20070804 Ver 1_Application_20070510

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STATE OF NORTH CAROLINA
MICHAEL F. EASLEY
GOVERNOR
Ms. Sonia Gregory
NCDWQ
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
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DEPARTMENT OF TRANSPORTATION
DIVISION OF HIGHWAYS
May 8, 2007
Subject: Nationwide Permit #14
SR-2112 (Bethel Church Rd) Randolph County
Project # 8C.076101(DWQ Permit Fee $200)
Ms. Gregory:
LYNDO TIPPETT
SECRETARY
o~oso4
The North Carolina Department of Transportation, Highway Division 8 is requesting Nationwide
Permit Number 14, and the associated 401 Water Quality Certification for project # 8C.076101 op'SR3~li2
(Bethel Church Rd.) in Randolph County. The proposed project will replace an existing deficient crossing pipe as
follows: ~
Site 1-Replace existing 18"x 28' RCP with a 30"x 40' RCP. J
This pipe is being replaced in anticipation of a scheduled grading and paving project on a previously unimproved
road. The amount of pipe length increase (i28.) is needed to accommodate the widening of the roadbed. The total
percentage of impervious surface within the project area will-remain at less than 30%. All erosion c~ntroi devices
used on the project will be appropriate to the location and in compliance with the current version oft e NCDOT
Best Management Practices manual. There is a small wetland area adjacent to the site. Richard Spencer of the
USCOE conducted a jurisdictional determination site visit. Mr. Spencer determined that the plans as presented
would avoid any wetland impacts. The crossing is located on an Unnamed Tributary of Little Polecat Creek a class
WS-III; HQW stream (at this location) within the Cape Fear River basin. If any dewatering is required at this site
it will be done with the use of moveable devices (pre-cast concrete barriers or sheet metal piles). Construction will
be done under dry conditions whenever possible.
There were no threatened or endangered species observed within the project area during the required minimum
criteria check. The detour will be done off-site using existing state roads.
If you require any additional information, please contact me.
cc: Tim Johnson, PE
R J. Monroe
Barry Harrington
Sinc ly,
~~
Art C. King
Division Environmental Officer
Highway Division 8
P.O. BOX 1067, ABERDEEN NORTH CAROLINA 28315
PHONE [phone] FAX [phone]

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0 0.1 0.2 0.3 0.4 0.5 km G
0 0.09 0.18 0.27 0.35 6.45 mi
35.8789°N, 79.7049°W (NAD83/WGS$4)
Bethel Church, USGS Climax (NC) Quadrangle M=-8.111
Projection is UTM Zone 17 NAD83 Datum G=0 , 759
http://www.topozone.com/print.asp?lat=3 5.8789&lon=-79.7049&s=24&size=l&u=5&layer--DRG&datu..
Page 1 of 1
4/25/2007

Office Use Only: Form Version March OS
USACE Action ID No. DWQ No. 2 0 ~ 7 ~ 8 ~ 4
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. Processing
1. Check all of the approval(s) requested for this project:
X Section 404 Permit ^ Riparian or Watershed Buffer Rules
^ Section 10 Permit ^ Isolated Wetland Permit from DWQ
X 401 Water Quality Certification ^ Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NW #14
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 Cazolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: ^
S. If your project is located in any of North Cazolina'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
Mailing Address: Timothy Johnson, P.E., Division Engineer
North Carolina Department of Transportation, Division 8
P.O. Box 1067
Aberdeen, North Carolina 28315
Telephone Number: 910-944-2344 Fax Number: 910-944-5623
E-mail Address: tjohnson ,dot.state.nc.us
2. Agent/Consultant 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: R.J. Monroe
Company Affiliation: North Carolina Department of Transportation
Mailing Address: 126 DOT Drive
Asheboro. N.C. 27205
Telephone Number: 336-625-2078 Fax Number: 336-625-0146
E-mail Address: jmonroe ,dot.state.nc.us
Updated 11/1/2005
Page 5 of 12

III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmazks 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 cleazly 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 2112 (Bethel Church Rd)
2. T.LP. Project Number or State Project Number (NCDOT Only): 8C.076101
3. Property Identification Number (Tax P1I~: N/A
4. Location
County: Randolph Nearest Town: Asheboro. N.C.
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers/names, landmarks, etc.): From Randleman take US
220 Business north to SR 2116 (New Salem Rd) -turn right travel 6.5 miles to SR 2112
(Bethel Ch Rd) on left
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum): 35.8789 °N 79.7049 °W
6. Property size (acres): N/A Stream Crossing
7. Name of nearest receiving body of water: Polecat Creek
8. River Basin: Cape Fear
(Note -this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h?o.enr.state.nc.us;adinin/maps;'.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Secondary road pipe crossing in a ruraU agricultural area
updaua i vtnoos
Page 6 of 12

