20041444 Ver 1_Complete File_20040830

Certificate of Completion
DNA'Q Project !`u_: l ?? ?f y Counr- : _-A y 0 " ZJ f-'
AppIicanr. C?T*-) 07-
Project Namc: ?y-7l?
Date of Issuance of 401 Rater Quality Certification:
Upon couPlrtion of all work 8PPm1md within the 401 Wa= Qua1ii3• Cer-,ification and $u$? ??s and
any subsequent modifications, the applicant is required to return this certificate to the 40lIR--;findslicit,
North Carolina Division of Watw Quality, 1631 Mail Semi= C: nter, Raleigh, NC, 27699-1621_ i his fo:
may be return-d to DWQ by the applicant, the applicant's authorized aScnt, or the project =L=jne=_ 1t is
not n..:essary to send cerdfi=cs from a.1] of th-se_
?ppficant's Certification
I, state ZhZL7- ro the trest of m-,, abiihi „-
cs .??_ . an:
diii a;.nccw -.s used ..._ ., m the D bs.. v anon of the consm --don such thin one cors=ction was oh io C,
built -" irhin substantial co=iianct and intent of the -dal - at.--. Quail; N' Cer =-ration and 3t:= Rules to
approved plans and sp=z fficarions, and other sunporti Il1aIeti:aic
Dazes:
?05,
_A-Cat's Certification
herby stain f=t. To the best of my abitiri=s- ch - , an['
dffi=c,,=ce was used ;T, the obsmwat on of*..he --onscu..uon such that !he consu action ups oes.--vetd Io
built within substantial conmhan= and intent of the 401 RTai,- Qua_ii y Cc dncazion and Bu:M= Rid=s, th--
approved plans and sn rcincations. and other suaporring,
mat,.--tats.
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Darc_
f this projeal was designed ny a Cerz ft d Professional
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DENR . WATER QUALITY
WETLANDS AND STORMWATER BRANCH
ATe? Micharl 1'. I?uslr?. (iovcrnor
? ?t V,'illi;un li. Ross Jt.. Sccreurn•
?? Cr North Carolina l )cpartmcnt of I.nvironmem and Natural Resources
r
-_i Alan \1 Khmck. V-1... I>ircclor
< 1)1\ JSIon ol, \\ tiler (,tn:;lity
September 16, 2004
DWQ# 04-1444
Alexander County
Mr. Mike Holder, P.E. WETLANDS/ 401 GROUP
NCDOT Division 12
P.O. Box 47 SEP 2 3 2004
Shelby, NC 28151
APPROVAL of 401 Water Quality Certification with Additional Conditions WATER QUALITY SECTION
Dear Mr. Holder:
You have our approval, in accordance with the attached conditions and those listed below, to permanently
impact 22 linear feet (If) (12 If of culvert extension and 10 If of riprap inlet and outlet protection) of an unnamed
tributary to Outz Creek* for the purpose of replacing an existing culvert for the proposed upgrading of an
unpaved road to a paved road as described in your application received by the Division of Water Quality
(DWQ) on August 30, 2004. The location of the project is State Road 1470 (Tom Meadows Road), in
Alexander County. After reviewing your application, we have determined that this project is covered by Water
Quality General Certification Number 3404. This certification corresponds to Nationwide Permit 14 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 listed in the attached certification.
1. Placement of culverts and other structures in waters, streams and wetlands must be below the elevation of
the streambed by one (1) 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 for low flow passage of water anc
aquatic life, as well as prevent headcutting of the streams. 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 (i.e., the depth of the channel must not be reduced by a widening of the
streambed). 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.
No stream determination performed.
NOne
hCarolina
)Qaturally
North Carolina Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 Phone [phone] Customer Service
Internet h2o.enr.state.nc•us 512 N. Salisbury St. Raleigh, NC 27604 PAX [phone] 1-877-623-6748
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
Page 2
3. Heavy equipment must be operated from thbanks rather e
likelihood of introducing other pollutantshntoPhe stbrleam.
order to minimize sedimentation and reduce
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.
geomoros c' condo lld of be modified.
