20050254 Ver 1_Complete File_20050510

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William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
May 10, 2005
Randolph County
DWQ Project No. 05-0254
SR 2633 (Coltrane Meadow Road)
APPROVAL of 401 Water Quality Certification
Mr. Timothy Johnson, P.E., Division Engineer
North Carolina Department of Transportation, Division 8
PO Box 1067
Aberdeen, North Carolina, 28315
Dear Mr. Johnson:
You have our approval, in accordance with the attached conditions and those listed below, to place
permanenet fill material, culverts, and piping in 61 linear feet of streams with 50 linear feet of temporary
impacts (111 linear feet total) for the purpose of widening SR`2633 (Coltrane Meadows Road) in
Randolph County. The stream impacts are approved as presented in the tables below.
Stream Impacts in the Cave Fear River Basin
Site Station No. Stream Name Type Stream
Classification/
Index No. Impact
Type Impacts
(Linear Feet)
1 -L- 9+36 UT to Brush Creek Perennial Class C/17-23 Permanent 46
Temporary 25
2 -L- 33+54 UT to Brush Creek Perennial Class C/17-23 Permanent
- 15
-
Temporary
em or
1 25
Total 111
The project shall be constructed in accordance with your application dated February 7, 2005 (received
February 9, 2005). After reviewing your application, we have decided that this fill is covered by General
Water Quality Certification Number 3404. This certification corresponds to the Nationwide Permit 14
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 mith 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 211.0506 (h) (6) and (7). For this
approval to remain valid, you must adhere to the conditions listed below and in the attached certification.
Pplp e Carolina
Transportation Permitting Unit Nuturalllff
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] Internet: http://h2o.enr.state.nc.us/ncwetiands
An Equal Opportunity/Affirmative Action Employer-50% Recycled/10% Post Consumer Paper
Mr. Johnson
May 10, 2005
1) Approximately six (6) months after the installation of a culvert or other structure in waters, streams,
and wetlands, the upstream and downstream areas adjacent to the structure shall be inspected for
erosional areas, headcutting, perching, etc. Eighteen (18) months after installation another visual
inspection shall be conducted. Any problems found during the inspections should be documented and
the appropriate Regional DWQ staff member shall be notified. NCDOT shall consult with the
Regional DWQ staff member to determine if a permit modification is needed to correct the problem.
2) 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.
3) 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.
4) During the construction of the project, no staging of equipment of any kind is permitted in waters of
the U.S., or protected riparian buffers.
5) The dimension, pattern and profile of the stream above and below the crossing should not be
modified. Disturbed floodplains and streams should be restored to natural geomorphic conditions.
6) Any riprap used must not interfere with thalweg performance and aquatic life passage during low
flow conditions.
7) 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.
8) 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.
9) 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.
10) All work shall be performed during low or normal flow conditions.
11) Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or adjacent to
surface waters is prohibited.
12) NCDOT and its authorized agents shall conduct its activities in a manner consistent with State water
quality standards (including any requirements resulting from compliance with §303(d) of the Clean
Water Act) and any other appropriate requirements of State law and Federal law. If DWQ determines
Mr. Johnson
May 10, 2005
that such standards or laws are not being met (including the failure to sustain a designated or achieved
use) or that State or federal law is being violated, or that further conditions are necessary to assure
compliance, DWQ may reevaluate and modify this certification to include conditions appropriate to
assure compliance with such standards and requirements in accordance with 15A NCAC 2H.0507(d).
Any new or revised conditions shall be provided to NCDOT in writing, shall be provided to the
United States Army Corps of Engineers for reference in any permit issued pursuant to Section 404 of
the Clean Water Act, and shall also become conditions of the 404 Permit for the project.
13) 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.
14) The outside buffer, wetland or water boundary located within the construction corridor approved by
this authorization shall be clearly marked by orange fabric fencing prior to any land disturbing
activities. Impacts to areas within the fencing are prohibited unless otherwise authorized by this
certification.
15) 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.
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. 27611-7447. 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 Brian Wrenn at 919-733-5715 or John Hennessy at 919-
733-5694.
a cer ly,
m
n W. Klimek, P.E. ?.
Mr. Johnson
May 10, 2005
Attachment
cc: Richard Spencer, Amy Corps of Engineers Wilmington Regulatory Field Office
Sue Homewood, DWQ Winston-Salem Regional Office
File Copy
Central Files
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STATE of NORTH CAROLINA
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DEPARTMENT OF TRANSPORTATION
NficHAEL F. EASLEY DIVISION OF HIGHWAYS LYNDo Tipptw
GovERNOR SECRETARY
April 28, 2005
MEMORANDUM TO: John E. Hennessy,
NCDWQ 401 Wetlands Unit
FROM: Art C. King, DEO 6 9.01<
NCDOT Highway Division 8
SUBJECT: Modification to PCN Applications for SR-1187 and
SR-2633 in Randolph County
Included in this package are the modifications you requested in your letters dated March
29, 2005. You had requested some clarifications to the information contained in the PCN
applications for SR-1 187 and SR 2633 in Randolph County. The listing of the impacts on
page 8 of the PCN have been corrected as per your request. Please note that the manner
in which the impacts were listed on our previous applications was done as directed by the
DWQ staff who reviewed our applications at that time.
We have also added an image of the existing pipe to the permit drawings as you
requested. The drawings submitted with our permit applications are drawn in a fashion
that were requested and approved by Richard Spencer of the Corp of Engineers
Wilmington District Office. Previous drawings of this type had also been approved and
accepted by Ms. Beth Barns, of the 401 Wetlands Office. While the depiction of the road
itself is done on a 20 scale, the image of the pipe section has been enlarged to greater
than scale for the purposes of improved visual clarity. The drawings are done in this
fashion because we had found in the past that in order to include all :the information that
Mr. Spencer required on a single sheet; and to make it to scale, would make the drawing
very difficult to read. We had agreed that the drawings done . in that fashion were
acceptable to all parties at that time. All of the information and data. included on the
drawing is accurate. In a recent conversation with Mr. Spencer, he has asked that we not
change the format that we use to depict our drawings for PCN applications for now. He
has informed me that he was in the process of drafting new set of standard requirements
for PCN submissions for Highway Divisions 6 & 8. It is my understanding that Mr.
Spencer plans to consult with DWQ on this matter before the plans are finalized. If you
have any question related to this issue please contact Mr. Spencer.
If you require additional information or changes please contact me.
P.O. BOX 1067, ABERDEEN, NORT$ CAROLINA 28315
PHONE [phone] FAX [phone]

