20050864 Ver 1_Complete File_20050518

Certificate of Completion V@ 2 OWIR P
_ MAY 2 6 2005
DWQ Project No. 0 5 - U7, 6`1 County: 0 __.._ -ER QUALITY
WETMS MID STORMWATER SRAICH
?? Ycc_. c- ?? e d ?c?,?
Applicant:
Project Name:
Date of Issuance of 401 Water Quality Certification: 5 ? o - Os
Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules,
and any subsequent modifications, the applicant is required to return this certificate to the
401/Wetlands Unit, North Carolina Division of Water Quality, 1621 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.
Applicant's Certification
I, , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to
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:
Agent's Certification
I, !-c?F•? ?"7; ..-? , 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
built within substantial compliance and intent of the 401 Water Quality Certification and Buffer
Rules, the approved plans anAspecifications, and other supporting materials.
aL,(` 5
Signature: Date:
If thi p ect was designed by a Certified Professional
1, , as a duly registered Professional
(i.e., Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been
authorized to observe (periodically, weekly, full time) the construction of the project, for the
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 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:
. ?CF W A T?9Q
?? r
Mr. Benton Payne, P.E.
NCDOT Division 10
716 West Main Street
Albemarle, NC 28001
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
am rr--x R 5W 19 1
JUN 1 2005
DENR - WATER QUALITY
WETLANDS AND STORMWATER BRANCH
APPROVAL of 401 Water Quality Certification with Additional Conditions
Dear Mr. Payne:
May 20, 2005
DWQ# 05-0864
Union County
You have our approval, in accordance with the attached conditions and those listed below, to permanently
impact 27 linear feet (If) of an unnamed tributary (perennial stream) to Waxhaw Creek as described in your
application received by the Division of Water Quality (DWQ) on May 18, 2005. The culvert was replaced prior
to issuance of the 401 Water Quality Certification due to a failing road shoulder. During the installation, the
stream was overwidened and riprap placed on the banks and in the stream. In an effort to correct the
overwidening, a floodplain bench was created in the stream. The creation of the floodplain bench required 27
If of stream impact. The location of the project is NC 200 (Lancaster Highway) in Union County. After
reviewing your application, we have determined that this project is covered by Water Quality General
Certification Number 3494. This certification corresponds to the Nationwide Permit Number 3 issued by the
U.S. Army Corps of Engineers (USACE). Please note that you should get any other federal, state or local
permits before proceeding with your project, including those required by (but not limited to) Sediment and
Erosion Control, Non-Discharge, and Water Supply Watershed regulations. This approval will expire with the
associated 404 permit unless otherwise specified in the Water Quality Certification.
This approval is valid solely for the purpose and design that you described in your application (unless modified
below). Should your project change, you must notify the DWQ in writing and you may be required to 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 conditions. If total wetland fills for this project (now or in
the future) exceed one acre, or if total impacts to streams (now or in the future) exceed 150 linear feet,
compensatory mitigation may be required as described in 15A NCAC 2H.0506 (h)(6) and (7). For this approval
to remain valid, you must adhere to the conditions in the attached certification and those listed below:
1. Design and placement of culverts and other structures including temporary erosion control measures shall be
installed in such a manner that the original stream profiles are not altered. Existing stream dimensions
(including pattern and profile) are to be maintained above and below locations of each culvert. The applicant
may be required to provide evidence that the equilibrium has been maintained, if requested in writing -by the
DWQ.
2. Riprap must not interfere with thalweg performance and aquatic life passage during low flow conditions.
3. Heavy equipment must be operated from the banks rather than in the stream channel, when possible, in
order to minimize sedimentation and reduce the likelihood of introducing other pollutants into the stream.
.O ` Carolina
Ntura!!y
North Carolina Division of Water Quality 610 East Center Avenue, Suite 301 Phone [phone]
Internet h2o.enrstate.na.us Mooresville, NC 28115 FAX [phone]
An Equal OpportunitylAffimtative Action Employer- 5016 Recycled/100/6 Post Consumer Paper