6. The dimension, pattern and profile of the stream above natural below
Disturbed floodplains and streams shoed be restored to 7. All mechanized equipment operated near surface
fuels, lubricants, hydrae lic fluids, oe othea tox camaterialsto
prevent contamination of stream waters from
8. All work shall be performed during low or normal flow conditions.
9. Erosion and sediment control practices must utilize Best Management Practices (BMP) and be in full
compliance with all specifications governing the proper design, installation, and operation and maintenance of
such BMP in order to protect surface water
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 mpleme i ation of these measures must be in accordance with the
requirements of the Sedimentation
10. Sediment and erosion control measures shall not be placed in wetlands or waters to the maximum extent and
unavoidab practicable. If placement of sediment and aestorednwithin e30 days after D v s ontof Land R sou Iles has
they shall be removed and the natural g
released the project.
11. 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 i
is a direct impact from road construction activities.
12. 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.
13. Continuing Compliance. NCDOT shall conduct its activities in a manner consistent with state water quality
standards [including any requirements for compliance with section 303(d) of the Clean Water Act] and any
other appropriate requirements of state and federal law. If DWQ determines that such standards or laws are
not being met (including the failure to sustain designated
to assure achieved compliance, DWQ may eevaluatelands
being violated, or that further conditions are nee
Page 3
modify this certification to include conditions appropriate to assure compliance with such standards and the
certifica requirements in accordance with 15 A NCAC 2H.050Be fore 1 codifying A NCAC 2H 0503tion, WO shall notify with , NCDOT and the USACE, provide public notice in accordan new
revised opportunity for public hearing in accordance with 15A NCAC the USACE for reference in any pe mcito'ssued puhsulant
be provided to NCDOT in writing, shall be provided to
to Section 404 of the Clean Water Act, and shall also become conditions of the 404 Permit for the project. dicatory
hearin If you do not accept any of the conditions of this certification,
ayou sk foaa ask for an adjua written petition that u must
Hearings , 6714
act within 60 days of the date that you receive this letter. ministra
conforms to Chapter 1508 of the North Carolina General Siand its ? o'nditio sdare finaltand binding unless
Mail Service Center, Raleigh, N.C. 27699-6714. This certification
you ask for a hearing. Section 4
1 of
Act This letter completes the review of the Division of Water
aQuality sse in therMoores IOIe Reg onal aOffcetat 704-663-
you have any questions, please telephone Polly Lesp
1699.
Sincerely,
,D
Alan W. Klimek, P.E.
Attachments
cc: Steve Lund, USACE Asheville Field Office
Rob Ridings, DWQ Central Office
Central Files
File Copy
1.*40 STATE of NORTH CAROLINA

WETLANDS/ 401 GROUP
AUG 3 0 2001
WATER QUALITY SECTION
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY DIVISION OF HIGHWAYS LYNDO TIPPETT
GOVERNOR SECRETARY
August 27, 2004
Mr. John Hennessy
40I/ Transportation Permitting Unit 444
1650 Mail Service Center a
Raleigh, N.C. 27699-1650
SUBJECT: Pipe replacement on SR 1470 (Tom Meadows Rd), Alexander County
Dear Mr. Hennessy:
The North Carolina Department of Transportation proposes to replace an existing deteriorating
cross pipe on SR 1470 (Tom Meadows Rd) in Alexander County. An existing 36-foot z 24"
CMP will be replaced with a 48-foot a 36" CMP with five feet of Class B riprap at the inlet and
outlet for structure protection. The scope of the work will permanently impact an additional 12
linear feet of jurisdictional waters associated with the unnamed tributary to Outz Creek, which is
classified as Class C Waters by the Division of Water Quality. The project is not located within
'/z mile of any critical watershed area; therefore, hazardous spill basins are not required. Enclosed
is the hazardous spill basin checklist.
The installation of the replacement pipe should be completed within an 8-hour period. Due to the
low flow nature of the stream no bypass pumping or cofferdams, for stream management during
pipe replacement, will be necessary. This department requests the issuance of WQC#3404 for the
proposed pipe replacement activity. Upon project completion, all disturbed areas will be restored
as nearly as possible to pre-construction conditions.
