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Date of Issuance of 401 Water Quality Certification: ? e t Pm 6cr I q 2noy
11 Upon completion of all work approved within the 401 'rater Qualr3• C=:-dfication and Buff= Rubs. and
any subsequent modifications, the applicant is required to =tiara this certificate to the 4011"Vk-',c: nes unit
North Carolina Division ofWat=- Quality, 1631 MaR S=-%i= Center, Raleigh, NC, 2769P-1621_ Tnis m
may IY retained to DWQ 'try the anplicant, the applicant's autho agent, or the project It is
not nee..-ssary to send certificates from all ofihr_st.
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Mr. Mike Holder, P.E.
NCDOT Division 12
P.O. Box 47
Shelby, NC 28151
DENR - WATER QUALITY
WETLANDS AND STORMWATER BRANCH
APPROVAL of 401 Water Quality Certification with Additional Conditions
Dear Mr. Holder:
Alan W. Klimck, F.E. Director
Division of Water Quulity
December 14, 2004
DWQ# 04-1948
Alexander County
You have our approval, in accordance with the attached conditions and those listed below, to permanently impact a total
of 129 linear feet (If) as listed in the table below:
Location/Station Stream Name Length of pipe Length of inlet/outlet Total length of
extension/fill protection/cross vane weir impacts
installation
Site 1 1 Unnamed tributary to 16 feet 5 feet 21 linear feet
Station 35+50
Site 2 Elk Shoal Creek
2 Unnamed tributary to
14 feet
10 feet
24 linear feet
Station 41+70
Site 3 Elk Shoal Creek
3 Unnamed tributary to
44 feet
10 feet inlet/outlet protection
84 linear feet
Station 83+00 Elk Shoal Creek 30 feet for cross vane weir
installation
In addition, you have our approval to temporarily impact 40 linear feet of stream at Sites 1 and 2 for the purpose of
installing temporary cofferdams. Impacts will be to multiple unnamed tributaries` for the purpose of replacing and/or
extending existing pipes in anticipation of secondary road paving scheduled for next year as described in your application
received by the Division of Water Quality (DWQ) on December 7, 2004. The location of the project is State Road 1631
(Stikeleather Road) in Alexander County. After reviewing your application, we have determined that this project is
covered by Water Quality General Certification Numbers 3404 and 3366. This certification corresponds to Nationwide
Permit Numbers 14 and 33 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:
No stream determinations performed.
No Carolina
Naturally
North Carolina Division of Water Quality 610 East Center Avenue, Suite 301
Internet h2o.enr.state.nc.us Mooresville, NC 28115
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Phone [phone]
FAX [phone]
An Equal Opportunity/Affirmative Action Employer- 50% Recyded/10% Post Consumer Paper
Page 2
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 and 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. The cross vane weirs shall be constructed and 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 the location of the cross vane weir. The structure
shall be designed and installed to allow for fish and other wildlife movement as well as prevent headcutting of the
stream. The applicant may be required to provide evidence that the equilibrium has been maintained, if requested in
writing by the DWQ.
3. Riprap must not interfere with thalweg performance and aquatic life passage during low flow conditions. Riprap placed
for bank stabilization should be limited to the stream bank below the high water mark and vegetation should be used for
stabilization above the high water mark.
4. 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.
5. Temporary dewatering sites must be restored to pre-existing conditions unless more natural geomorphic conditions can
be provided.
6. No live or fresh concrete shall come into contact with waters of the state until the concrete has hardened.
7. 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.
8. All mechanized equipment operated near surface waters must be regularly inspected and maintained to prevent
contamination of stream waters from fuels, lubricants, hydraulic fluids, or other toxic materials.
9. All work shall be performed during low or normal flow conditions.
10. Discharging hydroseeding mixtures and washing out hydroseeders and other equipment in or adjacent to surface waters
is strictly prohibited.
11. 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, 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.
12. 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.
Page 3
13. 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.
14. 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.
15. 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 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 150B
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,
Alan W. Klimek, P.E.