Page 2
4. Temporary dewatering sites must be restored to pre-existing conditions unless more natural geomorphic
conditions can be provided.
5. No live or fresh concrete shall come into contact with waters of the state until the concrete has hardened.
6. 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.
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. All work shall be performed during low or normal flow conditions.
9. Discharging hydroseeding mixtures and washing out hydroseeders and other equipment in or adjacent to
surface waters is strictly prohibited.
10. Erosion and sediment control practices must utilize Best Management Practices (BMP) and be in full
compliance with all specifications,goveming the proper design, installation, and operation and maintenance of
such BMP in order to protect surface water standards:
a. The design, installation, operation, and maintenance of the sediment and erosion control measures
must be such that they equal, or exceed, the requirements specified in the most recent version of
the North Carolina Sediment and Erosion Control Manual. The devices shall be maintained on all
construction sites, borrow pit sites, and waste pile (spoil) projects, including contractor-owned or
leased borrow pits associated with the project.
b. For borrow pit sites, the erosion and sediment control measures must be designed, installed,'
operated, and maintained in accordance with the most recent version of the North Carolina Surface
Mining Manual.
c. The reclamation measures and implementation of these measures must be in accordance with the
requirements of the Sedimentation Pollution Control Act.
11. Sediment and erosion control measures shall not be placed in wetlands or waters to the maximum extent
practicable. If placement of sediment and erosion control devices in wetlands and waters is unavoidable,
they shall be removed and the natural grade restored within 30 days after the Division of Land Resources has
released the project.
12. The North Carolina Department of Transportation (NCDOT) and its contractors and/or agents shall not
excavate, fill or perform mechanized land clearing at any time in the construction or maintenance of this
project within waters and/or wetlands, except as authorized by this Certification, or any modification to this
Certification (e.g., no work shall occur outside of the footprint of the plans provided). In addition, there shall
be no excavation from or waste disposal into jurisdictional wetlands or waters associated with this
Certification without appropriate modification. If this occurs, compensatory mitigation may be required since it
is a direct impact from road construction activities.
13. Upon completion of the project, the applicant shall complete and return the enclosed "Certificate of
Completion" form to notify DWQ when all work included in the 401 Certification has been completed. Please
include photographs upstream and downstream of the structure to document correct installation.
14. Continuing Compliance. NCDOT shall conduct its activities in a manner so as not to contravene any state
water quality standard [including any requirements for compliance with section 303(d) of the Clean Water Act]
and any other appropriate requirements of state and federal law.
?ft
Page 3
If DWQ determines 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 15 A NCAC
2H.0507(d). Before codifying the certification, DWQ shall notify NCDOT and the USACE, provide public
notice in accordance with 15A NCAC 2H.0503, and provide opportunity for public hearing in accordance with
15A NCAC 2H.0504. Any new or revised conditions shall be provided to NCDOT in writing, shall be provided
to the USACE 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.
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 1508 of the North Carolina General Statutes to the Office of Administrative Hearings, 6714
Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its conditions are final and binding unless
you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If
you have any questions, please telephone Polly Lespinasse in the Mooresville Regional Office at 704-663-
1699.
Sincerely,
/D, i,?,(, fr?- - ?
for Alan W. Klimek, P.E.
Attachments
cc: Steve Lund, USACE Asheville Field Office
Rob Ridings, DWQ Wetlands Unit
Central Files
File Copy

