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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
July 18, 2005
Halifax County
DWQ Project No. 051211
APPROVAL of 401 Water Quality Certification
Mr. R.E. Greene, Jr., P.E. Division Engineer
NCDOT, Division 4
509 Ward Boulevard
PO Box 3165
Wilson, NC 27895
Dear Mr. Greene:
You have our approval, in accordance with the conditions listed below, for the following impacts for the purpose of
upgrading SR 1802 in Halifax County.
Impact Locations Stream Impacts - Permanent Fill
(Linear Feet) Wetland Impacts-Permanent Fill
(acres)
Site 1 24 .079
Site 2 18 N/A
Site 3 12 .205
Site 4 N/A .137
The project shall be constructed in accordance with your application dated received July 7, 2005. After reviewing
your application, we have decided that the stream impacts described are covered by General Water Quality
Certification Numbers 3404 and 3366. This certification corresponds to the Nationwide Permit 14 and the
Nationwide Permit 33 issued by the Corps of Engineers. In addition, you should acquire any other federal, state or
local permits before you proceed with your project including (but not limited to) Sediment and Erosion Control,
Non-Discharge and Water Supply Watershed regulations. This approval will expire with the accompanying 404
permit, unless otherwise specified in the Water Quality Certification.
This approval is valid solely for the purpose and design described in your application (unless modified below).
Should your project change, you must notify the DWQ and submit a new application. If the property is sold, the
new owner must be given a copy of this Certification and approval letter, and is thereby responsible for complying
with all the conditions. If total wetland fills for this project (now or in the future) exceed one acre, or of total
impacts to streams (now or in the future) exceed 150 linear feet, compensatory mitigation may be required as
described in 15A NCAC 2H.0506 (h) (6) and (7). For this approval to remain valid, you must adhere to the
conditions listed in the attached certification.
1.) Upon completion of the project, the NCDOT shall complete and return the enclosed "Certification of
Completion Form" to notify DWQ when all work included in the 401 Certification has been completed. The
responsible party shall complete the attached form and return it to the 401/Wetlands Unit of the Division of
Water Quality upon completion of the project.
2.) During the construction of the project, no staging of equipment of any kind is permitted in waters of the U.S., or
riparian buffers.
One
Caro ?a
Transportation Permitting Unit " ' ""?uCQI?J
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] /FAX [phone] / Internet: htti):Hh2o enr state.nc. us/ncvvetlands
3.) Riparian vegetation must be reestablished 'within the construction limits of the project by the end of the growing
season following completion of construction.
4.) The dimension, pattern and profile of the stream above and below the crossing should not be modified by
widening the stream channel or reducing the depth of the stream. Disturbed floodplains and streams should be
restored to natural geomorphic conditions.
5.) Any riprap used must not interfere with thalweg performance and aquatic life passage during low flow
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.) Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or adjacent to surface
waters is prohibited.
8.) 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.
9.) There shall be no excavation from or waste disposal into jurisdictional wetlands or waters associated with this
permit without appropriate modification of this permit. Should waste or borrow sites be located in wetlands or
stream, compensatory mitigation will be required since it is a direct\impact from road construction activities.
10.) 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.
11.) Placement of culverts and other structures in waters, streams, and wetlands must be placed below the elevation
of the streambed by one foot for all culverts with a diameter greater than 48 inches, and 20 percent of the
culvert diameter for culverts having a diameter less than 48 inches, to allow low flow passage of water and
aquatic life. Design and placement of culverts and other structures including temporary erosion control
measures shall not be conducted in a manner that may result in dis-equilibrium of wetlands or stream beds or
