20051433 Ver 1_Complete File_20050825

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
DWQ Project No.: X06 /y33 County:
Applicant: NCDOT
Project Name: ,S/? o y-
Date of Issuance of 401 Water Quality C ification

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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 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
I, Joel B. Setzer, P.E., 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 mt of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, su n materials.
Signature: _ Date:
Agent's lification
I, , 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
1, , 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:
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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), hftp://h2o.enr.state.nc.us/ncwetiands/

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Michael F. Easley, Governor
William G. Ross Jr., Secretary
Cp North Carolina Department of Environment and Natural Resources
SF ©j O Alan W. Klimek, P.E. Director
n??NR ,1,?, ?O?Jr Division of Water Quality
?STp MQU'
Ray?y August 25, 2005
Jackson County
DWQ Project No. 051433
NCSR 1717 (Poplar Drive)
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
Sylva, North Carolina 28779
Dear Mr. Setzer:
You have our approval, in accordance with the attached conditions and those listed below, to impact 20 linear feet of an
unnamed tributary to Scott Creek (20 linear feet of rip rap), in order to repair the eroding embankment adjacent to NCSR
1717 (Poplar Drive) in Jackson County. The project should be constructed in accordance with your application dated July
25, 2005 (received August 1, 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. 3495,
corresponding to the U.S. Army Corps of Engineers Nationwide Permit Number 13. 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 211 .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.
Erosion and sediment control practices must be in full compliance with all specifications governing the proper design,
installation and operation and maintenance of such Best Management Practices in order to protect surface waters
standards:
a. The erosion and sediment control measures for the project must be designed, installed, operated, and
maintained in accordance with the most recent version of the North Carolina Sediment and Erosion Control
Planning and Design Manual.
b. The design, installation, operation, and maintenance of the sediment and erosion control measures must be
such that they equal, or exceed, the requirements specified in the most recent version of the North Carolina
Sediment and Erosion Control Manual. The devices shall be maintained on all construction sites, borrow
sites, and waste pile (spoil) projects, including contractor-owned or leased borrow pits associated with the
project.
c. For borrow pit sites, the erosion and sediment control measures must be designed, installed, operated,
and maintained in accordance with the most recent version of the North Carolina Surface Mining Manual.
Noe Carolina
Nawrally
North Carolina Division of Water Quality 2090 U.S. Highway 70 Swannanoa, NC 28778 Phone [phone] Customer Service
Intemet h2o.enr.state.nc.us FAX [phone]
An Equal Opportunity/Affirmative Action Employer
Mr. J. B. Setzer, P.E.
August 25, 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. The NCDOT shall use Best Management Practices for the Protection of Surface Waters (NCDOT August 2003) and
Sedimentation and Erosion Control Guidelines for Sensitive Watersheds [15A NCAC 4B.0124 (a)-(e)]. Temporary
cover (wheat, millet or similar annual grain) or permanent herbaceous cover should be planted on all bare soil within
fifteen (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 staples or wherever possible, live stakes of native trees. Straw mulch and tall fescue should
not be used in riparian areas.
5. The dimension, pattern and profile of the stream, above and below this work, should not be modified by widening or
narrowing the stream channel or reducing the stream depth. Disturbed floodplains and streams should be restored to
natural geomorphic conditions.
6. Stormwater shall be directed to vegetated buffer areas, grass lined ditches or other means appropriate to the site for
the purpose of pre-treating stor nwater 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.
7. Riparian vegetation should be preserved to the extent possible. Native trees and shrubs (e.g. Rhododendron, dog
hobble, willows, alders, sycamores, dogwoods, black walnut and red maple) should be restored wherever possible
along the repaired slope and streambank to reestablish the riparian zone and to provide. long-term erosion control.
8. 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. The rocks placed on the bank should be backed with
filter cloth and should be clean and sediment free.
9. 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.
10. 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.
11. Excavation in the stream channel 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.
12. Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or adjacent to surface waters is
strictly prohibited.
13. 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 bank stabilization work. 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.
14. 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 bank stabilization work.
15. All work shall be performed during low flow conditions (below bankfull).
16. 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.