STATE OF NORTH CAROLINA
T??o. 9y ?O
osFy?fi .r
9y?'h9 •f, V"
V6, o?.
DEPARTMENT OF TRANSPORTATION s9?
MICHAEL F. EASLEY DIVISION OF HIGHWAYS W. Lo TIPPETT
GOVERNOR SEC TARY
April 26, 2005
Asheville Regulatory Field Office
U.S. Army Corps of Engineers PAYMENT . c? 0 $ _U
Attn: Mr. Steve Lund
151 Patton Avenue, Room 208 RECEIVED
Asheville, NC 28801-5006
Subject: Union County NC 200 (Lancaster Highway) - "After the Fact" Request for Permit .
Authorization. WBS Element No. 1013.209011 (DWQ Minor Permit Fee $200.00).
Dear Mr. Lund:
The purpose of this letter is to notify you of the fact that the North Carolina Department of
Transportation (NCDOT) has replaced two sections of reinforced concrete pipe (RCP) on NC 200
(Lancaster Highway) in Union County due to a failing road shoulder. This work was preformed without
prior notification to your office.
Two four-foot long sections of 30" RCP were replaced on an unnamed tributary to Waxhaw
Creek, Catawba River Basin, Hydrologic Unit 03050103. There were 27 linear feet of permanent stream
impacts incurred as a result of this activity.
The purpose of this letter is to request an "after the fact" authorization of the aforementioned work
under a Section 404 Nationwide Permit 3 as well as a Section 401 Water Quality Certification GC3494.
We are providing copies of this application to the North Carolina Department of Environment and Natural
Resources, Division of Water Quality, for their review as well.
Thank you for your assistance with this project. If you have any questions or need any additional
information concerning this project, please contact Mr. Larry B. Thompson, Division Environmental
Officer, at [phone]
Sin erely,
L,4 L." rE.
Benton G. Payne, Division Engineer
BGP/LBT
cc: Mrs. Polly Lespinasse, NCDWQ
Ms. Marella Buncick, USFWS
Mrs. Marla Chambers, NCWRC
N#Fo-ri,b
716 West Main Street, Albemarle, NC 28001 • [phone] 9 Fax [phone]
Union County
NC 200 (Lancaster Highway) A
Office Use On yp Form,?ersio 2001
?'? 0 5 08 64
USACE Action ID No DWQ No.
If any. particular item is not applicable to this project, please enter "Not Applicable" or rather than
leaving the space blank.
I. Processing
Check all of the approval(s) requested for this project:
® Section 404 Permit
? Section 10 Permit
® 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: Nationwide 3
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: N C Department of Transportation
Mailina Address: 716 West Main Street
Albemarle. NC 28001
Telephone Number: [phone] Fax Number: [phone]
E-mail Address:
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: Benton G Payne P E
Company Affiliation: Division Enaineer
Mailing Address: 716 W. Main Street
Albemarle. NC 28001
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: bpayne@a dot state nc us
Union County
NC 200 (Lancaster Highway)
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: NC 200 (Lancaster Highway)
2. T.I.P. Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Union Nearest Town: Waxhaw
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): From the intersection of NC 16
and NC 75 in the town of Waxhaw. travel east beariniz right onto Old Waxhaw Monroe
Road. Turn right onto Providence Road and travel south until you reach the intersection of
NC 200 and Providence Road Turn left onto NC 200 and travel north until you pass the
intersection of NC 200 and McWhorter/Tom Starnes Rd. Project location is 0.1 mile beyond
this intersection.
5. Site coordinates, if available (UTM or Lat/Long): 34° 52' 14.64" N / 80° 39" 39.28" W
(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:
Mixed use: Residential/A ricultural
7. Property size (acres): N/A
8. Nearest body of water (stream/river/sound/ocean/lake): Waxhaw Creek
9. River Basin: Catawba Basin (Hvdroloc ic Unit 03050103)
(Note - this must be one of North Carolina's seventeen designated mayor river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/map-2L/-)
Union County
NC 200 (Lancaster Highway)
10. Describe the purpose of the proposed work: Pipe replacement activities were undertaken at
this location to address the failing road shoulder. The work consisted of replacing two failing
four foot sections of reinforced concrete pipe (RCP) with two new sections of RCP of the
same len h.
11. List the type of equipment to be used to construct the project: Trackhoe and Dump Truck.
12. Describe the land use in the vicinity of this project: There is a wooded buffer present
U stream of the project and open land that is being utilized as pastures on both sides of the
hi hwa at/near the pipe itself. Mixed land use consisting of both agriculture and residential
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain- Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland. stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? 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
3
Union County
NC 200 (Lancaster Highway)
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
t
i
Wetland Impact
Site Number
n ma)
t
di
i
Type of Impact* Area of
Impact
acres Located within
100-year Flbbdplain**
es/no) o
stance
D
Nearest Stream
Type of Wetland***
e o
ca
n N/A
N/A N/A N/A N/A N/A

r!-;na ararlina_ fill-
* List each impact separately and identify temporary impacts. unpacts u,ctuu?. ?uL v? 11v1 1luaia.u -?•• - _.__...?
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 (FENLA) Flood Insurance Raze Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-368-9616. or
online at http://,,«tlvfema.2ov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/salt%vater marsh- forested wetland- beaver pond.
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: N/A
Total area of wetland impact proposed: N/A
2. Stream Impacts, including all intermittent and perennial streams
Length Average
Stream Impact
Site Number
Type of ImPact* of Impact
(linear
Stream Name** Width of