banks, adjacent to or upstream and down stream of the above structures. The applicant is required to provide
evidence that the equilibrium shall be maintained if requested in writing by DWQ.
12.) If the above condition (#11) is unable to be met, due to bedrock or other limiting features encountered during
construction, please contact the NCDWQ for guidance on how to proceed and to determine whether or not a
permit modification will be required.
13.) No live or fresh concrete shall come into contact with waters of the state until the concrete has hardened.
14.) 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.
15.) All work shall be performed during low or normal flow conditions.
16.) All fill slopes located in jurisdictional wetlands shall be placed at slopes no flatter than 3:1.
17.) 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.
18.) For the areas being impacted due to site dewatering activties, the site shall be graded to its preconstruction
contours and revegetated with native vegetation.
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. 276 1 1-7447. 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 Christina Breen at [phone].
Si ly,
n
Alan W. Klimek,
JEH/cmb
Attachment
cc: Mr. Bill Biddlecome, US Army Corps of Engineers, Washington Field Office
Mr. Jamie Shern, Division 4 Environmental Officer, 509 Ward Blvd., Wilson, NC 27895
NC DWQ Raleigh Regional Office
Central Files
File Copy
c:\Correspondence\20050therProjects\DWQ05121 1\071805wgc.doc
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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
GOVERNOR
DIVISION 4
July 1, 2005
Mr. Bill Biddlecombe
U.S. Army Corps of Engineers
Washington Regulatory Field Office
Post Office Box 1000
Washington, North Carolina 27889-1000
(Two Copies)
Ms. Christina Breen
Wetlands/401 Unit
NC DENR Division of Water Quality
2321 Crabtree Blvd
Raleigh, NC 27604
(Seven Copies)
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Sr??RO?
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LYNDO TIPPETT
SECRETARY
051211
Ct'
SUBJECT: Halifax County, Improvement of SR 1802
WBS Element: 33488. 1.1
Dear Sir or Madam:
The North Carolina Department of Transportation (NCDOT) proposes to widen and pave
SR 1802 to bring the road into compliance with standard safety design specifications.
This activity will result in impacts to streams due to the replacement and extension of
crossline pipes to facilitate travel lane and shoulder widening. The NCDOT anticipates
that the pipe replacement activities will be authorized under Nationwide Permit (NWP)
14, and temporary losses to the waters will be minimized by the use of sheet pile
cofferdams being placed within the proposed 0.421 acre impact area. The sheet pile
cofferdams will be removed immediately upon completion of the crossline pipe
replacements. This application is also intended as request for written authorization from
the NC Division of Water Quality to replace the pipes under General Water Quality
Certificate # 3375 (NWP 14). The following information is being provided to satisfy
Nationwide Permit Condition 13 (Federal Register January 15, 2002) and Condition I of
General Water Quality Certificate # 3375.
Post Office Box 3165, Wilson, North Carolina 27895-3165
Phone [phone] Fax [phone]
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APPLICATION INFORMATION
Enclosed please find the Pre-construction Notification (PCN) Form and supporting
documentation for the above referenced project.
In accordance with North Carolina General Statute 143-215.3D(e) the following
information is being provided to facilitate payment of fees associated with the appropriate
Water Quality Certificate:
• Certificates being requested: #3375 (NWP 14) and #3366 (NWP 33)
• WBS Element: 33488.1.1
• Amount of fee: $200
PROJECT INFORMATION
Road Name SR Number Priject Length
(miles) Classification
Shields Fann Rd 1802 1.08 Rural
River Basin: DIWDQ Water Quality Designation % New Impervious Surface
Roanoke 23-36 C
Buffer Rules Buller Use Designation
No Not Applicable
Protected Species Present Mapped Historic Properties
No No
PIPE REPLACEMENT INFORMATION
Site (Station) 41 11 1 10 L- Map Status Shown on topo and ssurvey
Existing RCP Proposed RCP
Diameter (in) 24 Diameter 24
Length (ft) 28 Length 52
Construction
Method
Low flow installation Dewatenng
*

