20210672 Ver 1_14C 088085.TroutNotificationForm_20210615

State of North Carolina 
Department of Environmental Quality 
  Division of Water Resources 

15A NCAC 02H .0506(b)(4) Water Quality Certification,  
Notification of Work in Trout Watersheds 
FORM:  TroutWS 11‐2017 

Water Resources
Environmental Quality
Notification of Work in Trout Watersheds Form
A. Applicant Information
1. Processing
1a. Specify Nationwide Permit (NWP) number: 3 or General Permit (GP) number: 4132
1b. Has the NWP or GP number been verified by the Corps? Yes x No
1c. Does the project meet all the Conditions of the applicable Water Quality
Certification x Yes No
Please note that your project may be subject to the Sediment and Erosion Control Program and/or Trout Buffers
implemented by the Division of Energy, Mineral, and Land Resources. Find more info at:
https://deq.nc.gov/about/divisions/energy-mineral-land-resources/erosion-sediment-control
2. Project Information
2a. Name of project: Kemp Road Widening and Paving
2b. County: Transylvania
2c. Nearest municipality / town: Pisgah Forest, NC
3. Owner Information
3a. Name(s) on Recorded Deed: NC DOT
3b. Responsible Party (for LLC if
applicable):
3c. Street address: 253 Webster Rd.
3d. City, state, zip: Sylva, NC 28779
3e. Telephone no.: 828-333-1188
3f. Email address: [e-mail]
4. Agent/Consultant Information (if applicable)
4a. Name:
4b. Business name
(if applicable):
4c. Telephone no.:
4d. Email address:
B. Project Information
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID):
1b. Site coordinates (in decimal degrees): Latitude: Longitude: -
(DD.DDDDDD) (-DD.DDDDDD)

2. Project Description
2a. Explain the purpose of the proposed project (continue on back):
To widen and pave Kemp Road in Pisgah Forest.

2b. Describe the overall project in detail, including the type of equipment to be used:
Please see above

C. Stream Impacts: Please list all proposed impacts to the stream
1a. Stream Name: Middle Prong, Glade Creek (C; Tr)
1b.
Type of impact

Average stream
width (linear feet)
Impact length
(linear feet)
Bank Stabilization - Sloping and Revegetating
x Bank Stabilization - Sloping and Riprap/Armoring 4 10
Bank Stabilization - Gabion Baskets / Retaining Wall
Culvert Installation Culvert Diameter: ______________
Temporary Impacts for required dewatering activities
Other (describe): ____________________________________________
1c. Comments:

NC Department of Transportation

Owner/Agent's Printed Name

Kevin H Barnett
_______________________________
Owner/Agent's Signature
(Agent's signature is valid only if an authorization letter from the owner is
provided.)

06/14/2021

Date

For non‐transportation projects send one (1) copy of the completed application to DWR: 

If sending via US Postal Service: If sending via delivery service (UPS, FedEx, etc.): 
NC DWR ‐ 401 & Buffer Permitting Branch 
1617 Mail Service Center 
Raleigh, NC 27699‐1617 
NC DWR ‐ 401 & Buffer Permitting Branch 
512 N. Salisbury Street 
Raleigh, NC 27604 

For transportation projects send one (1) copy of the completed application to DWR: 

If sending via US Postal Service: If sending via delivery service (UPS, FedEx, etc.): 
DWR ‐ Transportation Permitting Branch 
1617 Mail Service Center 
Raleigh, NC 27699‐1617 
DWR ‐ Transportation Permitting Branch 
512 N. Salisbury Street 
Raleigh, NC 27604