20050166 Ver 1_Complete File_20060120

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STATE OF NORTH CAROLINA
Jq N 2 o ?V D
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?VDSti pSApR El
DEPARTMENT OF TRANSPORTATION 01„CH
MICHAEL F. EASLEY
GOVERNOR
P.O. BOX 25201, RALEIGH, N.C. 27611-5201 LYNDO TIPPETT
SECRETARY
January 3, 2006
North Carolina Division of Water Quality
401/Wetlands Unit
1621 Mail Service Center
Raleigh, NC 27699-1621
Reference: DWQ Project No. 050166 & 030307
NCDOT/SR 1143 & SR 2853 Randolph County
Dear Sir or Madam:
Attached is certification of completion for the work performed under the above
referenced permit. The certification is signed by our field agent. If additional
information is required please advise.
Sincerely,
Timothy Johnson P.E.
Division Engineer
Attachment
c: Tim Welch
Reuben Blakley
Barry Harrington
J. L. Picklesimer, PE PLS
Art King
File
DIVISION 8, P. O. BOX 1067, ABERDEEN, NC 28315
Telephone: [phone] Fax: [phone]
, 1. % .
Certificate of Completion
DWQ Project No.:
050166

County: 91 4n abke) ,
Applicant: X -4c 'Dc q ? iv. S;ate 00 SOV-t yNs b n
Project Name: SR \1Lk3 ??`A? P:?Q, C.hyrchRc}? Rarsap?P? C©vnfi
Date of Issuance of 401 Water Quality Certification: Feb r u?a r I 1 % a c., 0 5
Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules, and any
subsequent modifications, the applicant is required to return this certificate to the 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, , 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:
Agent's Certification
Date:
I, 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 compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature: Date: 9-27'65
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 Permittee hereby state that,
to the best of my abilities, due care and diligence was used in the observation of the construction such that
the construction was observed to 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:
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor William G. Ross, Jr., Secretary
Alan W. Klimek, P.E., Director
February 1, 2005
Randolph County
DWQ Project No. 050166
Pipe replacement on SR 1143 (High Pine Church Road)
APPROVAL of 401 Water Quality Certification with Additional Conditions
Mr. T. Johnson, P.E., Division Engineer
NCDOT Division 8
P.O. Box 1067
Aberdeen, NC 28315
Dear Mr. Johnson:
You have our approval, in accordance with the attached conditions and those listed below, to impact 120
linear feet of Bell Branch to replace a pipe under SR 1143 in Randolph County. The project shall be
constructed in accordance with your application dated January 27, 2005 (received January 31, 2005).
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 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 only valid for the purpose and design that you described in your application except as
modified below. If you change your project, you must notify us, in writing, and send us a new
application. If the property is sold, the new owner must be given a copy of this Certification and approval
letter and is thereby responsible for complying with all conditions. If total wetland fills for this project
(now or in the future) exceed one acre, or if stream impacts 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. Mowing of existing vegetated buffers is strongly discouraged, so that they may be utilized for storm
water diffuse flow.
2. All mechanized equipment operated near surface waters must be regularly inspected and maintained
to prevent contamination of stream waters from fuels, lubricants, hydraulic fluids, or other toxic
materials.
3. Riparian vegetation must be reestablished within the construction limits of the project by the end of
the growing season following completion of construction.
4. NCDOT is encouraged to use existing on-site vegetation and materials for stream bank stabilization
and to minimize the use of rip rap.
Transportation Permitting Unit One
7 ,
1650 Mail Service Center, Raleigh, North Carolina 27699-1650 NOrthCarOhna
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] FAX [phone] / Internet: ht!p://h2o.enr.state.nc.us/ncwetiands) Natumliff