r
Mr. J. B. Setzer. P.E.
August 25, 2005
Page Three
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,
Alan W. Klimek, P.E., Director
Division of Water Quality
Attachment
cc: 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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ewSWts
STATE of NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
GovERNoR
July 25, 2005
Ms. Angie Pennock, NCDOT Regulatory Project Manager
U. S. Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, NC 28801-2714
Subject: Nationwide 13 Permit Application
SR 1717 - Poplar Drive
Jackson County
State Project No. 14.050058
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LYNDO TTPETT
SECRETARY
051433
Dear Ms. Pennock:
The North Carolina Department of Transportation (NCDOT) is proposing to stabilize the fill
slope on SR 1717, Poplar Drive. The site is located approximately 150 feet from the intersection
with SR 1438. The sloughing bank and road shoulder has created a hazardous condition.
I am sending cross sections and a drawing for the bank stabilization, a marked county map and
USGS quad map.
The North Carolina Natural Heritage Database was checked for records of threatened and
endangered species. There are no records of threatened and endangered species listed for the
unnamed tributary to Scott Creek or Scott Creek. There are records for the Appalachian elktoe
(Alasmidonta raveneliana) approximately 3.0 miles downstream of the repair area in the
Tuckasegee River. The impact from the placement of shot rock and repairing the shoulder will
result in very minimal impact. For these reasons, there will be "no effect" on threatened or
endangered species.
The best management practices will be used to minimize and control sedimentation and erosion
on this project.
P41D
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Impacts to Waters of the United States
The unnamed tributary is shown on the USGS topographic map as a perennial stream. The
channel is composed of gravel and sand. The channel lacks vegetation. For these reasons, we
believe this stream is under the jurisdiction of the U.S. Army Corps of Engineers. In order to
stabilize the bank, it will be necessary to impact waters of the United States in the Little
Tennessee River Basin. Specifically, we propose to discharge rock into the edge of an unnamed
tributary to Scott Creek (DWQ, Class C Tr). Listed below is a summary of the impacts.
Site No. Existing Condition Proposed Condition Net Impacts
Station
Site 1 20' Eroded Bank 20' Stabilized Bank 20'
n/a
20 linear feet total
Permits Requested
NCDOT is hereby requesting authorization under Section 404 of the Clean Water Act. By copy
of this letter, I am asking Mr. David McHenry, Mountain Region Coordinator, of the North
Carolina Wildlife Resources Commission (NCWRC) to comment directly to you concerning the
404 Nationwide Permit request.
In addition, I am asking Mr. McHenry and Mr. Ed Ingle, Roadside Environmental Field
Operations Engineer (NCDOT), to comment directly to me concerning this permit request.
If you have any questions or need additional information, please contact me at [phone].
Your early review and consideration will be greatly appreciated.
7 Si e ,
onathan L. Woodard, P.E.
District Engineer
cc: Mr. David McHenry, Mountain Region Coordinator, NCWRC
Mr. J. B. Setzer, P.E., Division Engineer, NCDOT
Mr. Mark Davis, Division Environmental Officer, NCDOT
Mr. E. L. Ingle, Roadside Environmental Field Operations Engineer, NCDOT
Ms. Wanda Roach, P. E., County Maintenance Engineer, NCDOT
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Office Use Only: Form Version May 2002
4
USACE Action ID No. DWQ No. 20 05 1 . 33
(If any 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
2. Nationwide, Regional or General Permit Number(s) Requested: 13
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts (verify availability with NCEEP 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: ?
H. Applicant Information
1. Owner/Applicant Information
Name: North Carolina Department of Transportation
Mailing Address: 345 Toot Hollow Road
Bryson City, NC 28713
Attn: J L Woodard PE District Engineer
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: jwoodard @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: N/A
Company Affiliation: N/A
Mailing Address: N/A
Telephone Number: N/A
E-mail Address: N/A
Fax Number: N/A
Page 1 of 8
IIL 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: Bank Stabilization SR 1717 in Jackson County
2. T.I.P. Project Number or State Project Number (NCDOT Only): 14C.050058
3. Property Identification Number (Tax PIN): n/a
4. Location
County: Jackson Nearest Town: Sylva
Subdivision name (include phase/lot number): n/a
Directions to site (include road numbers, landmarks, etc.): From Sylva take US 23 Business
towards Waynesville Turn right on SR 1438 Follow SR 1438 to SR 1717 and turn left on
SR 1717 Go approximately 150' This is the project.
5. Site coordinates, if available (UTM or Lat/Long): N 35.377°W 83.211°
(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): 0.01 acres
7. Nearest body of water (stream/river/sound/ocean/lake): Scott Creek Class C Tr
8. River Basin: Little Tennessee
(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: Residential woodlands
Page 2 of 8
10. Describe the overall project in detail, including the type of equipment to be used:
This project includes placing shot rock and matting in an eroded area along the bank of an
unnamed tributary to Scott Creek and rebuilding the shoulder to stabilize the bank.
Equipment to be used will be Track Hoes Back Hoes Dump Trucks Bulldozers, Manual
Labor, etc.
11. Explain the purpose of the proposed work: Stabilization of eroded bank.
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.
No additional permits have been applied for in the past
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.
No additional permits are anticipated
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.
1. Provide a written description of the proposed impacts: Bank Stabilization
Page 3 of 8
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***