Attachments
cc: Steve Lund, USACE Asheville Field Office
Rob Ridings, DWQ Wetlands Unit
Central Files
File Copy
?aw AAlto? D D
,198 ? EC 472004
Q V .??. DENR - WATER QUALI
VYETLANpBAND8Tt7RMgUl9 H
STATE of NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY DIVISION OF HIGHWAYS LYNDO TIPPETT
GOVERNOR
SECRETARY
November 30, 2004
Mr. John Hennessy
Division of Water Quality
401/Transportation Permitting Unit
1650 Mail Service Center
Raleigh, N. C. 27699-1650
SUBJECT: Pipe replacements/extension on SR 163 1 (Stikeleather Road), Alexander County
Dear Mr. Hennessy:
The North Carolina Department of Transportation requests authorization to replace two existing cross pipes and
extend a third crosspipe on SR 1631(Stikeleather Rd) in Alexander County. The crosspipes are located on an
unpaved secondary road that is to be paved next year. At Site #1 (St 35+50), NCDOT proposes to extend an
existing 32-foot, 18" CMP to a length of 48 feet (16-foot extension). The crosspipe carries stormwater flow only.
It appears that a seep/spring begins at the existing pipe outlet and flows through an intermittent channel. The site is
non jurisdictional upstream of the existing pipe. The pipe extension will be laid upon a bed of #5 stone to allow the
spring to continue to flow under the pipe to the downslope intermittent channel. Due to the anticipated high
stormflows from the adjacent agricultural land and the slope of the pipe (-100/o), it is necessary to place a 5 foot
riprap apron, which will be embedded into the streambed, at the pipe outlet in an effort to prevent erosion. At Site
#2 (St. 41+70), a 36-foot, 95"a 67" CMPA will be replaced with a 50-foot, 84" CMP with inlet headwall and 20
feet of associated riprap for struchrre stabilization. At Site #3 (St 83+00), a 36-foot, 42" CMP will be replaced
with an 80-foot, 48" CMP with inlet headwall and 20 feet of associated riprap for structure stabilization. The pipes
at sites #2 and #3 will be buried one foot below the existing streambed elevation based upon the thalweg profile.
The pipe at site #3 is perched approximately 4 feet with a large scour hole at the pipe outlet. The streamgrade
upstream and downstream of the pipe is -31/o. It is necessary to place the new pipe on 51/o-6% grade to meet the
pipe burial requirement. Stream headcutting/ downcutting is a concern at this site; therefore, a series of three cross-
vane weirs (spaced - 5 feet apart) will be installed both upstream and downstream of the pipe at specific elevations
in an effort to control the streambed grade and prevent stream destabilization. (See enclosed sketches for
elevations). The pipe at this will be extended past the existing scour hole. The existing pipes must be lengthened to
bring the road up to paved road standards during next year's road paving project on SR 1631.
Temporary cofferdams and bypass pumping will be utilized at sites #2 and #3 to manage the streamflow during pipe
installation. "Stream" management is not necessary at site #1 since the jurisdictional area is located only on the
downstream end of the pipe. The scope of the work will result in 74 linear feet of pipe fill, 55 feet of riprap impacts
(this includes riprap used for structure stabilization and crossvanes) and 40 feet of temporary impacts from the
cofferdams to three, separate, unnamed tributaries to Elk Shoal Creek (East side), which is classified as WS-IV
Waters by the Division of Water Quality.
r,
SR 1631, Stikeleather Road
Page 2
The proposed project is located in Class WS-IV watershed; however, it is not located within ''/z mile of any critical
watershed area, nor is SR 1632 a rural or urban arterial. Hazardous spill basins are not required. Enclosed is the
NCDOT hazardous spill basin checklist.
This letter serves as an application from the Department of Transportation for the certification of the proposed
activities under the Division of Water Quality's WQC#3404 for permanent fill impacts associated with the linear
transportation crossings and WQC#3366 for temporary impacts and dewatering. I have enclosed a PCN
application, sketches of planned activities, and a location maps relative to the project.
