20040412 Ver 1_Complete File_20040317

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April 27, 2004
Halifax County
DWQ Project No. 040412
APPROVAL of 401 Water Quality Certification
Mr. Anthony W. Roper, P.E., Acting Division Engineer
NCDOT, Division 4
PO Box 3165
Wilson, NC 27895-3165
Dear Mr. Roper:
You have our approval, in accordance with the attached conditions and those listed below, to place fill material in 52
linear feet of streams, and 15,390 square feet (9487 square feet in Zone 1 and 5903 square feet in Zone 2) of
protected Tar-Pamlico River Riparian Buffers for the purpose of widening and improving SR 1515 in Edgecombe
County. The project shall be constructed in accordance with your application dated received March 17, 2004. After
reviewing your application, we have decided that this fill is covered by General Water Quality Certification Number
3404. This certification corresponds to the Nationwide Permit 14 issued by the Corps of Engineers. This approval
is also valid for the Tar-Pamlico River Buffer Rules (15A NCAC 2B .0259). In addition, you should acquire any
other federal, state or local permits before you proceed with your project including (but not limited to) Sediment and
Erosion Control, Non-Discharge and Water Supply Watershed regulations. This approval will expire with the
accompanying 404 permit, unless otherwise specified in the Water Quality Certification.
This approval is valid solely for the purpose and design described in your application (unless modified below).
Should your project change, you must notify the DWQ and submit a new application. If the property is sold, the
new owner must be given a copy of this Certification and approval letter, and is thereby responsible for complying
with all the conditions. If total wetland fills for this project (now or in the future) exceed one acre, or of total
impacts to streams (now or in the future) exceed 150 linear feet, compensatory mitigation may be required as
described in 15A NCAC 2H.0506 (h) (6) and (7). For this approval to remain valid, you must adhere to the
conditions listed in the attached certification.
1.) Upon completion of the project, the NCDOT shall complete and return the enclosed "Certification of
Completion Form" to notify DWQ when all work included in the 401 Certification has been completed. The
responsible party shall complete the attached form and return it to the 401/Wetlands Unit of the Division of
Water Quality upon completion of the project.
2.) All stormwater runoff shall be directed to sheetflow through stream buffers at nonerosive velocities, unless
approved otherwise by this certification.
3.) During the construction of the project, no staging of equipment of any kind is permitted in waters of the U.S., or
protected riparian buffers.
4.) Riparian vegetation must be reestablished within the construction limits of the project by the end of the growing
season following completion of construction.
5.) The dimension, pattern and profile of the stream above and below the crossing should not be modified by
widening the stream channel or reducing the depth of the stream. Disturbed floodplains and streams should be
restored to natural geomorphic conditions.

William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
N. C. Division of Water Quality 1650 Mail Service Center Raleigh, NC 27699-1650 [phone]
Customer Service: 1 800 623-7748
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6.) Any riprap used must not interfere with thalweg performance and aquatic life passage during low flow
conditions.
7.) All mechanized equipment operated near surface waters must be regularly inspected and maintained to prevent
contamination of stream waters from fuels, lubricants, hydraulic fluids, or other toxic materials.
8.) Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or adjacent to surface
waters is prohibited.
9.) The outside buffer, wetland or water boundary as well as along the construction corridor within these
boundaries approved under this authorization shall be clearly marked by orange fabric fencing for the areas that
have been approved to infringe within the buffer, wetland or water prior to any land disturbing activities.
10.) There shall be no excavation from or waste disposal into jurisdictional wetlands or waters associated with this
permit without appropriate modification of this permit. Should waste or borrow sites be located in wetlands or
stream, compensatory mitigation will be required since it is a direct impact from road construction activities.
