20050464 Ver 1_Complete File_20050414

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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
? April 14, 2005
'spy Clay County
1H DWQ Project No. 050464
NCSR 1124 (Joe Moody Road)
APPROVAL of 401 Water Quality Certification with Additional Conditions
Mr. J. B. Setzer, P.E.
Division Engineer
N C Department of Transportation
253 Webster Road
Sylva, North Carolina 28779
Dear Mr. Setzer:
You have our approval, in accordance with the attached conditions and those listed below, to impact 10 linear feet of an
unnamed tributary of Long Branch (10 linear feet of new culvert), in order to make improvements to NCSR 1124 (Joe
Moody Road) in Clay County. The project should be constructed in accordance with your application dated March 10,
2005 (received March 14, 2005), including the environmental comments made in the application letter. After reviewing
your application, we have decided that this fill is covered by General Water Quality Certification No. 3404, corresponding
to the U.S. Army Corps of Engineers Nationwide Permit Number 14. In addition, you must acquire any other federal,
state or local permits before you proceed with your project including (but not limited to) Sediment and Erosion Control,
Non-Discharge and Water Supply Watershed regulations. This approval will expire with the accompanying 404 Permit
unless otherwise specified in the Water Quality Certification.
This approval is valid solely for the purpose and design described in your application (unless modified below). Should
your project change, you must notify the DWQ in writing and submit a new application. If the property is sold, the new
owner must be given a copy of this Certification and approval letter, and is thereby responsible for complying with all the
conditions. If total wetland fills for this project (now or in the future) exceed one acre, or 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 be valid, you niust.follow the conditions listed in the attached certification and any
additional conditions listed below.
1. Erosion and sediment control practices must be in full compliance with all specifications governing the proper design,
installation and operation and maintenance of such Best Management Practices in order to protect surface waters
standards:
a. The erosion and sediment control measures for the project must be designed, installed, operated, and
maintained in accordance with the most recent version of the North Carolina Sediment and Erosion Control
Planning and Design Manual.
b. 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
sites, and waste pile (spoil) projects, including contractor-owned or leased borrow pits associated with the
project.
c. 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 Sui face Mining Manual.
NhCarolina
oy`
North Carolina Division of Water Quality 2090 U.S. Ilighway 70 Swannanoa, NC 28778 Phone [phone] Customer Service
Intemet: h2o.encstate.nc.us FAX [phone]
An Equal Opportunity/Affirmative Action Employer
R
Mr. J. B. Setzer, P.E.
April 14, 2005
Page Two
d. Any reclamation measures and implementation must comply with the reclamation in accordance with the
requirements of the Sedimentation Pollution Control Act.
2. No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or riparian areas beyond the footprint of the
impacts depicted in the Preconstruction Notice Application. All construction activities, including the design,
installation, operation, and maintenance of sediment and erosion control Best Management Practices, shall be
performed so that no violations of state water quality standards, statutes, or rules occur.
3. 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 six months of the date that the Division of Land Quality has released the project.
4. The NCDOT shall use Best Management Practices for the Protection of Surface Waters (NCDOT August 2003) and
Sedimentation and Erosion Control Guidelines for Sensitive Watersheds [15A NCAC 4B .0124 (a)-(e)]. Measures
should be implemented prior to any ground disturbing activities to minimize impacts to downstream aquatic
resources. Temporary or permanent herbaceous vegetation should be planted on all bare soil within 10 days of
ground disturbing activities to provide long-term erosion control. Erosion control mating should be used in
conjunction with appropriate seeding on disturbed soils in steep slope and riparian areas. Matting should be secured
in place with stables or wherever possible, live stakes of native trees. 'fall fescue should not be used in riparian areas.