Project information for the 401 Automated Payment Procedure is as follows:
• Work order member 150465-55120005-12C.002018-3855
• TIP #: NA
• Project Category: $200.00 Fee
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)
Office Use Only: n Form Version May 2002
USACE Action ID No. DWQ No t '? 9 4
(If any particular item is not applicable to this project, please enter "Not Applicable" 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
2. Nationwide, Regional or General Permit Number(s) Requested:WQC# 3404 (NW 14) and
WQC#3366 (NW 33).
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: ?
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: ?
H. Applicant Information
1. Owner/Applicant Information
Name: Mike Holder, N.C. Department of Transportation
Mailing Address: P.O. Box 47
Shelby, 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@a,dot.state.nc.us
Page 1 of 9
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: Stikeleather Road (SR 1631) Pipe replacements at Station 35+50, 41+70,
and 83+00 (in preparation for next year's secondary road paving project).
2. T.I.P. Project Number or State Project Number (NCDOT Only): 12C.002018
3. Property Identification Number (Tax PIN): NA
4. Location
County: Alexander Nearest Town: Hiddenite
Subdivision name (include phase/lot number): NA
Directions to site (include road numbers, landmarks, etc.): SR 1005 from Hiddenite, right
on SR 1617, then left on SR 1631.
5. Site coordinates, if available (UTM or Lat/Long): (Site #1) 35°52'29"N/81°05'49"W/
{Site #213 5'52'24"N/8 1'05'49"W/ {Site #313 5'5 1'42"N/8 1'06'05"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 replacements/extension - 0.60 acre (NCDOT right of way)..
7. Nearest body of water (stream/river/sound/ocean/lake):Three separate, unnamed tributaries
to Elk Shoal Creek WS-IV watershed (East Side)(from source to a point 1.4 miles
upstream of mouth).
8. River Basin: Catawba
(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/.)
Page 2 of 9
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 -pipes on unpaved secondary road.
General Land Use-predominately wooded and pasture land.
10. Describe the overall project in detail, including the type of equipment to be used: The
upcoming road paying project consists of the upgrade of the road with minimal alignment
changes. There will be two pine replacements and a pipe extension done in advance of the
road paving project. At Station 35+50, it appears a spring originates under the existing road
with a jurisdictional intermittent channel only on the downstream end of the pipe. The
existing, 32-foot, 18" RCP will be extended 16 feet. The crosspipe will carry stormwater flow
only. The pipe extension will be laid upon a stone bed to allow the spring to continue to flow
from under the pipe to the downslope intermittent channel. At St. 41+70, a 36-foot, 95" x
67" CIVIPA will be replaced with a 50-foot, 84" CHIP with inlet headwall and associated
r prap for structure stabilization. At St. 83+00, a 36', 42" CNT will be replaced with an 80',
48" CUT with inlet headwall and associated riprap for structure stabilization. The pipe at
this location is currently perched -4 feet. To meet the pipe burial requirement, the pipe will
be on a >5% grade. Stream headcutting/downcutting is a concern at this site; therefore, three
cross-vane weirs in series will be installed both upstream and downstream of the pipe in an
effort to control the streambed grade and prevent stream destabilization. Work will be done
using _typical heavy construction equipment: bulldozers, pans, backhoes, rollers, and pavers.
11. Explain the purpose of the proposed work: The purpose of the proposed work is to replace
and extend existing pipes for next years ars upgrade of the unpaved road to current paved road
standards. Constructing the new road to paved road standards will require a wider shoulder,
which will necessitate the longer pipe lengths at the three stream crossings.
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.
Bridge #144 (-St. 73+00 was replaced in 2003. The application date for the bridge
replacement was 3/7/02. The USACE authorization (Action Id. 200230624) for a GP 31 was
issued 4/4/02 and expired 12/31/02, therefore, a reverification of the expired permit
authorization was necessary, and was requested 2/6/03. The USACE reverification
authorization (Action Id. 200330467 & 200330468) for a NW 14 & 33 was issued 3/10/03 with
an expiration of 3/10/05. The DWO Certification (DWO Project No. 020356) was issued
3/25/02. The authorizations/certification authorized 80 linear feet of a double line of 96"
culverts and 40 linear feet of riprap impacts on Elk Shoal Creek.
Page 3 of 9
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.
No future permit requests related to the unpaved section are anticipated.
