in the channels must be minimized. Under no circumstances must rock, sand or other
materials be dredged from the wetted stream channel under authorization of this permit, except in the immediate
vicinity of the culverts. In-stream dredging has catastrophic effects on aquatic life, and disturbance of the natural
form of the stream channel will likely cause downstream erosion problems, possibly affecting other landowners.
18. This certification does not authorize the discharge of waste rock and dirt into the stream or riparian zone except for
permitted areas associated with the culvert extensions.
19. All work shall be performed during low flow conditions (below bankfull).
20. Upon completion of the project, the NCDOT shall complete and return the enclosed "Certificate of Completion " form
to notify NCDWQ when all work included in the §401 Certification has been completed. The responsible party shall
complete the attached form and return it to the Transportation Permitting Unit of the NC Division of Water Quality
upon completion of the project. The NCDOT is strongly advised to send in photographs upstream and downstream of
each structure to document correct installation.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must act
within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition, which conforms to
Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, 6714 Mail Service Center,
Raleigh, N.C. 27699-6714. This certification and its conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If you have
any questions, please telephone Mr. Mike Parker of the Asheville Regional Office at 828.296.4500.
Sincerely,
/0' PZ,
Alan W. Klimek, P.E.
Attachment
cc: Wilmington District, US Army Corps of Engineers
Mark Davis, Division 14, DEO
Ed Ingle, Roadside Environmental
Angie Pennock, USACE Asheville Field Office
Transportation Permitting Unit
Mike Parker, Asheville Regional Office
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DENR - b"?ATEK
STATE OF NORTH CAROLINA ` 11''?DS??'° sTOnffFtq "S WW CH
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
GOVERNOR
0600`1 3
December 21, 2004
Ms. Angie Pennock, NCDOT Regulatory Project Manager
U.S. Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, NC 28801-2714
Attention: Ms. Angie Pennock
NCDOT Coordinator
LYNDO TIPPETT
SECRETARY
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RQRavcy
Subject: Proposed Secondary Road Construction-Phase II
Poison Branch Road, SR 1111 Graham County.
State Project No. 140.038007 (DWQ Major Permit Fee $475)
Dear Ms. Pennock:
PAYNIEf ,l-
RECEIVED
The North Carolina Department of Transportation (NCDOT) is proposing to widen, grade
and pave Poison Branch Road, in Graham County. This proposal entails widening and
paving the existing gravel road to a standard 18'roadway. The proposed improvements of
Poison Branch Road have been identified as necessary maintenance and safety
improvements. This is the second phase as the first was completed in 2001- R/W has
since been acquired. Also, there were not any permits needed for Phase I. Funds have
been allocated for this project, and NCDOT would like to perform these activities as soon
as permits are obtained.
I am sending a straight-line diagram with the proposed erosion control and construction
limits along this project. In addition, I am sending a typical section of the road, cross
section, drawing for pipe culvert replacement as well as a marked county map and USGS
quad map. We propose to install the new culverts slightly below the existing streambed
elevations where bedrock is not encountered to minimize impacts to wildlife habitats and
allow the existing stream gradients to remain as unchanged as is physically possible.
The North Carolina Natural Heritage Database was checked for records of threatened and
endangered species. There are no records of threatened or endangered species for Poison
Branch. There are no records for the entire Long Creek watershed, which includes
. ,
Poison Branch. There is a pre-1981 record for the Appalachian elktoe (Alasmidonta
raveneliana) from nearby Tulula Creek. The unnamed tributaries to Poison Branch are
small (1 and 2-foot in width) and are not of sufficient size to support the Appalachian
elktoe. Additionally, the impacts that will result from the culvert replacements and
elimination of 120 feet of wet seep will be minimal. For these reasons, this project will
have "no effect" on endangered or threatened species.
Impacts to historic or cultural resources are not anticipated. If the State Historic
Preservation Office (SHPO) and the Office of State Archaeology determines that further
investigations are required, NCDOT will conduct the appropriate site investigations and
obtain compliance from SHPO prior to project construction.
The best management practices will be used to minimize and control sedimentation and
erosion on this project. The construction foreman will review all erosion control
measures daily to ensure sedimentation and erosion is being effectively controlled. If the
planned devices are not functioning as intended, they will be immediately replaced with
better devices. The erosion control devices will be in place prior to pipe culvert
construction and will remain in place until the project is stabilized.
Impacts to Waters of the United States
In order to complete the above-mentioned improvements along Poison Branch Road in
Graham County, it will be necessary to impact waters of the United States in the Little
Tennessee River Basin. Specifically, NCDOT is requesting to extend/replace 1 metal
culvert and add 1 culvert in an unnamed tributary to Poison Branch (Class C, Trout). The
addition of a culvert will eliminate 114' of roadside stream. Listed below is a summary
of the proposed impact.
Station Existing Proposed Net Impacts Stream Class
Condition Condition Name
Site #1 18"X 22'CMP 24"X45' CMP 23' extension UT to Poison C, Tr
32+56 Branch
Site 42 Roadside Add 18"X40' 40' UT to Poison C, Tr
33+70 stream CMP Branch
Site #2a 114 feet of Eliminate 114' UT to Poison
32+56- roadside stream roadside seep Branch
33+70
Total Impacts = 177 feet
Permits Requested
NCDOT is hereby requesting authorization under NWP 14 and Section 404 of the Clean
Water Act to proceed with the construction project outlined above. By copy of this letter,
I am asking Mr. David McHenry, North Carolina Wildlife Resources Commission
(NCWRC) Western Mountain Region Coordinator, to comment directly to you
concerning the 404 Nationwide Permit Request.
Also, by copy of this letter, I am requesting authorization to proceed under Section 401 of
the Clean Water Act from the North Carolina Department of Environment and Natural
Resources (DENR), Division of Water Quality (DWQ). In addition, I am asking Mr.
McHenry, and Mr. Ed Ingle, (NCDOT) to comment directly to me concerning this permit
request.
If you have any questions or need additional information, please contact me at (828) 321-
4105. Your early review and consideration will be greatly appreciated.
Sincerely, . Q
Michael A. Jo yes
County Maintenance Engineer
Copy: Mr. Carson Fisher, PE, Regional Engineer DEI-INR
Mr. J.B. Setzer, PE, Division Engineer, NCDOT
Mr. John Hennessy, DWQ, DEI-INR ( 7 copies)
Mr. David Mel leery, Western Mountain Coordinator, NCWRC
Mr. B.C. Burch, PE, Division Maintenance Engineer, NCDOT
Mr. W.T. Grindstaff, District Maintenance Engineer, NCDOT
Mr. Mark Davis, Division Environmental Officer, NCDOT
Mr. Mike Parker NCDOT Coordinator, DWQ, DEHNR
Mr. E. L. Ingle, Roadside Environmental Field Operations Engineer, NCDOT

