20051005 Ver 1_Complete File_20060726

D" Project No.:
Applicant:
Project Name:
Michael F. Easley, Governor
MW m G. Ross Jr., Secretary
North Carolina Department of Environ d Natural Resources
,01 _
a> ek, P.E. Director
v4ater Quality
Di
051005 County: Persoh
X07 3p ?V 5, T.l G. AlanGe agcy
(Z H'WP4 #e o15o,? Rd) .-9--, dqe /Yla;.? r4+?ahcQ oro;t??
Date of Issuance of 401 Water Quality Certification: ?r O 5zo.<-
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 Transportation Permitting
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, To r4 G. N an ce hereby state that, to the best of my abilities, due care and diligence
was used in the observation of t nstruction such that the construction was observed to be built within substantial
roand
compliance and intent of th O1 W r Quality Certification and Buffer Rules, th7oW;s
s
pecifications, and other pporti ri Signature: Date: /
Agent'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:
Engineer's Certification
Partial Final
Date:
1, , as a duly registered Professional Engineer 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
NofthCarolina
Transportation Permitting Unit Xaltima ley
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-50% Recycled/100/6 Post Consumer Paper
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Di for
Division of Wa?? ty
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DWQ Project No.: 2MU I I I S
Applicant: NC*C>oT" Vky S, TOr G. t4,v1
Project Name: Sk 12-3
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Date of Issuance of 401 Water Quality Certification: 01 112-+ oto cy
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 Transportation Permitting
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
1, 7-rv G. Nav) a 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 e Water Quality Certification and Buffer Rules, the approved plans and
specifications, and her sup o rials.
Signature: Date:
Agent's Certificatio
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:
Engineer's Certification
Partial Final
Date:
I, , as a duly registered Professional Engineer 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
Date
Registration No.
NorthCarolina
Transportation Permitting Unit akrally
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: htto://h2o.enr.state.nc.us/ncwetiands
County: Ff a4-1 i ? s`Rr. 6
An Equal Opportunity/Affirmative Action Employer-50% Recycled/10% Post Consumer Paper
o?o? WA??9p?
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C3 `C
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
June 15, 2005
Person County
DWQ Project No. 051005
APPROVAL of 401 Water Quality Certification and NEUSE RIVER RIPARIAN BUFFER AUTHORIZATION
Mr. Jon G. Nance, P.E. Division Engineer
NCDOT, Division 5
2612 N. Duke Street
Durham, NC 27704
Dear Mr. Nance:
You have our approval, in accordance with the conditions listed below, for the following impacts for the purpose of
replacement of a pipe conveying North Flat River on SR 1148 (Patterson Road) in Person County.
Impact Stream Impacts - Concurrent Stream Impacts - Riparian Buffer Impacts (Square Feet)
Locations Permanent Fill Temporary Dewateripg-
(Linear Feet) (Linear Feet) \
Site 1 38 38 2,249 (2,249 Zone 1 + 0 Zone 2)
The project shall be constructed in accordance with your application dated received May 31, 2005. After reviewing
your application, we have decided that the stream impacts and riparian buffer impacts described are covered by
General Water Quality Certification Numbers 3494 and 3366. This certification corresponds to the Nationwide
Permit 3 and the Nationwide Permit 33 issued by the Corps of Engineers. This approval is also valid for the Neuse
Buffer Rules (15A NCAC 2B .0233). In addition, you should acquire any other federal, state or local permits before
you proceed with your project including (but not limited to) Sediment and Erosion Control, Non-Discharge and
Water Supply Watershed regulations. This approval will expire with the accompanying 404 permit, unless
otherwise specified in the Water Quality Certification.
This approval is valid solely for the purpose and design described in your application (unless modified below).
Should your project change, you must notify the DWQ and submit a new application. If the property is sold, the
