20051122 Ver 1_Complete File_20050701

dF WArFR Michael F. Easley, Governor
O William G. Ross Jr., Secretary
09 North Carolina Department of Environment and Natural Resources
r Alan W. Klimek, P.E. Director
Q ,c Division of Water Quality
DWQ Project No.: 05112-2-
County: ?e r son
Applicant: NCDor 'Div 5 -Ton G. lQance
Project Name: 5R ?3yo (Concord-Cerfo Rd) NCn\ovr'n At1eaJ
Date of Nquance of. 401 Wilber Quality CertiFcation: 0-7101 ( C's
Certificate of Completion
Upon completion of all work approved within the 40.1 Water Quality Certification or applicable Buffer Rules, and
any subsequent mudi Fcatinns, the applicant is required to return this certificate to the 4011Wet.1 . s Unit, North
Carolina Division of Water Quality, 162.1 Mail Service Center, Raleigh, NC, 27699-1621. 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.
A pplicant's Cer ititcation
I. 0N 6, 1Jantk , hereby state that, to the best of my abilities, due care and diligence
was used in the observation of the construction such tbat the construction was observed to be built within substantial
compliance and intent of the Water Quality Certification and Buffer Rulcs, the approved plans and
specifications, and other poor g materials.
Signatur?c: a,-- Date: Z I
Aget's Certification
1, , 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 witbin 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
Date:
Partial Final
Z, ----- , 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
Pennittcc 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.
0EC, 2 7 2005
-NR - WATER QUALITY
k. '. .," (CM S'ORMVVAT ER BRANCH
TmnsporM lon Pormltdng Unit
9650 Mell Service Center, Raleigh, North Carolina 27622.16,50
2321 CrebbaA Boulm d, suite 2so, Raleigh, North Carolina 276()4
Phone: [phone] / FAX [phone] Intemet htbJ/h2o err state nc us/newetlands