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Pre-Construction Notification (PCN) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401 General Water Quality
Certifications, and Riparian Buffer and Watershed Buffer Rules
Poison Branch Road, SR I I `i I
Graham County
r`?oiNO?n?4? G
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NCDOT Division 14, District III
Prepared by: Michael Jones
County Maintenance Engineer
Cherokee & Graham Counties
Page t
Office Use Only: Form Version October 2001
0.000.10
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: NWP 14
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ? N/A
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ? N/A
II. Applicant Information
1. Owner/Applicant Information
Name: North Carolina Denartment of Transnortation (NCDO
Mailing Address: PO Box 1551
Andrews, NC 28901
Telephone Number: 828.321.4105 Fax Number: 828.321.3228
E-mail Address: mi les0dot.state.nc.us
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: Michael A. Jones
Company Affiliation: County Maintenance Frigineer
Mailing Address: (same as i1bove)
Telephone Number:
E-mail Address:
Fax Number:
Page 2
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Poison Branch Road, SR 1 1 1 1
2. T.I.P. Project Number or State Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Graham Nearest Town: Robbinsville
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): From Robbinsville take SR 1127
for approximately 1 mile to SR 1 110 for approximately .5 miles to Poison Branch Road on
the left.
5. Site coordinates, if available (UTM or Lat/Long):
(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.)
5. Describe the existing land use or condition of the site at the time of this application:
forest, light residential
6. Property size (acres):
7. Nearest body of water (stream/river/sound/ocean/lake): Poison Branch - Class C, Trout
8. River Basin: Little "Tennessee River
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://112o.enr.state.nc.us/a(iniin/neaps/.)
Page 3
9. Describe the purpose of the proposed work: Construct road to current NCDOT secondary
road standards
10. List the type of equipment to be used to construct the project: trackhoe backhoe, dozer
loader, trader dump trucks
11. Describe the land use in the vicinity of this project: forest light residential
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application:
N/A
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 4
1. Wetland Impacts No wetland impacts
Wetland Impact
Site Number
(indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
(es/no) Distance to
Nearest Stream
(linear feet
Type of Wetland***

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local Floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http:Hwww.femaj ov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property:
Total area of wetland impact proposed:
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact Length of Average Width Perennial or
Site Number Type of Impact* Impact Stream Name** of Stream Intermittent?
indicate on ma linear feet Before Impact leasespecify)
Site #1
Sta: 32+56 Culvert 23 feet poison Branch 2 feet I
Site tf 2 Culvert

Sta: 33+70 40' Poison Branch 2 feet I
Site 11 2a

Sta: 32+56 - Roadside Stream
114
Poison Branch
I foot
I
33+70 elimination
* 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 after, 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.usr_s.eov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.1OV07onc.com,
www.maPqucst.coni, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 177 linear feet
Page 5
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S. No open water impacts
Open Water Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
(acres) Name Waterbody
)
(if applicable) Type of Waterbody
(take, pond, estuary, sound,
bay, ocean, etc.

* List cacti impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. 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.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
Erosion and siltation control measures and BMP's will be used during construction to avoid
environmental impacts.
VIII. Mitigation N/A
DWQ - In accordance with 15A NCAC 21-1 .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 6
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
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
http•//112o.enr.state.nc.tts/newetlands/strmgicle.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 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.
N/A
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 httn://1,2o.enr.state.nc.tis/wrp/index.litm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information: N/A
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):
Page 7
Amount of Coastal wetland mitigation requested (acres):
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
(Meuse), 15A NCAC 2B .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 information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet) Multiplier Required
Mitigation
1 3
2 1.5
Total
* Zone I extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of "Lone I.
Page 8
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
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.
The existing compacted gravel roadway acts as an impervious surface Paving of the roadway
should eliminate sedimentation from fines associated with gravel surface treatment The
roadway surface will be approximately 40% of the right-of-way area Stormwater will be
diverted through settling basins or grass lined buffers prior to entering streams (See erosion
control plan).
XII. Scwage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No ?
Is this an after-the-fact permit application?
Yes ? No ?
XIV. Other Circumstances (Optional):
ichael
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).
12/21/04
Applicant/Agent's SignatG? Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 9

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Name: ROBBINSVILLE Location: 035° 18'23.1" N 083' 48'45.7" W
Date: 11/18/104 Caption: SR 1111, Poison Branch Road,
Scale: 1 inch equals 1290 feet Graham County
Copyright (C) 1997, Maplech, Inc.
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