20041082 Ver 1_Application_20040713

0 ~(l 0 8 z-
WETLgNOS/40i rRC~UP
~V ~ ~ 3 2004
WATER QuAU~, sECrioN
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
GOVERNOR
July 12, 2004
U.S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls of the Neuse Road, Suite 120
Raleigh, NC 27609
Attention: Mr. Eric Alsmeyer
NCDOT Coordinator
LYNDO TIPPETT
SECRETARY
Subject: REVISED APPLICATION for secondary road improvements to
SR 1128 om Oakley Road) from SR 1129 (Frank Timberlake Road) to
end of pavement in Person County. WBS element SC.073015 for $200.00
401 WQC fee.
The North Carolina Department of Transportation (NCDOT) proposes to upgrade and
pave SR 1128 (Tom Oakley Road) from SR 1129 (Frank Timberlake Road) to end of
pavement in Person County (Figures 1-4). See Appendix One for photographs of each
site and Appendix Two for USACE Wetland Delineation forms/DWQ rating sheets.
Total project length is 0.75 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 1128 is scheduled to be paved in the 2004-2005
Secondary Roads Construction Program.
Impacts to Waters of the United States
Site 1 (27+36) -Waters of US
Construction at this site will impact an unnamed perennial tributary to the South Flat
River (NCDENR-DWQ Index No. 27-3-3, Best Usage Classification WS-III NSW)
(Figure 3) in the Neuse River Basin. The existing structure that conveys the creek is a
72-in corrugated metal pipe that is 30 feet long. (see Appendix One for Photos 1 and 2).
Division 5. 2612 N. Duke Street, Durham, NC 27704
Phone: [phone] Fax: [phone]

s
2
This pipe will not be replaced. However, twelve feet of pipe extensions will be added to
both the inlet and the outlet ends of the existing pipe. Permanent impacts at the site
associated with the pipe extensions and minimal amounts of rip rap to protect the
extensions include 441inear feet existing channel impacted. The Site 1 work zone will be
temporarily dewatered for approximately 5 days. This will involve the temporary
placement of impervious dikes in the creek at the upstream and downstream limits of
construction. The impervious dikes will be sheet piling, sandbags, or fabric and stone
depending upon site conditions and availability of materials during construction. Once
the stream has been dewatered, the pipe extensions will be positioned into place. To
maintain water flow during construction, water upstream of the impervious structure will
be temporarily pumped out and conveyed downstream of the impervious structure.
Temporary concurrent impacts to the stream from this activity will result in dewatering
44 linear feet of stream. The materials used for the impervious dikes will be removed
after construction.
Site 2 (39+98) -Waters of US
Construction at this site (Figure 4) will have no temporary or permanent surface water
impacts. However, fill within a herbaceous drainage way wetland is anticipated at this site.
An existing structure that conveys drainage waters through this wetland area will be
replaced. The existing structure is a 15-inch reinforced concrete pipe that is 28 feet long.
(see Appendix One for Photographs 3 and 4). The replacement structure is an 18-inch
reinforced concrete pipe that is 52 feet long. The fill associated with grading and reworking
of ditches within the proposed 60 ftright-of--way and rip rap used to protect the new structure
will result in 1,128ft` (<0.03 ac) of fill in this drainage way wetland system (see Appendix
Two for USAGE Wetland Delineation forms/DWQ rating sheets).
Riparian Buffer Impacts
Site 1 (27+36) -Buffers
The construction at this site involves a road crossing of a stream that is subject to the
Neuse Riparian Buffer Rule. The unnamed perennial tributary to the South Flat River at
Site 1 is depicted on the most recent version of the Timberlake (1981) topographic
quadrangle (Figure 1) and the Soil Survey of Person County (USDA-SCS, 1984)
(Figure 2). The NCDOT proposes to install temporary erosion and sediment control
devices in Zone 1 and Zone 2 of the riparian buffer. Specifically, the NCDOT will place
temporary rock silt checks (Type A) and temporary silt fence in Zone 1, with temporary
rock sediment dam, Type B in Zone 2. The temporary structures will be removed once
the vegetation has been established and then seeded with a seed mixture of fescue and
Bahia grass. Please note that the placement of these structures are within the
60 right-of-way width and their associated impacts total 1,529 square feet in Zone 1
and 1,008 square feet in Zone 2 (totaling 39 linear feet of riparian buffer impacts).
Based on the impacts to the riparian buffer at this site, this crossing is EXEMPT.
Site 2 (38+98) -Buffers
No surface water (only wetland) impacts are proposed at this site. Therefore, no impacts
to riparian buffers will occur at Site 2.