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
July 1, 2005
Person County
DWQ Project No. 051122
APPROVAL of 401 Water Quality Certification
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
proposed pipe maintenance and improveftient to a structure conveying an ephemeral channel on SR 1340 (Concord-
Ceffo Road) in Person County.
The project shall be constructed in accordance with your application dated received June 21, 2005. After reviewing
your application, we have decided that the stream impacts described are 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 with the accompanying 404 permit, unless otherwise specified in the Water
Quality Certification.
This approval is valid solely for the purpose and design described in your application (unless modified below).
Should your project change, you must notify the DWQ and submit a new application. If the property is sold, the
new owner must be given a copy of this Certification and approval letter, and is thereby responsible for complying
with all the conditions. If total wetland fills for this project (now or in the future) exceed one acre, or of total
impacts to streams (now or in the future) exceed 150 linear feet, compensatory mitigation may be required as
described in 15A NCAC 2H.0506 (h) (6) and (7). For this approval to remain valid, .you must adhere to the
conditions listed in the attached certification. -
1.) Upon completion of the project, the NCDOT shall complete and return the enclosed "Certification of
Completion Form to notify DWQ when all work included in the 401 Certification has been completed. The
responsible party shall complete the attached form and return it to the 401/Wetlands Unit of the Division of
Water Quality upon completion of the project.
2.) During the construction of the project, no staging of equipment of any kind is permitted in waters of the U.S., or
riparian buffers.
3.) Riparian vegetation must be reestablished within the construction limits of the project by the end of the growing
season following completion of construction.
T. Carolina
,
.k.ar ,
Transportation Permitting Unit
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/ncwetlands
4.) The dimension, pattern and profile of the stream above and below the crossing should not be modified by
widening the stream channel or reducing the depth of the stream. Disturbed floodplains and streams should be
restored to natural geomorphic conditions.
5.) Any riprap used must not interfere with thalweg performance and aquatic life passage during low flow
conditions.
6.) All mechanized equipment operated near surface waters must be regularly inspected and maintained to prevent
contamination of stream waters from fuels, lubricants, hydraulic fluids, or other toxic materials.
7.) Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or adjacent to surface
waters is prohibited.
8.) The outside buffer, wetland or water boundary located within the construction corridor approved by this
authorization shall be clearly marked by highly visible fencing prior to any land disturbing activities. Impacts
to areas within the fencing are prohibited unless otherwise authorized by this certification.
9.) There shall be no excavation from or*vaste 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 dirgct impact from road construction activities.
10.) Heavy equipment must be operated from the banks rather than in the stream channel in order to minimize
sedimentation and reduce the likelihood of introducing other pollutants into the stream.
11.) Placement of culverts and other structures in waters, streams, and wetlands must be placed below the elevation
of the streambed by one foot for all culverts with a diameter greater than 48 inches, and 20 percent of the
culvert diameter for culverts having a diameter less than 48 inches, to allow low flow passage of water and
aquatic life. Design and placement of culverts and other structures including temporary erosion control
measures shall not be conducted in a manner that may result in dis-equilibrium of wetlands or stream beds or
banks, adjacent to or upstream and down stream of the above structures. The applicant is required to provide
evidence that the equilibrium shall be maintained if requested in writing by DWQ.
12.) If the above condition (#11) is unable to be met, due to bedrock or other limiting features encountered during
construction, please contact the NCDWQ for guidance on how to proceed and to determine whether or not a
permit modification will be required.
13.) No live or fresh concrete shall come into contact with waters of the state until the concrete has hardened.
14.) The presence of equipment in the channels must be minimized. Under no circumstances must rock, sand or
other materials be dredged from the wetted stream channel under authorization of this permit, except in the
immediate vicinity of the culverts.
15.) All work shall be performed during low or normal flow conditions.
16.) All fill slopes located in jurisdictional wetlands shall be placed at slopes no flatter than 3:1.