new owner must be given a copy of this Certification and approval letter, and is thereby responsible for complying
with all the conditions. If total wetland fills for this project (now or in the future) exceed one acre, or of total
impacts to streams (now or in the future) exceed 150 linear feet, compensatory mitigation may be required as
described in 15A NCAC 2H.0506 (h) (6) and (7). For this approval to remain valid, you must adhere to the
conditions listed in the attached certification.
1.) Upon completion of the project, the NCDOT shall complete and return the enclosed "Certification of
Completion Form" to notify DWQ when all work included in the 401 Certification has been completed. The
responsible party shall complete the attached form and return it to the 401/Wetlands Unit of the Division of
Water Quality upon completion of the project.
2.) All stormwater runoff shall be directed to sheetflow through stream buffers at nonerosive velocities, unless
approved otherwise by this certification. .
3.) During the construction of the project, no staging of equipment of any kind is permitted in waters of the U.S., or
riparian buffers.
None h arolina
Transportation Permitting Unit turQlilf
1650 Mail Service Center, Raleigh, North Carolina 27699.1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: httg://h2o.enr.state.nc.us/ncwetlands
An Eaual Onnortunity/Affirmative Action Emobver - 500% Recvcled/100% Post Consumer Paoer
4.) Riparian vegetation must be reestablished./within the construction limits of the project by the end of the growing
season following completion of construction.
5.) The dimension, pattern and profile of the stream above and below the crossing should not be modified by
widening the stream channel or reducing the depth of the stream. Disturbed floodplains and streams should be
restored to natural geomorphic conditions.
6.) Any riprap used must not interfere with thalweg performance and aquatic life passage during low flow
conditions.
7.) 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.
8.) Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or adjacent to surface
waters is prohibited.
9.) The outside buffer, wetland or water boundary located within the construction corridor approved by this
authorization shall be clearly marked by highly visible fencing prior to any land disturbing activities. Impacts
to areas within the fencing are prohibited unless otherwise authorized by this certification.
i
10.) 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.
11.) 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.
12.) 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.
13.) If the above condition (#12) is unable to be met, due to bedrock or other limiting features, encountered during
construction, please discontinue activities and contact the NCDWQ for directions on how to proceed.
14.) No live or fresh concrete shall come into contact with waters of the state until the concrete has hardened
15.) 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.
16.) All work shall be performed during low or normal flow conditions.
17.) All fill slopes located in jurisdictional wetlands shall be placed at slopes no flatter than 3:1.
18.) 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.
19.) For 38 linear feet of stream at Site 1 being impacted due to site dewatering activties, the site shall be graded to
its preconstruction contours and revegetated with native vegetation.
20.) All riparian buffers impacted by the placement of temporary fill or clearing activities shall be restored to the
preconstruction contours and revegetated with native woody species upon completion of the project
construction. A post-construction as-built with the restoration activities included shall be submitted to the
DWQ no later than 60 days after the project is closed out by the Department of Transportation.
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 Christina Breen at [phone].
me rely,
Alan W. Kliri ek, P.E.
JEH/cmb \
Attachment
cc: Mr. Eric Alsmeyer, US Army Corps of Engineers, Raleigh Field Office
Mr. Chris Murray, Division 5 Environmental Officer, 2612 N. Duke Street, Durham, NC 27704
NC DWQ Raleigh Regional Office
Central Files
File Copy
c:\Correspondence\20050therProjects\DWQ051005\061505wgc.doc