11.) Pursuant to NCACI5A 2B.0233(6), sediment and erosion control devices shall not be placed in Zone 1 of any
Neuse Buffer without prior approval by the NCDWQ. At this time, the NCDWQ has approved no sediment and
erosion control devices in Zone 1 anywhere on this project. Moreover, sediment and erosion control devices
shall be allowed in Zone 2 of the buffers provided that Zone 1 is not compromised and that discharge is released
as diffuse flow.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must
act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition that conforms
to Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, P.O. Box 27447,
Raleigh, N.C. 27611-7447. This certification and its conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If you
have any questions, please contact John Hennessy at 919-733-5694.
cer y,
Alan W. Klimek, P.E._'::?i -
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Raleigh Field Office
DWQ Raleigh Regional Office
File Copy
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
c:\ncdot\SR 1515\wqc\040412 wgc.doc
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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLIiy LYNDO TIPPETT
'
GOVF.RNOR Sr.CRI?TARP
October 3v, 2003 X(-V- /
Mr. Mike Bell
U.S. Army Corps of Engineers
Washington Regulatory Field Office
Post Office Box 1000
Washington, North Carolina 27889-1000
(One Copy)
Mr. John Hennessy
Wetlands/401 Unit
NC DENR Division of Water Quality
1650 Mail Service Center
Raleigh, NC 27699
(Seven Copies)
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Subject: Secondary road improvements to SR 1515 from intersection with SR 1514 to
NC 33 in Edgecombe County. (it/ / L1
State Project No. 4C.033019 DWQ Buffer Authorization Request 4 Z C-D
The North Carolina Department of Transportation (NCDOT) proposes to upgrade to
Secondary road improvements to SR 1515 from 1515 from intersection with SR 1514 to
NC 33 in Edgecombe County. SR 1515 is an unpaved roadway that will be upgraded to a
paved roadway. Total project length is 2.18 miles.
Transportation and highway laws of North Carolina (G.S. 136-44.6, 136-44.7, 136-
44.7A, 136-44.8, and 136-44.9) require the NCDOT to develop annual work programs
for construction and maintenance of secondary roads. These general statutes specifically
set forth requirements for annual construction and paving of existing unpaved roads.
Paving of these roads is performed in priority order as established by the NCDOT for
each unpaved road within a given county. This number is based on characteristics of
each road, including number of homes, schools, churches, businesses, industries,
recreational facilities, traffic counts, presence of school bus routes, and value as a
thoroughfare. SR 1515 is scheduled to be paved in the 2003-2004 Secondary Roads
Construction Program
Post Office Box 3165, Wilson, North Carolina 27895-3165
Phone [phone] Fax [phone]

Impacts to Waters of the United States
Notification of the use of a NWP to the USACE to cover this project may not be required
as no wetlands will be impacted and stream impacts total 52 feet at the four crossings. A
copy is being provided so the Corp can track the impacts. Construction of the project
will necessitate minor impacts to waters of the United States and buffers in the Tar River
Basin. The project crosses four unnamed intermittent tributaries to the Tar River.
Impacts to the streams and buffers result from culvert replacement. The subject road will
be closed during construction and a temporary detour using existing roads will be
provided. The three pipe replacements listed below will impact a total 52 feet of stream
channel, due to minimal increases in the length of the proposed pipes required for the
calculated runoff.
LOCATION
Station EXISTING
Diameter in. EXISTING
Length ft. PROPOSED
Diameter in. PROPOSED
Len h (ft.
4+63-L- 18 40 24 56
33+63-L- 18 40 18 52
51+27-L- 36 48 42 60
95+15-L- 24 40 30 52
No impacts to wetlands are anticipated due to the subject project.
Waters of the U.S. Mitigation
Avoidance:
All wetlands or surface waters not affected by the project will be protected from
unnecessary encroachment. No staging of construction equipment or storage of
construction supplies will be allowed in or near wetlands or surface waters.
Minimization:
Strict enforcement of sedimentation and erosion control Best Management Practices for
the protection of wetlands and surface waters will be enforced during project
construction. Continued coordination will occur with maintenance forces and the
Environmental Officer during construction to minimize impacts to waters of the U.S. at
these sites.
Compensatory Mitigation:
Construction of the project will result in impacts to 521. f. of waters of the U.S at four
crossings. Impacts have been minimized to the maximum extent possible during the
design process. No compensatory mitigation is proposed.
Riparian Buffer Impacts
The construction of the project involves four road crossings of streams that are located
within the Tar River Basin and therefore is subject to Riparian Buffer Rules. Efforts will
be made to minimize the impacts of storm water by the installation of appropriate best
management practices for sediment and erosion control to maximize diffuse flow through
the buffer. Whenever possible, any temporary sediment control devices will be installed
outside the buffer or confined to Zone 2 and the existing ditches will not be deepened but
the banks will be graded to allow for stable vegetation. Any exposed areas within the
buffer will be immediately stabilized with seeding and excelsior matting where needed to
establish a stable grassed swale. Operating the equipment used to perform the pipe
replacement can disturb the existing vegetation within the buffer and sometimes expose
bare soil. Road crossings that impact less than or equal to 40 If are exempt uses.