1. Wetland Impacts
* 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 b.gp://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.)
MAY 0 ` 2f
0
115
WMANDSAND RMWATF BRANCH
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 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?
specify).
Site 1 Perm Pipe 46ft UT of Brush Creek 8-12 P
Temp 25ft
Site 2 Perm pipe 1511 8-12 P
Temp 25ft

* 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.usas.QOV. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.m4Wue9t.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: perm=61 ft temp=50$
Page 8 of 12
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WAr? Michael F. Easley, Governor
Q R
QC? QG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
`
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tT_ Alan W. Klimek, P.E. Director
Division of Water Quality
o ?
March 29, 2005
Mr. Art King
Division Environmental Officer, Division 8
NC Department of Transportation
PO Box 1067
Aberdeen, North Carolina, 28315
Re: Permit Applications for proposed widening of SR 2633 in Randolph County, DWQ No. 050254
Dear Mr. King:
The Division of Water Quality has reviewed your submittal for a 401 Water Quality Certification for the
aforementioned project. Review of your application revealed it lacking necessary information required
for making an informed permit decision. The permit application was deficient in the following areas:
The stream impacts were presented incorrectly. For stream crossings where an existing pipe or _
culvert will be extended or replaced, the net additional impacts should be presented in Section IV.
2. in the stream impacts table. For example, if a 34 linear foot pipe will be replaced with an 80
linear foot pipe, the net additional impact will be 46 linear feet (80 linear feet of impact minus the
existing 34 linear feet of impact) of stream not 80 linear feet of stream. Any new rip-rap or other
energy dissipating structures in the stream channel should be included as impacts. Temporary
and permanent impacts should be presented separately in the impact table. Please submit a
revised table correctly presenting the stream impacts.
The permit drawings in the application did not show the existing pipe locations. Permit drawings
for stream, wetland, and other surface water impacts should show any existing structures (e.g.,
pipes, culverts, bridges, etc.) as well as the proposed structures and the permanent and temporary
impacts that will occur as a result of the structures. Any rip-rap or other energy dissipating
structures in the stream channel should be included as impacts. These permit drawings should be
drawn to scale. Please submit revised drawings correctly showing the existing and proposed
structures and permanent and temporary impacts.
Therefore, pursuant to 15A NCAC 2H .0507(a)(5), we will have to place the permit application on hold
until we are supplied the necessary information. Furthermore, until the information is received by the NC
Division of Water Quality, we request (by copy of this letter) that the US Army Corps of Engineers place
the permit application on hold.
Hopefully, we can work together to expedite the processing of your permit application. If you have any
questions or require additional information, please contact Brian Wrenn at 919-733-5715.
S' cere y,
tan W. Klimek, P.E.
Director
NorthCarolina
Transportation Permitting Unit Naturally
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone]/ FAX [phone]/ Internet: http://h2o.enr.state.nc.us/ncwetlands
An Equal Opportunity/Affirmative Action Employer - 500/6 Recycled/10% Post Consumer Paper
cc: Ken Averitte, DWQ Fayetteville Regional Office
Richard Spencer, US Army Corps of Engineers Wilmington Field Office
File Copy
a502?4
MICHAEL F. EASLEY
GOVERNOR
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
DIVISION OF HIGHWAYS
February 7, 2005
Mr. Rob Ridings
NCDWQ
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Subject: Nationwide Permit #14
SR-2633 Randolph County
Project # 8C.076022 (DWQ Permit Fee $200)
Mr. Ridings:
LYNDO TIPPETT
SECRETARY
Lgg g
FEB 9 2005
WE71AN SAN STORMWATERBRANCH
The North Carolina Department of Transportation, Highway Division 8 is requesting Nationwide
Permit Number(s) 14 for project 8C.076022 on SR-2633 (Coltrane Meadow Rd.) in Randolph County.
The proposed project will replace and modify the existing deficient crossing pipes as follows: ?0
Site 1) Replace existing one line of 72"x 34' CMP with one line of 137"x 87"x 80' CMPA
Site 2) Extend existing 112"x 75"x 55' CMP with the addition of a 15' section with kneewail rLe7- Gt(,lry,
The pipes are being replaced and modified in preparation for widening and paving of this road. 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 project is outside of
the critical habitat area for the Cape Fear Shiner.
The pipe replacement is located on Brush Creek, a class C stream in the Cape Fear 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.
cc: Tim Johnson, PE
Reuben E. Blakley
Sincerely, PAYMENT
RECEIVED
Art C. King
Division Environmental Officer
Highway Division 8
P.O. BOX 1067, ABERDEEN NORTH CAROLINA 28315
PHONE [phone] FAX. [phone]
v
Office Use Only: 0502 54 Form Version October 2001
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing D R? (?;5ZL 0 mri,
1. Check all of the approval(s) requested for this project: FEB 9 2005
® Section 404 Permit
DENR - WATER Q?4
? Section 10 Permit VVE DSq?NDST0nMV/iU7AERL.1gRTygN4H
® 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: 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 (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: 910-944-2344 Fax Number: (910)944=5623
E-mail Address: [e-mail]
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: Reuben E. Blakley
Company Affiliation: NC Department of Transportation
Mailing Address: 948 Southmont Dr.
Asheboro, N.C. 27205
Telephone Number: 336-625-2078 Fax Number: 336-625-0146
E-mail Address: rblakleygdot.state.nc.us
- 5 -