I have enclosed a pre-construction notification, sketches of planned activities, and location maps
relative to the project.
Project information for the 401 Automated Payment Procedure is as follows:
• Work order number: 150459-55120005-120.002019-3855
• TIP #: NA
• Project Category: $200.00 Fee
SR 1470
Page 2
August 27, 2004
If you have any questions or concerns, please feel free to contact me at [phone]. Thank
you for your time and consideration to this matter
Respectfully yours,
M.L. Holder, P.E.
Division Engineer
Twelfth Division
BY:
Trish Simon
Division 12 Environmental Supervisor
Enclosures
Cc: Polly Lespinasse, DWQ, Mooresville Regional Office
Ron Linville, Wildlife Resources Commission (Courtesy Copy)
Aug-06-2004 ll:Ilam From-NC DOT ALEXANDER COUNTY +828 63Z 0854
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NCDOT
HAZARDOUS SPILL BASIN CHECKLIST
Division: 19 County: Alexander Project ID: 12C.002019
River Basin: Yadkin Bridge No: SecondM Road Pavin Pipe
Replacement
Route: SR 1470, Tom Meadows Road
IV
Stream: UT to Outz Creek, WS-
Water Quality Criteria:
Yes No
Stream Crossing Blue Line On USGS r' R
ORW F Fr
WSI r Fr
WS II,III OR IV, Crossing Within 0.5mi of W.S. Critical Area F F
Roadway Criteria:
Route Designation-
Arterial Urban
Arterial Rural
Additional Site Information:
Is a Hazardous Spill Basin Required?
Yes No
r a
r Fj
Yes No
r pr
Criteria Based Upon NCDOT "Best Management Practices for the
Protection of Surface Waters" (March, 1997).
SR 1470, Pipe Replacement
Ilk I
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4 eB2 1466
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106 Soil Survey
TABLE 4.--ACREAGE AND PROPORTIONATE EXTENT OF THE SOILS

Map I I
I Soil name I
I
Acres I
(Percent
I
symboll
I I I

AcD I I
IAshe-Cleveland complex, 8 to 25 percent slopes, stony------------------------------1
388 I
1 0.2
AcE IAshe-Cleveland complex, 25 to 60 percent slopes, stony-----------------------------1 1,553 1 0.9
BeB (Bethlehem gravelly sandy loam, 2 to 8 percent slopes-------------------------------1 780 1 0.5
BeC (Bethlehem gravelly sandy loam, 8 to 15 percent slopes------------------------------1 3,106 1 1.8
BrC (Bethlehem-Urban land complex, 2 to 15 percent slopes-------------------------------1 278 1 0.2
BsC2 (Braddock and Hayesville clay loamy, 6 to 15 percent slopes, eroded-----------------1 1,444 1 0.9
BsD2 (Braddock and Hayeaville clay loams, 15 to 25 percent slopes, eroded----------------1 2,427 1 1.4
BuA ]Buncombe loamy sand, 0 to 3 percent slopes, occasionally flooded-------------------1 462 1 0.3
CeB2 ]Cecil sandy clay loam, 2 to 8 percent slopes, eroded-------------------------------1 15,113 1 9.0
CfB (Cecil-Urban land complex, 2 to 8 percent slopes------------------------------------1 1,402 1 0.8
ChA lChewacla loam, 0 to 2 percent slopes, frequently 'flooded --------------------------- 1 6,392 1 3.8
CnF (Cleveland-Rock outcrop complex, 8 to 90 percent slopes-----------------------------1 900 1 0.5