NCDOT Randolph County SR 1143, DWQ # 050166
Page 2
February 1, 2005
5. The pipe replacement required for this project shall be installed in such a manner that the original
stream profile is not altered (i.e. the depth of the channel must not be reduced by a widening of the
streambed). Existing stream dimensions (including the pattern and profile) are to be maintained
above and below locations of the culvert. The culvert shall be designed and installed to allow for fish
and other wildlife movement as well as prevent headcutting of the stream.
6. The disturbed floodplain and stream should be restored to natural geomorphic conditions.
7. 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.
d. Any reclamation measures and implementation must comply with the reclamation in accordance
with the requirements of the Sedimentation Pollution Control Act.
8. 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.
9. Sediment and erosion control measures shall not be placed in wetlands or waters to the maximum
extent practicable. If placement of sediment and erosion control devices in wetlands and waters is
unavoidable, they shall be removed and the natural grade restored within six months of the date that
the Division of Land Resources has released the project.
10. 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.
11. 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. Please include
photographs of the completed construction upstream and downstream of the culvert site to document
correct installation.
NCDOT Randolph County, SR 1143, DWQ # 050166
Page 3
February 1, 2005
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing.
You must act within 60 days of the date that you receive this letter. To ask for a hearing, send a written
petition that conforms to Chapter 150B of the North Carolina General Statutes to the Office of
Administrative Hearings, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its
conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water
Act. If you have any questions, please telephone Ms. Beth Barnes at 919.715.8394.
Si erely,
Alan W. Klimek, P.E.
Attachment
Pc: Wilmington District Corps of Engineers
Richard Spencer, USACE Wilmington Field Office
Ken Averitte, NCDWQ Fayetteville Regional Office
Central Files
File Copy
d?
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EAsMY DIVISION OF HIGHWAYS
GOVERNOR
January 27, 2005
Mr. Rob Ridings
NCDWQ
401 Wetlands Unit aP1@RBWffl U
1650 Mail Service Center
Raleigh, NC 27699-1650
JAN 3 y 2005
Subject: Nationwide Permit #14
SR-1143 Randolph County ET EN ASTT QUALITY
BRANCH
Project # 8B.207611(DWQ Permit Fee $200) V4
Mr. Ridings:
LYNDO TIPPET T
SECRETARY
The North Carolina Department of Transportation, Highway Division 8 is requesting Nationwide
Permit Number(s) 14 for project 813.207511 on SR 1143 (High Pine Church Rd.) in Randolph County.
The proposed project will replace an existing deficient crossing pipe as follows:
Site 1) Replace existing one lines of 60"x 60' CMP with one line of 95"x 6T'x 80' CMP
The pipe is being replaced as part of routine maintenance. The proposed increase in pipe diameter will require an
increase in the fill material, and widening of the roadbed at this location to attain a stable shoulder. The total
percentage of impervious surface within the project area will remain at less than 30%. All erosion control devices
will be appropriate to the location and in compliance with the current version of the NCDOT Best Management
Practices manual.
There are no wetlands, HQW or OWR located within the project areas.
The pipe replacement is located on Bell Branch, a class C stream in the Yadkin River Basin.
If dewatering is required at this site, it will be done with the use of a movable structure ( sheet metal piles or pre-cast
concrete barriers). Construction will be done under dry conditions whenever possible. There were no threatened or
endangered species observed within the project area during the required minimum criteria check. All detours will be
done off site using local state roads.
If you require any additional information, please contact me.
Sincerely, PA u14ENr
,?J? e, / -'
ECE
1 V?p ,0 R Art C. King
Division Environmental Officer
Highway Division 8
cc: Tim Johnson, PE
Tim Welch, PE
P.O. BOX 1067, ABERDEEN NORTH CAROLINA 28315
PHONE [phone] FAX [phone]

Office Use Only: Form Version October 2001
5 6 6
USACE Action ID No. DWQ N, ® 1
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:
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name: North Carolina Department of Transportation
Mailing Address: Timothy Johnson, P.E., Division Engineer
North Carolina Department of Transportation Division 8
P.O. Box 1067
Aberdeen, North Carolina 28315
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: TJohnsongdot.state.nc.us
PA??
R ?E?? Ep 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: T. F. Welch, PE
Company Affiliation: NC Department of Transportation
Mailing Address: PO Box 289
Siler City, NC 27344
Telephone Number: [phone] Fax Number: _ [phone]
E-mail Address: twelch ,dot.state.nc.us
-5-
.F
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 1143 Randolph County
2. T.I.P. Project Number or State Project Number (NCDOT Only): 813.207611
3. Property Identification Number (Tax PIN): N/A
4. Location
County : Randolph Nearest Town: Asheboro
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): From Asheboro follow US 220
Business South for approx. 2 miles, turn right onto SRI 114. Go approx. 1 i/2 mile and turn
right onto SR 1142. Go approx. 1 1/2 mile and turn left onto SR 1143. Site is approx. 0.6
miles.
5. Site coordinates, if available (UTM or Lat/Long): N 35* 36.89' W 79* 51.90'
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application:
Rural
7. Property size (acres): N/A
8. Nearest body of water (stream/river/sound/ocean/lake): Bell Branch
9. River Basin:-Yadkin- Pee Dee
(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/.)
-6-
r
10. Describe the purpose of the proposed work: Replace existing 1 line of 60"x 60' CMP with 1
line of 95"x 67"x 80' CMP
11. List the type of equipment to be used to construct the project: Excavator
12. Describe the land use in the vicinity of this project: Rural/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.
N/A
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.
-7-
1. 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***
None

* 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 htty://www.fema.gov.
*** 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
Site Number
indicate on ma)
Type of Impact* Length of
Impact
linear feet)
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)
Perm pipe 80 ft Bell Branch loft Perennial
Temp/rip rap 40ft

* 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, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** 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.uses.eov. Several internet sites also allow direct do*nload and printing of USGS maps (e.g., www.topozone.com,
www.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 120ft
-8-
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
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.)
None

* List each 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.): N/.
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.
N/A
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.
-9-
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/ncwetlands/strmgide.html.
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 NOW". 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 http://h2o.enr.state.nc.us/wrp/index.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet):
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):
-10-
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 V
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.
-11-
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.
Neither the current impervious cover (asphalt pavement) nor the new proposed impervious cover
(asphalt pavement) will exceed 30% of the total site area. Erosion control devices appropriate to
the site will be utilized on this project which may include silt fences, check dams, and storm
water retaining basins.
XII. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
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):
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).
z?/as
Applicant/Agenp< Signature ( Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
-12-

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