N. C. DEPARTMENT OF TRANSPORTATION

TRANSMITTAL SLIP DATE
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ACTION
,? NOTE ANDFILE ? PER OUR CONVERSATION.;:
[T NOTE AND RETURN TO ME ?. PER YOUR REQUEST
? RETURN WITH MORE DETAILS..? FORYOUR APPROVAL -
? NOTE AND SEE ME ABOUT THIS ? FOR YOUR INFORMATION
? PLEASE ANSWER ? FOR YOUR COMMENTS
? PREPARE. REPLY FOR MY SIGNATURE. ? SIGNATURE
? -TAKE APPROPRIATE ACTION ? INVESTIGATE AND REPORT..
COMMENTS:
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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
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MICHAEL F. EASLEY LYNDO TIPPETT Cy
GOVERNOR SECRETARY
May 26, 2005
U.S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls of the Neuse Road, Suite 120 O 5 1 0 0 5
Raleigh, NC 27609
Attention: Mr. Eric Alsmeyer, NCDOT Coordinator
Subject: Proposed maintenance improvements to structures conveying an unnamed
tributary to North Flat River on SR 1148 (Patterson Road) in Person
County. WBS element 511.207311, STAT IO# 9800370.
The North Carolina Department of Transportation (NCDOT) proposes to replace pipes
conveying an unnamed tributary to North Flat River on SR 1148 (Patterson Road) in
Person County (Figures 1- 3).
Impacts to Waters of the United States
The project crosses a perennial stream, an unnamed tributary to North Flat River, [NCDENR-
DWQ Index No. 27-3-2, Best Usage Classification WS-III NSW; HUC 03020201] (Figure 3)
in the Neuse River Basin. The existing structures that convey the creek are 2 @ 72-inch x 48-? M
inch corrugated metal pipe arches that are 42 feet long (see Photograph 1). The existing r-n
structures are rusted, undersized, and have resulted in a blowhole at the outlet. Please note
that the outlet of the proposed structures will be located inside the limits of this blowhole 1=
making it impractical to bury the pipes one foot in the stream bed that now exists at the
bottom of the blowhole. The NCDOT will attempt to set the invert of the pipes one foot
below the "theoretical" streambed elevation taken from projection of the streambed grade
from further down stream back into the blowhole. NCDOT hydraulics unit has indicated that
the increase in diameter of the proposed structures will reduce the water velocity and cause
sediment to accumulate in the blowhole and eventually fill up over time to match the
surrounding stream bed.
The NCDOT proposes to replace the existing structures with 2 @ 103-inch x 71-inch
corrugated metal pipe arches that are 60 feet long. During the construction of the project, the
NCDOT proposes to temporarily dewater the work zone for approximately 2 weeks. This will
involve the temporary placement of sheet piling at the construction limits of the project. To
maintain water flow during construction, water upstream of the sheet piling will be
temporarily pumped out by a hose and conveyed downstream of the construction activity
where it will be allowed to filter through vegetation before flowing into the stream. The
Division 5, 2612 N. Duke Street, Durham, NC 27704
Phone: [phone] Fax: [phone]

effluent from the work area will be pumped into a prefabricated silt bag allowing water to
slowly filter out of the bag in a dispersed manner and the sediment to be captured in the
bag. Once the stream has been dewatered, the pipe will be replaced. The sheet piling will be
removed after construction.
Permanent impacts at the site associated with the replacement of the structure involve a total
of 18 feet of surface water fill and 20 feet of rip rap placed along the streambank to protect
the structure. Temporary (concurrent) impacts will include the dewatering of 38 feet of
stream.
Riparian Buffer
Construction, at this site involves a road crossing of a stream that is subject to the
Neuse River Riparian Buffer Rules. The stream at Site 1 is depicted on the most recent
version of the Timberlake (USGS 1981) topographic quadrangle (Figure 1) as well as the
Person County Soil Survey (USDA-NRCS, 1995) (Figure 2). Construction impacts at this site
total 2,249-square feet in Zone 1 (totaling 38 linear feet of riparian buffer impacts). Based on
the impacts to the riparian buffer at this site, this crossing is EXEMPT.
Waters of the U.S. Mitigation
Avoidance: All wetlands and surface waters not affected by the project will be protected
from unnecessary encroachment. No staging of construction equipment or storage of
construction supplies will be allowed in wetlands or near surface waters.
Minimization: The side slopes have been steepened to the extent possible at jurisdictional
sites. Strict enforcement of sedimentation and erosion control Best Management Practices
for the protection of wetlands and surface waters will be enforced during project
construction. Continued coordination will occur with maintenance forces and the
Environmental Officer during construction to minimize impacts to these sites.
Compensatory Mitigation: Unavoidable impacts to 18 linear feet of stream associated
with this project will be mitigated (at a 2:1 ratio) by providing 36 linear feet of warm
water stream restoration equivalent in the Neuse River Basin (Hydrologic Cataloging
Unit 03020201). All compensatory mitigation requirements will be assimilated on a
quarterly basis and provided to the Ecosystem Enhancement Program (EEP) for their
acceptance with a copy provided to the USACE for verification and accounting purposes.
Protected Species
Plants and animals with federal classifications of Endangered, Threatened, Proposed
Endangered and Proposed Threatened are protected under provisions of Section 7 and
Section 9 of the ESA. As of January 29, 2003, there is one federally protected species
listed for Person County: dwarf wedgemussel (Alasmidonta heterodon). A mussel survey
was conducted at this crossing by biologists with Alderman Environmental Services, Inc.
on 05/6/05 with a finding of no effect for federally protected species. Additionally, a
review of the Natural Heritage Program database (last updated April 2005) revealed no
occurrences of protected species within the project area.