Stream Before Perennial or
' 1
Intermittent.
(indicate on map) feet Lm act
Outlet protection in
Site 1 the form of a rip rap 27 Feet UT to Waxhaw Creek Approx. 4' Perennial
energy dissapator.
_ . ,...t-, .,...d ?rcri ri r>_,•an
* List each impact separately and identify temporary impacts. impacts mciuue. ou1 arc 11u1 1uw- ,.u= • 1• u - - w- -- •.r . __
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, Gst as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at I-800-368-9616. or online at
www.uses.sov. Several intemet sites also allow direct download and printing of LSGS maps (e.g. w%yw.tooozone.com-
www.mamuest.com. etc.).
Cumulative impacts (linear distance in feet) to all streams on site: There have. been 27 feet
of permanent impacts incurred as a result of this project being constructed
4`
Union County
NC 200 (Lancaster Highway)
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds. Atlantic Ocean and any
other Water of the U.S.
e of Waterbody
T
Open Water Impact
Site Number
dicate on ma
i Type of Impact* Area of
Impact
(acres) Name of Waterbody
(if applicable) yp
(lake, pond, estuary, sound,
bav, ocean, etc.)
n
N/A N/A N/A N/A N/A

_,-.a , ... i„ nirwi rn- fill e.cnvation dred6ma.
* List each impact separately and identity temporary impacts. unpaci U1WUUc, UUL
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., darn/embankment, excavation. installation of
draw-down valve or spillway, etc.): N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): N/A
Size of watershed draining to pond: N/A Expected pond surface area: N/A
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable. discuss construction
techniques to be followed during construction to reduce impacts.
This project was constructed without prior notification to the USACE or NCDWQ. NCDOT
maintenance personnel operated under the assumption that the stream was not a tunsdictional
crossing citing that the stream channel remains dry during the summer months. After replacing
the failing sections of pipe, NCDOT staff filled U proximately 27 fee of the stream channel with
rip rap. Division environmental staff requested that excess ri ra and a rock
sediment check dam be removed from the stream bed after an on-site consultation with the
maintenance personnel. The enclosed hoto a hs show "before and after' shots.
Union County
NC 200 (Lancaster Highway)
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
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/str-rngide.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 bas in, 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.
An requested mitigation for this project will be forwarded to the Ecosvstem Enhancement
Program for consideration.
Union County
NC 200 (Lancaster Highway)
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://h2o enr state nc_us/wro/mdmhtrn_ 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)
Does the project involve an expenditure of public funds or the use of public (federal/stateflocal)
land?
Yes ® No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein.
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), ' 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify N/A )?
Yes ? No ® If you answered "yes", provide the following information.
Union County
NC 200 (Lancaster Highway)
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
s uare feet Multiplier Required
Mitigation
1 3
2 1.5
Total

* Zone 1 extends out 30 feet perpendicular from near bank or channel; c.uue c eatcnw M
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or .0260.
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.
There has not been an increase in impervious area as a result of this project being constructed.
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.
8
Union County
NC 200 (Lancaster Highway)
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ® No ?
Is this an after-the-fact permit application?
Yes ® No ?
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
As previously mentioned NCDOT personnel performed this work under the false impression
that this crossing was not a jurisdictional stream. In re once to this unauthorized activity.
Division environmental personnel have completed trainin sessions within our counties in an
effort to help prevent this from happening again. Furthermore. Union County maintenance
su ervisors have been directed to forward all future pipe replacement requests to division
environmental staff for their review prior to beginning construction.

Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
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Name: UNITY Location: 034° 52' 14.81 N 080° 39'41.34" W
Date: 4/25/2005 Caption: Hwy 200, (Union County)
Scale: 1 inch equals 1333 feet
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Union County - NC 200
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Legend
A permit site
.9
Prepared by:
North Carolina
Department of Transportation
L B. Thompson
Environmental Unit, Division 10
Date: April 25, 2005
This map Is Intended for Internal DOT use only.
For all other uses, no warranties of any sort,
Including accuracy, fitness, or merchantability
accompany this product.