17.) A copy of this Water Quality Certification shall be posted on the construction site at all times. In addition, the
Water Quality Certification and all subsequent modifications, if any, shall be maintained with the Division
Engineer and the on-site project manager.
18.) 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. 276 1 1-7447. This certification and its conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If you
have any questions, please contact Christina Breen at [phone].
Si ere y,
an W. Klimek, P.E. ?...
JEH/cmb
Attachment
cc: Mr. Eric Alsmeyer, US Army Corps of Engineers, Raleigh Fiela Office
Mr. Chris Murray, Division 5 Environmental Officer, 2612 N. bake Street, Durham, NC 27704
NC DWQ Raleigh Regional Office
Central Files
File Copy
c:\Correspondence\20050therProjects\DWQ051122\070105wgc.doc
.t
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os?gTF? rO'2
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION y
MICHAEL F. EASLEY LYNDO TIPPETT
GOVERNOR SECRETARY
June 6, 2005
U.S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls of the Neuse Road, Suite 120
Raleigh, NC 27609
Attention: Mr. Eric Alsmeyer
NCDOT Coordinator
051122
Subject: NC Moving Ahead project- improvements to SR 1340 (Concord-Ceffo
Road) and SR 1336 (McGhees Mill Road) in Person County.
WBS element 37651
As part of the NC Moving Ahead program, the North Carolina Department of
Transportation (NCDOT) proposes improvements to SR 1340 (Concord-Ceffo Road) and
SR 1336 (McGhees Mill Road) in Person County from Hwy 57 junction with SR 1340
east to SR 1336 then north on SR 1336 to the rail road crossing (Figures 1-3). This
project will involve upgrading cross lines, widening travel lanes, and resurfacing 2.6
miles of roadway. z
Within the project length there are two stream crossings, both of these are along the o
SR 1340 segment of this project. Only one of these sites is a permit site. The non permit
site, a culvert conveying Sargents Creek, will not be altered. This structure will not be
replaced or extended and the stream will be protected by silt fencing while construction
activities are underway in this area. The Site 1 stream crossing (Figure 1 - 2) is
approximately 900 feet east of the junction of SR 1340 with Hwy 57. The existing
roadway has 10 ft travel lanes and no paved shoulders. The upgrade proposal is to
provide 11 ft travel lanes with 1 ft paved shoulders.
Impacts to Waters of the United States
Site I - Waters of US
Construction at this site will impact a herbaceous linear wetland within a drainageway
that is supported by an ephemeral stream channel (Figure 3). This wetland is formed from
a stream that originates from a spillway of a pond. The existing structure conveying this
ephemeral stream is a 24-inch reinforced concrete pipe that is 52 feet long (see
Division 5, 2612 N. Duke Street, Durham, NC 27704
Phone: [phone] Fax: [phone]
a,
2
Photographs 1 and 2). The existing pipe at this site will not be replaced, however one 4 ft
joint will be added to each end with 5 feet of riprap added along the channel for
stabilization. Permanent impacts at the site include a total of 0.002 ac of fill in wetlands
(see Appendix One for USACE Wetland Delineation forms/DWQ rating sheets). No
surface water impacts are proposed at this site.
Riparian Buffer Impacts
The project is located in the Roanoke River Basin. Therefore, construction will be
completed without impacts to protected riparian buffers.
Waters of the U.S./Riparian Buffer 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 Miti ag tion: Unavoidable impacts to 0.002 acre of non-riverine wetlands
associated with this project will be mitigated (at a 1:1 ratio) by providing 0.002 acre of
non-riverine wetland restoration equivalent, in the Roanoke River Basin (Hydrologic
Cataloging Unit 03010104). 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). This ephemeral
stream does not provide suitable habitat for dwarf wedgemussel and furthermore no
dwarf wedgemussels are known to exist within the Roanoke River Basin. Therefore, a
Biological Conclusion of No Effect has been rendered for this species.
Historical Compliance
This project has been screened by all pertinent parties to ensure historic compliance.
.r
3
Summary
NCDOT proposes to upgrade cross lines, widen travel lanes, and resurface along 2.6
miles of roadway in Person County. Fill in wetlands of 0.002 ac is the only impacts
proposed with this project.
Application is hereby made for a Department of the Army Section 404 Nationwide
Permit (NWP) 14 and NCDENR-DWQ Section 401 Water Quality Certification (WQC)
No. 3404 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 37651. A
pre-construction notification is attached with this request. If you have any questions or
need additional information, please contact Ms. Heather Montague at [phone].
Sincerely,
. 1.0 - ro,
on G. Nance, P.E.
Division Engineer
cc: Ms. Nicole Thomson, NCDWQ
Mr. Battle Whitley, P.E., NCDOT
Mr. Dion Viventi, P.E., NCDOT
Ms. Katie Simmons, NCDOT
4