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* List each impact separately and identify temporary impacts. impacts include, out are not unuteu 1o. inechaiuMd %A?IM us, r:44-15, -.,
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 hayHNNwiv.fema.sov.
*** List a wetland type that best describes wetland to be 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: N/A
3. Individually list all intermittent and perennial stream impacts below:
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 lease ify)
150' from SR Bank stabilization 20 UT to Scott Creek 2 Perennial
1438
I
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R List each impact separately and identify temporary impacts. Impacts include, out are not unuwu w. Cuivclu auu ass IaLW tii-F,
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, riprap, crib wall, gabions, etc.), excavation, ditchingfstraightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included
R R 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
wtirtiv.usgs.sov. Several internet sites also allow direct download and printing of USGS maps (e.g., Nyww tonozone nom,
www.ma)quest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 0
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
Type of Impact* Area °f
Impact Name of Waterbody Type of Waterbody
(lake, pond, estuary, sound,
(indicate on ma) (acres) ( applicable) bav, ocean, etc.)
Page 4 of 8
i_W.._.1 C71 ,o4:n ll?aflaina
* List each impact separately and identify temporary impacts. impacts mcluae, out are nut tntulcu LV. Lill,
flooding, drainage, bulkheads, etc.
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.). N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): N/A
Size of watershed draining to pond: N/A Expected pond surface area: N/A
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
The bank is being eroded b the flow that has left its natural channel. Shot rock will lessen
the erosion of the fill slope.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
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,
Page 5 of 8
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://h2o.enr.state.nc.us/ncwetlands/strmgide.htmI.
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 Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP 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
NCEEP, check the NCEEP website at http://www.nceep.net. If use of the NCEEP is
proposed, please check the appropriate box on page three and provide the following
information:
Amount of stream mitigation requested (linear feet): None
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
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 M
Page 6 of 8
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 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify _N/A)?
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 1 extends out 30 feet perpendicular from near bank of channel; "Zone 2 extends an
additional 20 feet from the edge of Zone 1.
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.
Page 7 of 8
XL Stormwater (required by DWQ)
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.
N/A
XH. 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.
No wastewater will be generated from the proposed project
XM. 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
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).
N/A

Applicant/Agenis Signature Date
s signature is valid only if an authorization letter from the applicant is provided.)
Page 8 of 8
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