Riparian vegetation must be reestablished within the construction limits of the project by the end of the growing
season following completion of construction.
5. Culverts that are less than 48-inch in diameter should be buried to a depth equal to or greater than 20% of their size to
allow for aquatic life passage. Culverts that are 48-inch diameter or larger should be buried at least 12 inches below
the stream bottom to allow natural stream bottom material to become established in the culvert following installation
and to provide aquatic life passage during periods of low flow. This may require increasing the size of the culvert to
meet flow conveyance requirements. If any of the existing pipes are perched, they shall be removed and replaced, and
re-installed correctly, unless demonstrated that this is topographically unfeasible.
6. Rock check dams at culvert outlets should be removed at the project completion to avoid impeding the movement of
aquatic life.
7. The dimension, pattern and profile of the stream, above and below the culverts, should not be modified by widening
the stream channel or reducing the stream depth. Disturbed floodplains and streams should be restored to natural
geomorphic conditions.
8. Stormwater shall be directed to vegetated buffer areas, grass lined ditches or other means appropriate to the site for
the purpose of pre-treating stormwater runoff, and must not be routed directly into streams. Mowing of existing
vegetated buffers is strongly discouraged, so that they may be utilized for stormwater diffuse flow.
9. Removal of vegetation at the stream crossing and adjacent to streams should be minimized. Native trees and shrubs
(e.g. Rhododendron, dog hobble, willows, alders, sycamores, dogwoods, black walnut and red maple) should be
planted along the streambank to reestablish the riparian zone and to provide long-term erosion control in the vicinity
of the road crossing and along the streams within dedicated rights of way.
10. Any riprap placed for bank stabilization should be limited to the streambank below the high water mark, and
vegetation should be used for stabilization above the high water elevation. Riprap should not be place in stream
channels in such a manner that it impedes aquatic life passage.
11. Heavy equipment must be operated from the banks rather than in the stream channel in order to minimize
sedimentation and to reduce the likelihood of introducing other pollutants into the stream.
12. 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.
13. Excavation of the stream crossings and relocations should be conducted in the dry, if possible. Sandbags, cofferdams,
flexible pipe or other diversion structures should be used to minimize excavation in flowing water.
14. If concrete is used during culvert construction (e.g., headwalls), a dry work area should be maintained to prevent
direct contact between curing concrete and stream water. Water that inadvertently contacts uncured concrete should
not be discharged to surface waters due to the potential for fish kills.
15. Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or adjacent to surface waters is
strictly prohibited.
16. The presence of equipment in the channels must be minimized. Under no circumstances must rock, sand or other
materials be dredged from the wetted stream channel under authorization of this permit, except in the immediate
vicinity of the culverts. In-stream dredging has catastrophic effects on aquatic life, and disturbance of the natural
form of the stream channel will likely cause downstream erosion problems, possibly affecting other landowners.
Mr. J. B. Setzer, P.E.
April 14, 2005
Page Three
17. This certification does not authorize the discharge of waste rock and dirt into the stream or riparian zone except for
permitted areas associated with the culvert extensions.
18. All work shall be performed during low flow conditions (below bankfull).
19. Upon completion of the project, the NCDOT shall complete and return the enclosed "Certificate of Completion " form
to notify NCDWQ when all work included in the §401 Certification has been completed. The responsible party shall
complete the attached form and return it to the Transportation Permitting Unit of the NC Division of Water Quality
upon completion of the project. The NCDOT is strongly advised to send in photographs upstream and downstream of
each structure to document correct installation.
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, which 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 Mr. Mike Parker of the Asheville Regional Office at 828.296.4500.
Sincerely,