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SR 1340 (Concord-Ceffo Road) - Person County
Photograph 1. View upstream from inlet.

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Office Use Only: U/V , io arIO5
?g??1 2
USACE Action ID No. D4 *44Z 1 'Ps
(If any particular item is not applicable to this project, please enter " able" or "N/A".)
1. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
® 401 Water Quality Certification ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 14
If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
II. Applicant Information
Owner/Applicant Information
Name: NCDOT Division 5 Jon G. Nance
Mailing Address: 2612 N. Duke St. Durham, NC 27704
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: [e-mail]
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:
E-mail Address:
Fax Number:
Page I of 8
III. Project;,Inf nation
Attach a vicinity inap 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 deuef6pment 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: NC Moving Ahead project, the North Carolina Department of
Transportation (NCDOT) proposes improvements to SR 1340 (Concord-Ceffo Road) and
SR 1336 (McGhees Mill Road) in Person County from Hwy 57 junction with SR 1340 east to
SR 1336 then north on SR 1336 to the rail road crossing This project will involve up rg ading
crosslines, widening travel lanes, and resurfacing 2.6 miles of roadway.
2. T.I.P. Project Number or State Project Number (NCDOT Only): WBS Element No. 37651
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 take
Hwv 57 North for approximately 6 miles, then make a riaht onto SR 1340 (Concord-Ceffo
Road) and travel approximately 900 feet to Site 1-
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): Site 1: 36.4476 ON 79.0646 °W
6. Property size (acres): 18.9 acre 2.6 mi project within the 60 ft right-of-way
7. Name of nearest receiving body of water: UT Hyco River
8. River Basin: Roanoke
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/mgps/.)
Page 2 of 8
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: This
project will involve upgrading crosslines, widening travel lanes, and resurfacing 2.6 miles of
roadway. Equipment used at this site, may include excavator, backhoe, bulldozer, grader, and
crane.
11. Explain the purpose of the proposed work: The project is part of the NC Moving Ahead,
program.
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.
Provide a written description of the proposed impacts: See cover letter for a thorough
description of the proposed impacts at Site 1.
Page 3 of 8
1. 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 Nearest Impact
(indicate on map) herbaceous, bog, etc.) Floodplain Stream (acres)
(yes/no) (linear feet)
Site 1 Fill drainageway, herbaceous no 0 ft 0.002
Total Wetland Impact (acres) 0.002
2. List the total acreage (estimated) of all existing wetlands on the property: N/A
3. 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 1 N/A Fill (piped length) N/A N/A 0 N/A
Rip rap armoring 0 N/A
along stream bank
Temporary 0 N/A
dewatering
Total Stream Impact (by length and acreage) N/A N/A
4. 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
5. List the cumulative impact to all Waters of the U.S. resulting from the project:
Stream Impact (acres): N/A
Wetland Impact (acres): 0.002
Open Water Impact (acres): NONE
Total Impact to Waters of the U.S. (acres) 0.002
Total Stream Impact linear feet): 0
Page 4 of 8
6. 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
7. 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 or protected
riparian buffers.
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
Page 5 of 8
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 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/newetlands/stlmgide.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.
NCDOT proposes to provide 0.002 ac of non-riverine wetlands restoration equivalent by
payment in the Ecosystem Enhancement Program.
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/wLM/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): N/A
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): 0.002 ac
Amount of Coastal wetland mitigation requested (acres): N/A
IX. Environmental Documentation (required by DWQ)
1. 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)?
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.
Page 6 of 8
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.
1. 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
213 .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
I N/A 3 (2 for Catawba) N/A
2 N/A 1.5 N/A
Total N/A N/A
* Zone I extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, 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 are 6.9 acre existing impervious surface
(22 foot wide existing; pavement) and 7.6 acre proposed (proposed 24 foot wide asphalt paved
road) of the 18.9 acre (2.6 mi) total project size Erosion and sediment control devices along the
project are comprised of temporary rock silt checks temporary silt basins and temporary silt
fence The temporary structures will be removed once the vegetation has been established and
then seeded with a seed mixture of fescue and bahia grass.
Page 7 of 8
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:
This NC Moving Ahead project will not result in additional development.
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).
05
Q Applicant/Agent's S`i nature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 8 of 8
Appendix One
(USACE Wetland Delineation forms/
DWQ rating sheets)
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Determination Manual)
: l? flC? J s.
T?
?v
Project / Site:- - ?;? cn? ?' • ?, f jr, j Date:
Applicant / Owner: /fC r r'%'- ! County: f?rr- o
Investigator. State: i'_
Do normal circumstances exist on the site? Yes No Community ID:
Is the site significantly disturbed (Atypical situation)? Yes No Transect ID:
Is the area a potential problem area? Yes No Plot ID:
"(explain on reverse if needed)
VEGETATION
Dominant Plant s : _Stratum ndicator Dominant Plant species Stratum ' Indicator
1. t eu5 FAC U!. 9.
2. 10.
3.
.
4•
12•
5. 13.
.6. 14. ..: ....: ,.
7. 15.
8. 16.
Percent of Dominant Species that are OBL, FACW, or FAC excluding FAC-). ldo%
Remarks: Wetland Vegetation Present Based Upon Greater than 50% of the Plant Species are/are not
Classified as FAC-OBL in the National List of Plant Species that Occur in Wetlands. Sample plot was taken...