10. Describe the overall project in detail, including the type of equipment to be used:, Grade,
Drain, Base. Pave and Erosion Control on SR 2112 utilizing Dozer. Pan, Backhoe Motor
Grader and Compactor
11. Explain the purpose of the proposed work: Pipe replacement and upgrade in conjunction with
Secondary Road Improvement Project
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. N/A
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.
N/A
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should 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: Replace existing 28 feet of 18 inch
concrete pipe with 40 feet of 30 inch reinforced concrete pike.
Updated 11/1/2005
Page 7 of 12

2. Individually list wetland impacts. Types of 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.
Wetland Impact
Site Number

(indicate on map)
Type of Impact Type of Wetland
(e.g., forested, marsh,

herbaceous, bog, etc.) Located within
100-year
Floodplain
es/no Distance to
Nearest
Stream
linear feet) Area of
Impact
(acres)
N/A

Total Wetland Impact (acres)
3. List the total acreage (estimated) of all existing wetlands on the property: N/A
4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, 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. To calculate acrea e, multi 1 len h X width, then divide b 43,560.
Stream Impact
Number
indicate on ma
Stream Name
Type of Impact
perennial or
Intermittent? Average
Stream Width
Before Im act Impact
Len th
linear feet Area of
Im act
aces
1 UT of Polecat
creek perm pipe I 1_2> 12' 0.001

Total Stream Impact (by length and acreage) 12' 0.001
5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, dredging, flooding, drainage, bulkheads, etc.
Open Water Impact
Site Number
indicate on ma
Name of Waterbody
(if applicable)
Type of Impact Type of Waterbody
(lake, pond, estuary, sound, bay,
ocean, etc. Area of
Impact
(acres

Total Open Water Impact (acres) N/A
Updated 1111 /2005
Page 8 of 12

6. List the cumulative im act to all Waters of the U.S. resultin from the ro'ect:
Stream Im act (acres): 0.001
Wetland Im act (acres): N/A
O en Water Im act acres): N/A
Total Im act to Waters of the U.S. (acres) N/A
Total Stream Impact (linear feet): 40
7. Isolated Waters
Do any isolated waters exist on the property? ^ Yes X No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.
8. 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.):
Current land use in the vicinity of the pond:
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
fmancial 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.N/A
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.
Updated 11/1/2005
Page 9 of 12

USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on January 15, 2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment aze 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
httpa/h?o.enr.state.nc.us/ucwetlands/strmaide.htnll.
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 sepazate 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 written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at htt~:!/h?o.enr. state.nc.us,!wrp/index.htut. If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:
Amount of stream mitigation requested (linear feet): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Ripazian wetland mitigation requested (acres): N/A
Amount ofNon-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
IX. Environmental Documentation (required by DWQ)
Updated 11/1/2005
Page 10 of 12

1. Does the project involve an expenditure of public (federaUstate/local) funds or the use of
public (federaUstate) land? Yes ® No
2. 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
3. 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 ripazian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Taz-Pamlico), ISA NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify )? Yes ^ No X
2. If "yes", 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 Multiplier Required
(square feet) Mitieation
3 (2 for Catawba)
1.5
Total
* Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration /Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within I SA NCAC 2B .0242 or .0244, or .0260. N/A
Updated 11/1/2005
Page 11 of 12

XI. Stormwater (required by DWQ)
Describe impervious acreage (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. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. Erosion Control Devices appropriate to the site
will be utilized on this project which mawinclude silt fences check dams and storm water
retaining basins. Asphalt pavement width of 20ft. within a 60ft right of way will equa133 3% of
impervious surface upon completion of yroject
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-dischazge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ^ No X
Isthis anafter-the-fact permit application? Yes ^ No X
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact neazby downstream water quality? Yes ^ No X
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
http:/;h2o.enr.state.nc.us!nc~~~etlands. If no, please provide a short narrative description: This
proiect is to unarade and pave an existing state maintained road
XV. 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/Age s Si a ure Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Updated 11/1/2005
Page 12 of 12

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TE~IPOR.-~R`c' DIVERSION DESIGti
ENERGY` DISSIP.-TER 4
?RIOT TO SCALE
CONCRET- ~Rlr? OR
STEEL ~'r.~=- , SUNG
NOTES:
1.) L~iSTALL TEMPORARY BER.biS, DIVERT STREA.I~f
FLAW BY PUMPING WATER AR0U1~ID
WORK AREA.
2.) PUMP C0NTAI111~FD AREA TO SILT BAG
A.tiD REiiOVE EXISTING PIPE f7 I~ADWALLS.
3.) L'~ISTALL PIPE AND BACKl~TLL
4.) BEHOVE TEMPORARY DIVERSION DEVICES
1
I
I
CONCRETE ~~RRER OR
~ STEEL S~~_T , .LING
I
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http://www.topozone.com/print.asp?lat=3 5.8789&lon=-79.7049&s=24&size=l&u=5 &layer=DRG&datu... 4/25/2007