mn @ m 0 wi 2 P
FEB 9 2005
III. Project Information DENR - WATER QUALITY
WETLANDS AND STORMWMER BRANCH
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 USOS 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 2633( Coltrane Meadow Rd.)
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN):
4. Location
County: Randolph Nearest Town: Asheboro
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): From Asheboro take US 64 East
11.53 miles to SR 2826 turn right go 0.6 miles to SR 2630 turn left go 2.7 miles to SR 2633
on left
5. Site coordinates, if available (UTM or Lat/Long) see attached sheet
(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:
Unpaved Secondary Road Pipe Crossing--
7, Property size (acres): N/A 2 pipe crossings and replacements
8. Nearest body of water (stream/river/sound/ocean/lake): Brush Creek
9. River Basin: C^pe Fear
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http:Hh2o.enr.state.nc.us/admin/maps/.)
-6-
FEB R
DENR - WP; ,E 10. Describe the purpose of the proposed work: Pipe R2?71' upgrade in conjunction
with Secondary Road Improvement Project
11. List the type of equipment to be used to construct the project: Trackhoe, Dozer, Pan,
Backhoe, Compactor and Motor Grader
12. Describe the land use in the vicinity of this project: farm land, forest land, private homes
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
-7-
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. 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
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 http://vvtivtiv.fema.2ov.
*** 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 map)
Type of Impact* Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Im act Perennial or
Intermittent?
(please specify)
Site I Perm Pipe 80 ft UT of Brush Crk. 8-12 R P
Temp/ rip rap. 25 ft
Site 2 Perm pipe 15 ft UT of Brush Crk. 8-12ft P
Temp/rip rap 25 ft

* 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
vvunv.usRs.rov. Several intemet sites also allow direct download and printing of USGS maps (e.g., .vwxy.topozone.com,
v,Nvtv.maj)quest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: Site 1= 105ft
Site 2= 40ft
-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 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/A
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.
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.
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
N/A
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at http:/Jh2o.enr.state.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):
IX. Environmental Documentation (DWQ Only)
-10-
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
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes F-1 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
Gone 1 extends out .fU feet perpendicular trom near bank of channel; Gone2 extends an
additional 20 feet from the edge of Zone I.
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
-11-
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
N/A
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 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
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 211.0500) 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).

Applicant/Agent's Signature ' Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
-12-
STREAM CROSSING LOCATION SUMMARY
Summary for SR 2633 Coltrane Meadow Road
Pipe no. 1 Station 9+36 N 35° 42' 27" W 79° 33' 43" use 1 c@ 80' 137" X
87" CMPA with Kneewall.
Pipe no. 2 Station 33+54 N 35° 42' 29" W 79° 33' 16" add 1 c@ 15' 112" X
75"CMPA with Kneewall after removing mitered section. Total Length =
70'
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