'
sheet pile
Device
Burial Depth 8 Inches Substrate Sandy clay loam
Construction Date ASAP Duration One week
Impacts (ft.) 24-piped; -rip-rap protection ; -Imporary
Comments Dewatering, if nec&d, will he accomplished by the use of sheet piles. Sheet piles will be placed within the
proposed 0.421 acre impact area.
Within 15 working days of the ol'the pipe replacement all collerdams will be entirely removed and natural stream
Restoration Plan contours will be restored and seeded. Temporary silt screens placed in intennittent channels will be cleaned and
removed following vegetation establishment.
?%_ r = mmoreeu concrete pipe; C ?MP = l onugated metal pipe; CMPA = Corrugated metal pipe arch; * K needed.

Site (Station) #2 17 +30 -L- Map Status Shown on topo and ssurvey
Existing RCP Proposed RCP
Diameter (in) 18 Diameter 24
Length (fl) 30 Length 48
Construction
Low flow installation Dewate ing
sheet pile
Method evice*
D
Burial Depth 16 Inches Substrate Sandy clay loam
Construction Date ASAP Duration One week
Impacts (fl.) 18-piped; -rip-cap protection ; -temporary
Comments Dewatering, if neded, will be accomplished by the use of sheet piles. Sheet piles will be placed within the
proposed 0.421 acre impact area.
Within 15 working days of the of'the pipe replacement all collcrdams will be entirely removed and natural stream
Restoration Plan contours will he rerstored and seeded. Temporary silt screens placed in intermittent channels will be cleaned and
removed following vegetation establishment.
KCP = reinforced concrete pipe; C'MP = Corrugated metal pipe: CM PA = Corrugated metal pipe arch; * If needed.
Site (Station) #3 36 +30 L- Map Status Shown on topo and ssurvey
Existing RCP Proposed RCP
Diameter (in) 15 Diameter 24
Length (fl) 36 Length 48
Construction
Low flow installation Dewatering
sheet pile
Method Device*
Burial Depth 8 Inches Substrate Sandy clay loam
Construction Date ASAP Duration One week
Impacts (fl.) 12-Piped; -rip-rap protection ; -temporary
Comments Dewatering, if needed, will he accomplished by the use of sheet piles. Sheet piles will he placed within the
proposed 0.421 acre impact area.
Restoration Plan Within 15 working days of the of the pipe replacement all cofferdams will be entirely removed and natural stream
contours will be restored and seeded. Tempomry silt screens placed in intermittent channels will be cleaned and
removed lollowing vegetation establishment.
KC P = reinforced concrete pipe: ('MP = C'or ugawd metal pipe: CM PA = Corrugated racial pipe arch; * If needed.
FEDERALLY-PROTECTED SPECIES AND CULTURAL RESOURCES
The Fish and Wildlife Sen ice (FWS) currently list four federally protected species for
Halifax County (Table 1).
Table I- Federally Protected Species of Halifax County
Federal Habitat Biological
Common Name Scientific Name Status Present Conclusion
Red-cockaded Picoidcs borealis E N No Effect
woodpecker
Bald eagle (tlaliacetus E N No Effect
leucocephalus)
Dwarf wedge mussel Alasmidonta heterodon E N No Effect
Tar spiny mussel Elliptio steinstansana E N No Effect