3
Summary
The NCDOT proposes to replace the existing structures with larger sized pipes.
Permanent impacts at the site associated with the replacement of the structures involve a
total of 18 feet of surface water fill and 20 feet of rip rap placed along the streambank to
protect the structure. The work zone will be dewatered for approximately 2 weeks.
Temporary impacts to the stream from this activity will result in the dewatering of 38 linear
feet (concurrent impacts) of stream. The sheet piling will be removed after construction.
Riparian buffer impacts at Site 1 associated with this activity total 2,249-square feet in
Zone 1 (totaling 38 linear feet of riparian buffer impacts). Based on the impacts to the
riparian buffer at this site, this crossing is EXEMPT.
Application is hereby made for a Department of the Army Section 404 Nationwide
Permit (NWP) 3, NWP 33, and NCDENR-DWQ Section 401 Water Quality Certification
(WQC) No. 3494, WQC No. 3366, and riparian buffer authorization for above-described
activities. An automated payment procedure has been implemented between the NCDOT
and NCDWQ. This procedure will enable the Division to apply for the 401 WQC without
submitting a check for this permit application. This procedure will provide payment to
the NCDWQ by charging the permit application fee of $200.00 directly to the appropriate
NCDOT WBS element 513.207311, STAT IO# 9800370. A pre-construction notification
is attached with this request. If you have any questions or need additional information,
please contact Mr. Chris Murray at [phone].
Sincerely,
J G Nance, P.E.
Division Engineer
cc: Nicole Thomson, NCDWQ
Dallie Bagwell, NCDOT
John Kearney, NCDOT
Katie Simmons, NCDOT
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Project Study Area
Replacement Of Existing Structures
SR 1148 in Person Co.
Person County Soil Survey
USDA-NRCS (1995)
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Photograph 1. View of stream immediately below pipe outlets. Note blowhole in stream bed.
Office Use Only: Form Version March 05
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ? Riparian or Watershed Buffer Rules**
? Section 10 Permit ? Isolated Wetland Permit from DWQ
® 401 Water Quality Certification ? Express 401 Water Quality Certification
** Note: Project is exempt per riparian buffer rules
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 3 and NWP 33
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
**Note: See pipe burial issues discussed in cover letter
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here:
If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
II. Applicant Information
Owner/Applicant Information
Name: NCDOT Division 5, Jon G. Nance
Mailing Address:2612 N. Duke St., Durham, NC 27704
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: JNancegdot. 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:
Company Affiliation:
Mailing Address:_
Telephone Number: Fax Number:
E-mail Address:
Page 1 of 8
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: Proposed replacement of structures conveying an unnamed tributary to
North Flat River on 1148 (Patterson Road) in Person County.
2. T.I.P. Project Number or State Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN)
N/A
4. Location
County: Person Nearest Town: Roxboro
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers/names, landmarks, etc.): From Roxboro, travel
southwest on NC 157, turn left and travel east on SR 1148 to project site.
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum): 36.3579123 ON 78.9979531 °W
6. Property size (acres): 0.2 acre
7. Name of nearest receiving body of water: UT North Flat River
8. River Basin: Neuse
(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: Site is surrounded by wooded areas and agricultural land.
10. Describe the overall project in detail, including the type of equipment to be used: The
NCDOT will replace the existing structures at Sitel. The NCDOT will also dewater the
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r
work zone during construction. Equipment may include excavator, backhoe, bulldozer,
grader, and crane.
11. Explain the purpose of the proposed work: The existing structures are rusted, undersized,
and has a blowhole at the outlet.
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. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should 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: The NCDOT will replace the
existing double lines of pipe at Site 1 with longer double lines of pipes. The NCDOT will also
dewater the work zone during construction.
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2. Individually list wetland impacts. Types of 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.
Wetland Impact Type of Wetland Located within Distance to Area of
Site Number Type of Impact (e.g., forested, marsh, 100-year
Floodplain Nearest
Stream Impact
(acres)
(indicate on map) herbaceous, bog, etc.) ( es/no) (linear feet
N/A