CaD ICowee-Saluda complex, 8 to 25 Percent slopes, stony --------------------------------1 2,811 1 1.7
CaE ICowee-Saluda complex, 25 to 60 percent slopes, stony-------------------------------1 10,843 1 6.4
DaB2 (Davidson clay loam, 2 to 8 percent slopes, eroded----------------------------------1 461 l 0.3
DaC2 (Davidson clay loam, 8 to 15 percent slopes, eroded---------------------------------1 404 ] 0.2
DOB IDogue sandy loam, 2 to 6 percent slopes, rarely flooded----------------------------1 133 I 0:1
ECD (Evard-Cowee complex, 8 to 25 Percent slopes, stony ---------------------------------1 3,443 1 2.0
EcE IEvard-Cowee complex, 25 to 60 percent slopes, stony--------------------------------1 15,922 1 9.4
HbC IHibriten very cobbly sandy loam, 8 to 15 percent slopes----------------------------1 170 1 0.1
HbE IHibriten very cobbly sandy loam, 15 to 60 percent slopes---------------------------1 6,784 1 4.0
MaB2 (Masada sandy clay loam, 2 to 8 percent slopes, eroded------------------------------1 771 1 0.5
MaC2 (Masada sandy clay loam, 8 to 15 percent slopes, eroded-----------------------------1 721 1 0.4
PaD IPacolet sandy loam, 15 to 25 percent slopes----------------------------------------1 18,943 I 11.2
PcB2 IPacolet sandy clay loam, 2 to 8 percent slopes, eroded-----------------------------1 8,937 1 5.3
PcC2 IPacolet sandy clay loam, 8 to 15 percent slopes, eroded----------------------------1 45,982 I 27.4
PuC IPacolet-Urban land complex, 2 to 15 percent slopes---------------------------------1 1,129 1 0.7
RnC IRion sandy loam, 8 to 15 percent slopes--------------------------------------------1 1,560 1 0.9
RnD IRion sandy loam, 15 to 25 percent slopes-------------------------------------------1 3,233 1 1.9
RnE (Rion sandy loam, 25 to 45 percent slopes-------------------------------------------1 4,628 1 2.8
RwB ]Rion-Wedowee complex, 2 to 8 percent slopes----------------------------------------1 860 1 0.5
RxA IRiverview fine sandy loam, 0 to 2 percent slopes, frequently flooded---------------1 1,352 I 0.8
StB (State sandy loam, 2 to 6 percent slopes--------------------------------------------1 284 1 0.2
TfB (Tate-French complex, 2 to 10 percent slopes----------------------------------------1 648 1 0.4
UdC IUdorthents-Urban land complex, 0 to 15 percent slopes------------------------------1 780 1 0.5
WaA IWehadkee loam, 0 to 2 percent slopes, frequently flooded---------------------------1 226 1 0.1
I Water-------------------------------------------------------------------------1
1-- 3,268
--------- 1 1.9
I-------
1
I Total--------------------------------------------------------------------1 168,538 1 100.0
Office Use Only: Form Version May 2002
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
L 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
2. Nationwide, Regional or General Permit Number(s) Requested: MC# #3404
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 (verify availability with NCWRP prior to submittal of PCN), 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: ?