Temporary stormwater measures are allowable uses. No mitigation is proposed but
measures will be taken to minimize buffer impacts. Impacts from exempt and allowable
uses may total 9487 sf in Zone 1 and 5903 sf in Zone 2.
Regulatory Review
The subject project has been reviewed by the Office of Human Environment within
NCDOT and has found that the project will not effect any National Register or Study-
listed properties within the subject projects Area of Potential Effects.
The subject project has been reviewed by the Environmental Officer for the presence of
listed threatened and endangered species. No element occurrences of protected species
are listed within a mile downstream of any of the crossings. The subject project has been
determined to have no effect on any listed threatened or endangered plant or animal
species.
Permit Issues
The construction of the project may be authorized under Section 404 Nationwide Permit
(NWP) 14, Linear Transportation Crossings. Notification for the use of this NWP to the
USACE is provided for this project, as a courtesy to the USACE as no wetlands will be
impacted and stream impacts total 52 feet at the four crossings. Although one of the
tributaries is listed as WS IV, NSW written Authorization from the North Carolina
Division of Water Quality (NCDWQ) for Section 401 Water Quality Certification
(WQC) No. 3404 is presumably not needed as the tributary is shown as intermittent on
the most recent topo quad. We do request written Buffer Authorization for expected
buffer impacts. NCDOT will comply with all conditions associated with this NWP and
WQC and buffer rules.
Summary
NCDOT proposes to upgrade and pave SR 1515 in Edgecombe County. The four
proposed pipe replacements/extensions will impact a total of 52 linear feet of existing
channel. No wetland impacts are anticipated as a result of the subject project. The
project is located in the Tar River Basin, which currently has riparian buffer regulations
in effect. Impacts from exempt and allowable uses may total 9487 sf in Zone 1 and 5903
sf in Zone 2. The NCDOT asks for written authorization for buffer impacts. The
NCDOT will adhere to all applicable conditions for NWP 14 and WQC 3404. If you
have any questions or need additional information, please contact James Sherri at (252)
237-6164.
Sincerely,
"6R? Iwo,
Anthony Roper, P.E.
Acting Division Engineer
cc: Mr. David Franklin, USAGE, Wilmington
Mr. Travis Wilson, NCWRC, Creedmoor
Mr. Garland Pardue, USFWS, Raleigh
Mr. Bryant Bunn, P.E., NCDOT Division Maintenance Engineer
Mr. R. L. Keeter jr. P.E., NCDOT District Engineer
Mr. James Shern, NCDOT Division Environmental Officer
Office Use Only:
USACE Action ID No.
DWQ No.
Form Version (k-tuber 2001
040412
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
I. Processing
1. Check all of the approval(s) requested for this project:
? Section 404 Permit
? Section 10 Permit
? 401 Water Quality Certification
® Riparian or Watershed Buffer Rules p - Z_
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 14, 33
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
11. Applicant Information
1. Owner/Applicant Information
Name: Mr. Anthony W Roper P E , Acting` Division Engineer
Mailing Address: North Carolina Department of Transportation/Division 4
- - - - - P.O.-Box 3165 -- -- -- - - - - - - ---- -
Wilson. NC 27895-3165
Telephone Number: _ 252 237-6164 Fax Number: _--(252 234-617.4___
E-mail Address:-- aroRerta)dot.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: Mr. James Shem
Company Affiliation: Division Environmental Officer
Mailing Address: North Carolina Department of Transportation/Division 4
- - P- O. Box 3165 ---
Wilson NC 27895-3165
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: ifshernL&dot state nc us
Page 5 of 12
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: SR 1515
2. T.I.P. Project Number or State Project Number (NCDOT Only): 4C.033019
3. Property Identification Number (Tax PIN): NA
4. Location
County: Edgecombe Nearest Town: Tarboro
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): Take NC 33 North from Tarboro,
after 1.1 miles, turn right onto SR 1515.