No element occurrences are listed on the NHP database within one mile of the project
area. During the onsite visit, it was determined that there was no habitat suitable for the
Bald eagle nor were there pine trees suitable for RCW foraging or nesting are in, or
adjacent to, the project area. There was also no habitat suitable for the Dwarf wedge
mussel or Tar spiny mussel. This project is not likely to jeopardize the continued
existence of any of the federally protected species listed in Halifax County.
No sites eligible for listing on the National Register occur within the area of potential
effect. This project will not affect listed or eligible historic properties.
MINIMIZATION INFORMATION
Impacts will be minimized by strict enforcement of Best Management Practices for the
protection of surface waters and wetlands, restrictions against the staging of equipment in
or adjacent to waters of the US, and coordination (including a pre-construction meeting)
with the Division Environmental Officer.
MITIGATION INFORMATION
Mitigation for stream and wetland impacts will be provided by the North Carolina
Ecosystem Enhancement Program (EEP) per the Memorandum of Agreement dated July
22, 2003. Total wetland impacts (0.421 acres) and total stream impacts (54 LF) will be
reported to the EEP following the end of the quarter as required by the September 1, 2004
guidance from the U.S. Army Corp of Engineers District Office in Wilmington.
If you have any questions or need any additional information, please contact Jamie
Guerrero at [phone] or Jamie Shern at [phone]. Your time and effort are
appreciated.
Respectfully yours,
R. E.
r., PE
Division Engineer, Division 4
cc: Mr. James F. Shern, Division Environmental Officer
Mr. Ronnie Keeter, P.E., District 1 Engineer
Mr. Bryant Bunn, P. E., NCDOT Division Maintenance Engineer
Mr. Franz Enders, P.E., Assistant District 1 Engineer
Ms. Katie Simmons, Roadside Environmental Field Operations Technician
02@1NU?2N
JUL 0 1 2005
Office Use Only: WET
LA WA DDSNR • WATER ggq??y A Innlr
i
on May 2002
D STORM UA T BRANt:H j ?J USAGE Action ID No. DWQ,
tir any pantcuiar item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
® 401 Water Quality Certification
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: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. 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:_ Mr. R.E. Greene Jr. P E Division Engineer
Mailing Address: North Carolina Department of Transportation/Division 4
P.O. Box 3165
Wilson NC 27895-3165
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: rgreene(c),dot. state. nc.us
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name: Mr. Jamie Shern
Company Affiliation: Division Environmental Officer
Mailing Address: North Carolina Department of Transportation/Division 4
P.O. Box 3165
Wilson NC 27895-3165
Telephone Number: 252 296-3530 Fax Number: [phone]
E-mail Address: ishem(&dot.state. nc.us
Page 5 of 12
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: SR 1802, Shields Farm Road
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Halifax Nearest Town: Hobgood
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): NC 903 east out of Scotland
Neck. After 1.5 miles turn left onto SR 1804. After 4.0 miles turn left onto SR 1802.
5. Site coordinates, if available (UTM or Lat/Long): Norfleet Quad Map: 36.1497 N 77.3308W
(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. Property size (acres): N/A
7. Nearest body of water (stream/river/sound/ocean/lake): UT to Cypress Swamp (DWQ
ID#23-36 C)
8. River Basin: Roanoke
(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 agn icultural residential
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used: Road
gadinQ, drainage, base, paving, and erosion control using heavy construction equipment
backhoe, excavator, dump truck, bulldozer, wader).
11. Explain the purpose of the proposed work: To pave existing gravel road and to bring in
compliance with standard safety design specifications.
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 pen-nit 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 7 of 12
1. Provide a written description of the proposed impacts: Add fill to widen roadway
2. Individually list wetland impacts below:
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***
#1 11 + 10 -L- Fill 0.079 No 0 Forested
#3 36 + 30 -L- Fill 0.205 No 0 Forested
#4 47 + 95 -L- Fill 0.137 No 200 Forested

List each impact separately and identity 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 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 Center at 1-800-358-9616, or
online at http://www.tcma.laov.
*** List a wetland type that best describes wetland to he impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property: N/A
Total area of wetland impact proposed: 0.421
3. Individually list all intermittent and perennial stream impacts below:
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 secif )
#1 11 + 10 -L- 24" RCP 24 UT to Cypress Swamp 5 feet Intermittent
#2 17 + 30 -L- 24" RCP 18 UT to Cypress Swamp 2 feet Intermittent
#3 36 + 30 -L- 24" RCP 12 UT to Cypress Swamp 5 feet Intermittent

r r:
List each impact separately and identity 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, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear tootprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic snaps. 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.uses.goy. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.topozone.c(nn,
www.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 54
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.)

• List each impact separately and identity temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
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.
All wetlands or surface waters not affected by the proiect will be protected from unnecessarv
encroachment. No staginp, of construction equipment will be allowed in or near wetlands or
waters of the U.S. Strict enforcement of sedimentation and erosion control Best Mananl;ement
Practices for the protection of wetlands and surface waters will be enforced during 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.
Page 9 of 12
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://h2o.enr.state.nc.us/ncwetiands/stnngide.htlnl.
I . Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at http://h2o.enr.statc.nc.us/wrp/index.htin. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) 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 (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.
Will the project impact protected riparian buffers identified within 15A NCAC 213 .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 213 .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify Roanoke )?
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
C.oric i extends out .31) Teel perpendicular from near bank ofchannel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 1 I 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.
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss ston-nwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Temporary dewatering and all appropriate best management practices for sediment and erosion
control will be implemented during pipe replacement.
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 pen-nit 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).
Applicant/Agent's'
(Agent's signature is valid on
re
Date
f an authorization letter from the applicant is provided.)
G - 29-as
Page 12 of 12
TopoZone - The Web's Topographic Map
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6/30/2005 5:05 PM

IMPACT OVERVIEW
COUNTY.- Halifax
Franz Enders 4/ 26/ 05
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COUNTY: Halifax
SCALE: I" = 100'
S I TE: 3
Franz Enders 4/ 26/ 05
I MPAC; I MAP
COUNTY: Halifax SITE: 4
SCALE: I" = 100' Franz Enders 4/ 26/ 05