H. Applicant Information
1. Owner/Applicant Information
Name: Mike Holder. N Department of Transportation
Mailing Address: P.O. Box 47
Sheft North Carolina 28151
Telephone Number: 704-480-9020 Fax Number: 704-480-5401
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: Trish Simon
Company Affiliation: N C Department of Transportation
Mailing Address: P O Box 47
Shelby, North Carolina 28151
Telephone Number: 704-480-9044 Fax Number: 704-480-5401
E-mail Address: tsimon o dot state nc us
Page 1 of 8
M. 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: Secon Road Pavin Pipe replacement, SR 1470.
2. T.I.P. Project Number or State Project Number (NCDOT Only): 12C.002019
3. Property Identification Number (Tax PIN): NA
4. Location
County: Alexander Nearest Town: Hiddenite
Subdivision name (include phasellot number): NA
Directions to site (include road numbers, landmarks, etc.): Take Hwy 90 east from
Hiddenite Turn left onto SR 1456 turn right onto SR 1461 then right onto SR 1470, To
Meadows Rd, project site first pipe crossing
5. Site coordinates, if available (UTM or Lat/Long): 35°55'30.71"N/81°01'56.90"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. Property size (acres): Pipe replacement = <0.1 acres (NCDOT right of way),
7. Nearest body of water (stream/river/sound/ocean/lake): UT to Outz Creek. Class C Waters
8. River Basin: Yadkin
(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:Existing Conditions -pipe on unpaved secondary road that is to
be paved. General Land Us Agricultural, residential, some wooded area
Page 2 of 8
10. Describe the overall project in detail, including the type of equipment to be used: NCD T
proposes the upgrade an existing unpaved road to current paved road standards using
bulldozers trans backhoes sheen foot rollers and pavers At Station 6+50 an existing 36-
foot: 24" CMP will be reulaced with 48-foot. 36" CMP. Five feet of Class B riprap will be
placed on the inlet and outlet embankment for structure protection Installation of the pipe is
to be one within an 8-hour period, therefore no dewatering of the site will occur.
11. Explain the purpose of the proposed work: The purpose of the proposed work is Rave the
road and upgrade the existing alignment which will necessitate the len hening and
Mlacement of the pipe at Station 6+50.
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.
NA
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.
None Anticipated
VL Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Provide a written description of the proposed impacts: Permanent impacts from minimal
increase in pipe length and associated riprap for structure stabilization
Page 3 of 8
2 Individuall list wetland im acts below: NO WETLAND EMPACTS
Wetland Impact
Site Number Type of impact*
indicate on ma Area of
Impact
acres Located within
loo-year FloodpWn**
no Distance to
Nearest Stream
linear feet
Type of Wetland***

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized
clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both
structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance
Rate Maps (FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service
Center at 1400-358-9616, or online at http://www.fema.QOV.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver
pond, Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property: 0
Total area of wetland impact proposed: 0
3. Individually list all intermittent and mrennial stream impacts below:
Stream Impact Average Width Peremdal or
Site Number Type of Length of Impact Stream Name** of Stream Intermittent?
(indicate on Impact* (linear feet) Before impact (please specify)
map)
1 m
cr 12 feet Ut to Outz Creels 1 feet Intermittent
l
pipe
Riprap on
I bank for 5 feet upstream « « «
structure
stabilization I 5 feet downstream
* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and
associated rip-rap, dams (separately list impacts due to both structure and flooding), relocation (include linear feet before
and after, and net loss/gam), 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 steams must be included
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the
nearest downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616,
or online at www.usgs.gov. Several intemet sites also allow direct download and printing of USGS maps (e.g.,
www.topozone.com, www.mapguest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: Permanent Impacts = 22
feet
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U. S.) below: 0
Open Water Impact Area of Name of Waterbody Type of waterbody
Site Number Type of Impact* Impact (if applicable) (lake, pond, estuary, sound,
indicate on map) acres bay, ocean, etc.

List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation,
dredging, flooding, drainage, bulkheads, etc.
Page 4 of 8
Pond Creation: NO POND IMPACTS
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.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
The nine is being lengthened the minimum amount necessary to bring the roadway section up to
cent paved road standards The minimal amount of rip= necessary for structure stabilization
will be used The replacement nine will be buried 20% of diameter to accommodate aquatic
passage.
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.
Page 5 of 8
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/strmizide.html.
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreagellinear 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.
IMPACTS < 150 FEET, MITIGATION NOT ANTICIPATED
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at http://h2o.enr.state.nc.us/wM/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) 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 ?
Page 6 of 8
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 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ® If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
zone* Impact
(SQUM feet Multiplier ?u nme d
Miti
gation 3
2 1.5
Total
* zone 1 extends out 30 feet perpendicular from near bank of channel; zone 2 extends an
additional 20 feet from the edge of zone 1.
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.
NA
XI. Stormwater (required by DWQ)
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.
Minimal amount of impervious surface is prows Minor widening of the existing unpaved
roadway and minor shifts of roadway alignment will increase the impervious acreage -0.5 acres.
Page 7 of 8
XH. 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.
NA
XIM 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. 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).
? / 7S
i.
a'27-D
Applicant/Agent's Signature Date i
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 8 of 8