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
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. Temporary impacts
associated with temporary cofferdams and bypass pipinir related to the pipe replacement.
2. Individually list wetland impacts below: NO WETLAND IMPACTS
Wetland
Impact Area of Located within Distance to
Site Type of Impact* Impact 100 year Floodplain** Nearest Stream Type of Wetland***
Number (acres) (yes/no) (linear feet)
(indicate
on ma

* 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 WMM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service
Center at 1-800-358-9616, or online at hUp://www.fema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland,
beaver pond, Carolina Bay, bog, etc.) 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
Page 4 of 9
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact Length of Perennial or
Site Number Type of Impact* Impact Stream Name** Average Width of Intermittent?
(indicate on map) (linear feet) Stream Before (please specify)
impact
1 Unnamed tributary
1- (Station 35+50) #5 Stone bed/pipe 16 feet to Elk Shoal Creek 1 feet Intermittent
fill over seep (East side)
Riprap apron at 5 ft "
1 outlet
2° Unnamed
2- (Station 41+70) Pipe (Increase in 14 feet tributary to Elk Shoal 2 feet Perennial
i length) Creek (East side)
Riprap on embank- 5 ft-upstream; 5
2 ment for structure ft-downstream "
stabilization 10 fleet - total
10 ft upstream
2 Temporary of pipe; 10 feet
cofferdams downstream of "
pipe
3 Unnamed
3- (Station 83+00) Pipe (Increase in 44 feet tributary to Elk Shoal 4 feet Perennial
i length) Creek (East side)
Riprap on 5 ft-upstream; 5
3 embankment for ftdownstrewn "
structure protection 10 feet -total
Crossvanes to 6 crossvanes (3
3 prevent stream upstream & 3
headcutting/ downstream); "
downcutting -5 feet impacts/
vane= 30 feet
10 ft upstream
Temporary of pipe; 10 feet
3 Cofferdams downstream of "
pipe
• List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated
rip-rap, dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and
after, and net loss/gain), stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation,
ditching/straightening, etc. If stream relocation is proposed, plans and profiles showing the linear footprint for both the
original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to
the nearest downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-
9616, or online at www.usgs.gov. Several internet sites also allow direct download and printing of USGS maps (e.g.,
www.tgpozone.com, www.ntapguest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: Total Pipe Fill = 74
feet; Total Permanent Riprap Impacts (structure stabilization & crossvanes) = 55 feet;
Temporary, cofferdam impacts = 40 feet.
Page 5 of 9
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and anv 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 ma 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.
5. 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.
To construct the road to current paved road standards during next year's road project, it is
necessary to increase the current pine len hs to provide for adequate roadway shoulder and fill
slope Due to the topography and the existing perched pipe condition at site #3, it is anticipated
that stream headcutting or downcutting may occur. The pipe is perched -4 feet with a large
scour hole at the outlet and the existing grade upstream of the pipe is -3%. A series of three
crossvanes in series(- 5 feet apag) is to be placed at specific elevations upstream and
downstream of the pipe (See enclosed sketches for elevations). The crossvanes should control
the grade of the stream in the vicinity of the pipe and prevent the headcutting upstream of the
pipe and downcutting downstream of the pipe The pipe at Site #3 will be extended past the
existing scour hole.
The pipe at site #1 is a crosspipe for stormwater only. The pipe extension will be laid on a bed
of #5 stone to allow the spring to seep through the stone under the pipe and flow to the adjacent
channel Due to the anticipated high stormflows from the adjacent agricultural land and the
slope of the pipe (-10%), it is necessarv to place a_riprat) apron embedded into the streambed at
the outlet in an effort to prevent erosion.
Page 6 of 9
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/stnngide.htmi.
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.
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/w!P/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):
Page 7 of 9
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 ?
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.
mitigation is required calculate the required amount of mitigation by applying
multipliers.
Zone* Impact
(square feet Multiplier Mitigation
1 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
the buffer
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
Page 8 of 9
XL 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.
Appropriate erosion and sedimentation control measures will be in place at each stream during
the replacement/extension of the pipe.
XU. 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
XIIL Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (I 5A 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).

Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 9 of 9
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