HYDROLOGY:.:
_ Recorded Data (Describe In Remarks): Wetland Hydrology Indicators
_ Stream, Lake, or Tide Gauge
_ Aerial Photographs Primary Judicators:
Other Inundated
_ aturated in Upper 12"
No Recorded Data Available - Water Marks
_ Drift Lines
Field Observations: _ Sediment Deposits
_ Drainage Patterns in Wetlands
Depth of Surface Water: (•) Secondary Indicators:
Oxidized Roots Channels in Upper 12"
Depth to Free Water in Pit: O tom, Water-Stained Leaves
Local Soil Survey Data _-
Depth to Saturated Soil: -21-011.) _-! FAC-Neutral Test
Other (Explain in Remarks)
Remarks-.
SOILS

Map Unit Name
(Series and Phase): Drainage Class:
Taxonomy (Subgroup): Confirm Mapped Type? Yes_ No
Profile Description:
Depth Matrix Colors Mottle Colors Mottle Texture, Concretions,
inches Horizon (Munseil Moist) (Munseli Moist). Abundance/Contrast Structure, etc. -

Hydric Solt Indicators:
_ Histosol - Concretions
Histic Epipedon _ High Organic Content in Surface Layer In Sandy Soils
_ Sulfldic Odor Organic Streaking in Sandy Soils
Aquic Moisture Regime Listed On Local Hydric Soils List
_ Reducing Conditions Listed on National Hydric Soils"List '
/Gleved or Low-Chroma Colors - Other (Explain in Remarks)
Remarks.

WETLAND DETERMINATION
Hydrophytic Vegetation Present? Yes No Is the Sampling Point
Wetland Hydrology Present? Yes No Within a Wetland? Yes_ No
Hydric Soils Present? Yes No
Remarks: Location (describe) is/is not classified as a wetland based upon the criteria set fordi in the 1987
Army Corps of Engineers Wetlands Delineation Manual. R
71.
;:ii' /.:s:.;a:•/:::yM:;:-::a.::.__ _ .>-: :/. <. >"?; i.:..._..:yx. i.»w M9 c..`Fir:; :,•c />:...,.:./.
c3.i%i't:?i".....y;. ,1,::> :a,.L'::'<p'???: - ' '3:@•.••?•. < .??:Yf. ?' a 'Z?isi??, f?'!tS>a?Z?'?fi'.f;?iSw'?.?p?w,'?i><:+.e53.1'9?<i>ii/?dj•• • ?/.iG:<»YG?r'::;???.
Nom/ / ?/?yy??
Project Name ?04core. Nearest Road ,
v"? wetland Area ages Wetland Width fee
Name of evaluator //e -6,;"r ??°'' "?/ ` Bate
Wetland Location
on pond or lake
on perennial stream
on intermittent stream
within interstream divide
?other ?P_?c"cam?-< s << ..c???,,,t.
Soil series
predominantly organic - humus, muck,
or peat
predominantly mineral - non.-sandy
/predominantly sandy
Adjacent land use
(within 112 mile upstream, ups-slope, or radius)
/ forested/natural vegetation %
agriculture, urban/suburban %
"impervious surface -`
Dominant vegetation