Total Wetland Impact (acres) N/A
3. List the total acreage (estimated) of all existing wetlands on the property: N/A
4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, 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. To calculate acreage, multiply length X width, then divide by 43,560.
Stream Impact . Perennial or Average Impact Area of
Number Stream Name Type of Impact Intermittent? Stream Width Length Impact
(indicate on ma Before Impact (linear feet) (acres)
Site I UT N. Flat River Fill (piped length) Perennial 13 ft 18 0.005
Rip rap armoring 20 N/A
along stream bank
Temporary 38 N/A
dewatering (concurrent)
Total Stream Impact (by length and acreage) 38 0.005
5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, dredging, flooding, drainage, bulkheads, etc.
Open Water Impact Name of Waterbody Type of Waterbody Area of
Site Number (if applicable) Type of Impact (lake, pond, estuary, sound, bay, Impact
indicate on ma) ocean, etc.) (acres)

N/A

Total Open Water Impact (acres) N/A
6. List the cumulative impact to all Waters of the U.S. resulting from the project:
Stream Impact (acres): 0.005
Wetland Impact (acres): NONE
Open Water Impact (acres): NONE
Total Impact to Waters of the U.S. (acres) 0.005
Total Stream Impact (linear feet): 38
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7. Isolated Waters
Do any isolated waters exist on the property? ? Yes ® No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.
N/A
8. 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
Current land use in the vicinity of the pond: 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. All wetlands and surface
waters not affected by construction will be protected from unnecessary encroachment during
construction. Strict enforcement of Best Management Practices for the protection of wetlands
and surface waters will be enforced during construction. Only the smallest amount of fill
necessary to complete the project will be placed in waters of the United States
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 January 15, 2002, 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,
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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.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.
Unavoidable impacts to 18 linear feet of stream associated with this project will be mitigated
(at a 2:1 ratio) by providing 36 linear feet of warm water stream restoration equivalent in the
Neuse River Basin (Hydrologic Cataloging Unit 03020201). All compensatormitigation
requirements will be assimilated on a quarterly basis and provided to the Ecosystem
Enhancement Program EEP) for their acceptance with a copy provided to the USACE for
verification and accounting pLimoses.
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 written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at http://h2o.enr.state.nc.us/wrp/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:
Amount of stream mitigation requested (linear feet): 36 ft
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/local) funds or the use of
public (federal/state) land? Yes ® No ?
2. 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)?
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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
3. 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 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water, Supply Buffer Requirements), or other (please
identify, )? Yes ® No ?
2. If "yes", 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.
Site 1
Zone* Impact
(square feet) Multiplier Required
Mitigation
1 2,249 3 (2 for Catawba)
2 0 1.5
1 Total 2,249
Lone t extends out 3u teet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration / Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B .0242 or .0244, or .0260. N/A
XI. Stormwater (required by DWQ)
Describe impervious acreage (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. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. There is 0.04 acre existing impervious surface
with the 0.2 acre project site. No additional impervious surface is proposed with this
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maintenance pipe replacement project. Erosion and sediment control devices at this site are
comprised of temporary silt fence and special stilling basin silt bag).
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
This project will not generate wastewater.
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application? Yes ? No
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ? No
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
http://h2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description:
The project involves replacement of existing structures. No additional roadway improvements
will be associated with this project. No additional development will result from this action
XV. 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).

Appl} ant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
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