5. Site coordinates, if available (UTM and Lat/L.ong):Tarboro Quad Map: UTM 18 269668E
3980014N 35.9392N 77.5533W, 18 270489E 3980326N 35.9422N 77.5443W; 18 270815E
3980724N 35.9485N 77.5408W, 18 270632E 3981784N 35.9553N 77.5432W
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application: Rural,
timber agricultural
7. Property size (acres): NA
8. Nearest body of water (stream/river/sound/ocean/lake):-----UT to Tar River (DWO ID 28-74
WS-1V), UT to Fishing Creek_(DW ID #28-79-30.5 _WS_-N) 9. River Basin: Tar/Pamlico River
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.ear.state.nc.us/admin/maps/.)
Page 6 of 12
10. Describe the purpose of the proposed work: Paving a secondary road and erosion control
to bring existing gravel road in compliance with standard safety design specifications.
11. List the type of equipment to be used to construct the project: Construction equipment
(backhoe excavator, dump truck bulldozer, grader)
12. Describe the land use in the vicinity of this project: Rural timber & agricultural
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:
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.
Page 7 of 12
1. Wetland Impacts
Wetland Impact Area of Located within Distance to
Site Number Type of Impact* Impact 100-year Floodplain** Nearest Stream 'type of Wetland***
indicate on ma acres es/no linear fee
NA
* List each impact separately and identify temporary impacts. Impacts include, but arc 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 F'EMA Map Service Center at 1-800-358-9616, or
online at hltp://www.fernagov.
*** List a wetland type that best describes wetland to be impacted freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: NA
Total area of wetland impact proposed: NA
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact Length of Average Width Perennial or
Site Number Type of Impact* Impact Stream Name" of Stream Intermittent'?
indicate on ma linear feet Before Impact leasespecify)
4+63 -L- 24" RCP 16 UT to Tar River 6 feet Intermittent
33+63-1- 18" RCP 12 UT to Tar River 6 feet Intermittent
51+27 -L- 2 x 42" CMP 12 UT to Tar River 14 feet Intermittent
95+15 -L- 30" RCP 12 (If to Fishing Creek 5 feet Intermittent
" 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.ussts.kov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.t(ipozone.com,
www.mapquest.ann, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 52
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact Area of Name of Waterbod
y Type of Waterbody
Site Number Type of Impact* Impact (if applicable) (lake, pond, estuary, sound,
indicate on ma acres bay, ocean, etc,
NA
* Fist each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
Page 8 of 12
4. Pond Creation
if construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): NA
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): NA
Size of watershed draining to pond: NA Expected pond surface area: NA
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
All wetlands or surface waters not affected by the project will be protected from unnecessary
encroachment No staging of construction equipment will be allowed in or near wetlands or
waters of the U.S. Strict enforcement of sedimentation and erosion control Best Management
Practices for the protection of wetlands and surface waters will be enforced during project
construction
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 9 of 12
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/strm,gide.htmi.
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.
NA
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at http://h2o.enr.state.tic.us/wrp/index.litn,. 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): NA
Amount of buffer mitigation requested (square feet): NA
Amount of Riparian wetland mitigation requested (acres): NA
Amount of Non-riparian wetland mitigation requested (acres): NA
Amount of Coastal wetland mitigation requested (acres): NA
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
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 ® Minimum Criteria applies
Page 10 of 12
If yes, has the document review been finalized by the State Clearinghouse'? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X.
Proposed impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Yes ® No ? If you answered "yes", provide the following information:
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
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.
%one* Impact Multiplic7 Required
(square feet Miti ation
1 9487 3
2 5903 1.5
Total
• "Lone 1 extends out 30 feet perpendicular from near bank of channel Zone 2 extends an
additional 20 feet ITom the edge of Lone 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 213.0242 or.0260.
Operating ....the equipment used to perform the pipe replacement can disturb the existinr;
vegetation within the buffer and sometimes expose bare soil Road crossings that impact less
than or equal to 40 if are exempt uses Temporvy stormwater measures are allowable uses. No
mitigation is proposed but measures will be taken to minimize buffer impacts
Page 11 of 12
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
No increase in impervious surface is proposed All appropriate best management practices for
sediment and erosion control will be implemented during pine replacements.
XII. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
NA
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12

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