Alan W. Klimek, P.E.
Attachment
cc: Mark Davis, Division 14, DEO
Ed Ingle, Roadside Environmental
Angie Pennock, USACE Asheville Field Office
Transportation Permitting Unit
Mike Parker, Asheville Regional Office

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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY March 10, 2005
GOVERNOR
Ms. Angie Pennock, NCDOT Regulatory Project Manager
U.S. Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, NC 28801-2714
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SECRETARY
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Subject: Nationwide 14 Permit Application
SR 1124, Joe Moody Road
Clay County
WBS Element 14C.022016 (DWQ Minor Permit Fee $200)
Dear Mr. Hendrix:
The North Carolina Department of Transportation (NCDOT) is proposing to widen, grade, and
pave SR 1124, Joe Moody Road, in Clay County. There is one jurisdictional site along this
section of roadway where right-of-way is now available. Funds have been allocated for this
project, and NCDOT would like to perform these activities sometime during the 2005 paving
season.
I am sending drawings for pipe culvert replacements as well as a marked county map and USGS.
quad map. We propose to install the new culverts slightly below the existing streambed
elevations where bedrock is not encountered to minimize impacts to aquatic habitats and allow
the existing stream gradients to remain as unchanged as physically possible. `
The North Carolina Natural Database was checked for records of threatened and endangered :e- w
species. There are no records for threatened and endangered species listed for the Long Branch ?
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watershed. Additionally, there are no records for the adjacent watersheds, Walker Branch and ?- U
Webb Creek. The unnamed tributary is small and is not of sufficient size to support fish or °?- C)=
freshwater mussels. The impact from this culvert extension will be minimal. For these reasons,
this project will have "no effect" on threatened and endangered species.
If the State Historic Preservation Office (SHPO) and the Office of State Archaeology determines
that further investigations are required, NCDOT will conduct the appropriate site investigations
and obtain compliance from SHPO prior to project construction.
The best management practices will be used to minimize and control sedimentation and erosion
on this project. The construction foreman will review all erosion control measures daily to
ensure sedimentation and erosion is being effectively controlled. If the planned devices are not
functioning as intended, they will be immediately replaced with better devices.
Andrews District Office
191 Robbinsville Road, Andrews, N. C. 28901
Phone: [phone]
Fax: [phone]
/•
Impacts to Waters of the United States
The unnamed tributary has perennial flow. The channel is composed of sand and gravel and
lacks vegetation. Therefore, we believe the unnamed tributary is under the jurisdictional
authority of the U.S. Army Corps of Engineers. In order to construct the project in accordance
with our current secondary road standards, it will be necessary to impact waters of the United
States in the Hiwassee River Basin. Specifically, NCDOT is requesting to replace one metal
culvert in an unnamed tributary to Long Branch (WS-IV). Listed below is a summary of the
proposed impacts.
Site No. Existing Proposed Net Impacts
Station Condition Condition
Site 1 35' x 24" CMP 45' x 36" CMP 10'
22+07
10 linear feet total
Permits Requested
NCDOT is hereby requesting authorization under Section 404 of the Clean Water Act to proceed
with the construction project outlined above. By copy of this letter, I am asking Mr. David
McHenry, Mountain Region Coordinator, of the North Carolina Wildlife Resources Commission
(NCWRC) to comment directly to you concerning the 404 Nationwide Permit request.
Also, by copy of this letter, I am requesting authorization under Section 401 of the Clean Water
Act from the North Carolina Department of Environment and Natural Resources (DENR),
Division of Water Quality (DWQ). In addition, I am asking Mr. McHenry and Mr. Ed Ingle,
Roadside Environmental Field Operations Engineer (NCDOT), to comment directly to me
concerning this permit request.
If you have any questions or need additional information, please contact me at [phone].
Your early review and consideration will be greatly appreciated.
Sincerely, 1
Joshua B. Deyton
County Maintenance Engineer
cc: Mr. John Hennessy, DWQ, DENR, Raleigh (seven copies)
Mr. David McHenry, Mountain Region Coordinator, NCWRC
Mr. Mike Parker, NCDOT Coordinator, DWQ, DENR
Mr. J.B. Setzer, P.E., Division Engineer, NCDOT
Mr. Mark Davis, Division Environmental Officer, NCDOT
Mr. E. L. Ingle, Roadside Environmental Field Operations Engineer, NCDOT