(3)
Flooding and wetness
Hydraulic factors
steep topoaphy
ditched or channelized
total wetland width k100 feet
semipermanendy to permanently
flooded or inundated
seasonally flooded or inundated
intermittanly flooded or temporary
surface water
no evidence of flooding or surface water
Wetland type (select one)*
Bottomland hardwood forest Pine savanna
Headwater forest Freshwater marsh
Swamp forest Bog/fen
Wet flat Ephemeral wetland
Pocosin Carolina Bay
Bog forest - __Z6ther ?yb• r'~'
*the rating system cannot be applied to salt or brackish marshes or stream channels _____
R
A
i
I
N
G
Water storage
Bank/Shoreline stabilization
Pollutant removal
Wildlife habitat
Aquatic life value
s
x 4.00 =
x 4.00 =
* x 5.00 =
' x 2.00 =
1 x 4.00 =
Recreation/Education O x 1.00 =

*Add 1 point if in sensitive watershed and >10% nonpoint disturbance within 1/2 mile upstream,
weight
Wetland
y-s R1e_ or radius_
------ ----------------------------------------------------------------------------------------
DATA FORM
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Determination Manual)
Project / Site:
z 5
Date:
Applicant / Owner: Irv
county.

?
•
Investigator: /0,:-
Do
normal circumstances exist on the site? Yes No
r
Community ID:
Is the site significantly disturbed (Atypical situation)? Yes No_
; Transect ID:
Is the area a potential problem area? Yes No Uf Plot ID:
(explain on reverse if needed)
VEGETATION.....
DominantOlant Species Stratum Indicator Dominant Plant species Stratum Indicator
X 9.
7 10.
3. '16q
4. arrl?s?:?1? jai If-' f 12.
5. 13.
.6. 14. ......:. ....
7. 15.
8. 16.
r,,r
Percent of Dominant Species that are OBL, FACW, or FAC excluding FAC+
Remarks: Wetland Vegetation Present Based Upon Greater than 50% of the Plant Species are/are not
Classified as FAC-OBL in the National List of Plant Species that Occur in Wetlands. Sample plot was taken...

HYDROLOGY.
- Recorded Data (Describe In Remarks): Wetland Hydrology Indicators
Stream, Lake, or Tide Gauge
_ Aerial Photographs Primary Indicators:
_ Other _ Inundated
_Saturated in Upper 12"
No Recorded Data Available -Water Marks
_ Drift Lines
Field Observations: - Sediment Deposits
_ Drainage Patterns in Wetlands
Depth of Surface Water:
Secondary Indicators:
Oxidized Roots Channels in Upper 12"
Depth to Free Water in Pit:
t•) _ Water-Stained Leaves
_ Local Soil Survey Data
Depth to Saturated Soil: Jl (inj FAC-Neutral Test
_ Other (Explain in Remarks)
Remarks:
?? 5+?P5 64 ?MJ?r4 , E'

SOILS
v
Map Unit Name
(Series and Phase): Drainage Class:
Taxonomy (Subgroup): Confirm Mapped Type? Yes_ No .
Profile Description:
Depth Matrix Colors : Mottle Colors Mottle Texture, Concretions,
inches Horizon (Munseli Moist) (Munsell Moist). Abundance?Contrast Structure, etc.-
"
f ?.
14-
Hydric Soil Indicators:
_ Histosol - Concretions
Histic Epipedon High Organic Content in Surface Layer in Sandy Soils
Sulfidic Odor Organic Streaking in Sandy Soils
- Aquic Moisture Regime Listed On Local Hydric Soils List
- Reducing Conditions ` Listed on National Hydric Soils List
_ Gleyed or Low-Chroma Colors Other (Explain in Remarks)
Remarks. ,.

WETLAND DETERMINATION
Hydrophytic Vegetation Present? Yes No Is the Sampling Point
Wetland Hydrology Present? Yes No Within a Wetland? Yes_ No
Hydric Soils Present? Yes No
Remarks: Location (describe) istis not classified as a wetland based upon the criteria set forth in the 1987
Army Corps of Engineers Wetlands Delineation Manual: t .
r? ty .