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Pre-Construction Notification (PCN) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401 General Water Quality
Certifications, and Riparian Buffer and Watershed Buffer Rules
SR 1124, Joe Moody Rd., Clay County
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NCDOT Division 14, District III
Prepared by: Joshua B. Deyton
County Maintenance Engineer
Clay and Macon Counties
Page I of 10
;:. Form Version May 2002
USACE Action ID No. DWQ NP 5 0 4 6 4
kiI niiy Naiucuiui Rriu IS f4Vl dppnCaoie to finis project, please enter "Not Applicable" or "N/A".)
1. Processing
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:
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 Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts (verify availability with NCEEP 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: ?
II. Applicant Information
Owner/Applicant Information
Name: North Carolina Department of Transportation (NCDOT)
Mailing Address: 191 Robbinsville Road
Andrews, NC 28901
Telephone Number: 828.321.4105 Fax Number: 828.321.3228
E-mail Address: ibdeytonndot.state. nc.us
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: Joshua B. Deyton
Company Affiliation:_ County Maintenance Engineer
Mailing Address: (same as above)
Telephone Number: Fax Number:
E-mail Address:
Page 2 of 10
111. ProProject 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: Joe Moody Rd., SR 1124
2. T.I.P. Project Number or State Project Number (NCDOT Only): 14C.022016
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Clay Nearest Town: I-Iayesville
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): From Hayesville. take US 64
west for approximately 0.7 miles to SR 1100, Old US 64 "Turn left onto Old US 64 Take.
Old US 64 approximately 3.64 miles to SR 1125 Turn right on SR 1125 Take SR 1125
approximately 0.6 miles to SR 1 124 Turn right on SR 1 124
5. Site coordinates, if available (UTM or Lat/Long): Site 1 - 35.0253° N 83.8867° W
6. _
(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.)
7. Property size (acres): 3.16
8. Nearest body of water (stream/river/sound/ocean/lake): UT To Long Branch (Class IV)
9. River Basin: Hiawassee
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at littp:Hli2o.enr.state.nc.us/admin/maps/.)
10. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: forest, pasture light residential
Page 3 of 10
11. Describe the overall project in detail, including the type of equipment to be used: Clearing,
grubbing widening grading drainage and paving. Equipment to be used: Hydraulic
excavator, crawler tractor, backhoe loader, motor grader, wheel loader, vibratory roller, and
dump trucks.
12. Explain the purpose of the proposed work: Construct road to current NCDOT secondary
road standards
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 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
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
Page 4 of 10
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.
i . Provide a written description of the proposed impacts: A culvert extension will be
necessary to complete the proiect and will impact 10 feet of additional stream channel
2. Individually list wetland impacts below:
Wetland Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(es/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
N/A

eac......... Mepiuitteiy anu iucnury 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 1-800-358-9616, or
online at http:/hvww.fema.eov.
*** 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
Total area of wetland impact proposed: N/A
3. Individually list all intermittent and perennial stream impacts below:
N/A
Stream Impact
Site Number
(indicate on ma)
Type of Impact* Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
(please secif
Site #I Calvert 10 feet UT of Long Branch 2' P

* t ct rr, ..I. .-A :J_ :C.
-, 1-p- ??paia«ly aJIU rocntuy 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
Page 5 of 10
www.uses.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.coin,
www.niapguest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 10
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number

(indicate on ma
Type of Impact* Area of
Impact

acres

at
(if Name applicable) W Type of Waterbody

(lake, pond, estuary, sound,
bay, ocean, etc.
N/A

-1F-'1-Y-'- w-uwy Lc111NvIaIy uupucts. Impacts Include, out are not Ilmltetl to: till, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): N/A
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.
Minimal lengths of pipe were used to achieve the minimum design widths for secondary
Roadways in NC. We are proposing to install the new pipes slightly below the existing
streambed to allow for fish/aquatic life passage
Page 6 of 10
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 NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.ne.us/ncwetIands/strmPide 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 (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.
N/A
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCEEP, check the NCEEP website at http://www.nceep.net. If use of the NCEEP is
proposed, please check the appropriate box on page three and provide the following
information:
Page 7 of 10
Amount of stream mitigation requested (linear feet): 10
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) 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 213 .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify N/A )?
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
(square feet Multiplier Required
Mitigation
1 3
2 1.5
Page 8of10
Total
* Zone I 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.
N/A
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.
The existing compacted gravel roadway acts as an impervious surface Paving of the roadway
should eliminate sedimentation from fines associated with gravel surface treatment The
roadway surface will be approximately 40% of the right-of-way area Stormwater will be
diverted through settling basins lined with filtering stone or grass lined buffers prior to entering
streams. (See erosion control plan)
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
N/A
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
XIV. 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).
1-1
Joshua B. Denton 3/10/05
Page 9 of 10
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 10 of 10

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