Project Study Area
SR 1128 Tom Oakley Road
Person County
Timberlake
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Project Study Area
SR 1128 Tom Oakley Road
Person County
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3
Waters of the U.S./Riparian Buffer Mitigation
Avoidance: All wetlands and 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 wetlands or near surface waters.
Minimization: The side slopes have been steepened to the extent possible at jurisdictional
sites. 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 these sites.
Compensatory Miti ag tion: Construction of the project will result in only minimal impacts
to waters of the United States. Impacts have been avoided and minimized to the
maximum extent possible during the design process. Due to minimal impacts,
compensatory mitigation for stream and buffer impacts will not be provided for this
project.
Protected Species
Plants and animals with federal classifications of Endangered, Threatened, Proposed
Endangered and Proposed Threatened are protected under provisions of Section 7 and
Section 9 of the ESA. As of January 29, 2003, there is one federally protected species
listed for Person County: dwarf wedgemussel (Alasmidonta heterodon). Based on a no
observation survey conducted on 06/17/04 by NCDOT biologists Neil Medlin,
Jared Gray, Jason Mays, and Mike Sanderson, a Biological Conclusion of No Effect-Not
Likely to Adversely Affect has been rendered for this species.
Historical Compliance
This project has been screened by all pertinent parties to ensure historic compliance.
Summary
NCDOT proposes to upgrade and pave SR 1128 (Tom Oakley Rd) in Person County. -
Impacts are proposed to Waters of the United States including surface water fill and fill
in wetlands. In addition impacts to the riparian buffers within the Neuse River Basin are
proposed. Application is hereby made for a Department of the Army Section 404
Nationwide Permit (NWP) 14, NWP 33, and NCDENR-DWQ Section 401 Water Quality
Certification (WQC) No. 3404 and WQC No. 3366 for above-described activities.
Application is also made for a Neuse Buffer Certification for impacts at Site 1.

4
An automated payment procedure has recently been implemented between the NCDOT
and NCDWQ. This procedure will enable the Division to apply for the 401 WQC without
submitting a check for this permit application. This new procedure will provide payment
to the NCDWQ by charging the permit application fee of $200.00 directly to the
appropriate NCDOT WBS element SC.073015. Apre-construction notification is
attached with this request. If you have any questions or need additional information,
please contact Ms. Heather Montague at [phone].
Sincer ly,
Jo G. Nance, P.E.
Division Engineer
cc: Mr. John Hennessy, NCDWQ
Mr. Battle Whitley, NCDOT
Mr. Billy Timberlake, NCDOT
Mr. Jeremy Goodwin, NCDOT

Office Use Only: Form Version May 20112
USACE Action ID No. DW No. ~ ~ ~~ ~ ~
Q
(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:
® 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: NWP 14, NWP 33, and
Neuse Buffer Certification.
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 (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ^
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ^
II. Applicant Information
Owner/Applicant Information
Name: NCDOT Division 5 Jon G. Nance
Mailing Address: 2612 N. Duke St. Durham, NC 27704
Telephone Number:~919) 560-6851 Fax Number: [phone]
E-mail Address: JNance(a~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:
Company Affiliation:
Mailing Address:
Telephone Number:_
E-mail Address:
Fax Number:
Page 1 of 8

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: Proposed extension of a structure conveying an unnamed tributary to the
South Flat River and the replacement of a structure convey dg_ rainage water throu hg_a
wetland area, in association with ungrading_ and paving SR 1128 (Tom Oakley Road) in
Person County.
2. T.I.P. Project Number or State Project Number (NCDOT Only):_
WBS Element No. SC.073015
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Person Nearest Town: Roxboro
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): From Roxboro take Hwy 501
South towards Durham. At Timberlake make a right onto Dick Holeman Rd, then at the first
right turn onto SR 1128 (Tom Oakley Road).
5. Site coordinates, if available (UTM or Lat/Long): Site 1:36.2770°N, 78.9907°W
Site 2: 36.2730°N. 78.9867°W (Note - If
project is linear, such as a road or utility line, attach a sheet that separately lists the coordinates
for each crossing of a distinct waterbody.)
6. Property size (acres): 5.45 acre (Project is 0.75 mi long)
7. Nearest body of water (stream/river/sound/ocean/lake):_
Site 1: Unnamed Tributary to the South Flat River
Site 2: drainageway -wetland only
8. River Basin: Neuse
Page 2 of 8

(Note -this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Sites are surrounded by wooded areas and agriculture land.
10. Describe the overall project in detail, including the type of equipment to be used: Grade,
drain, pave, and erosion control at SR 1128 (Tom Oakley Rd). The NCDOT will also
dewater the Site 1 work zone during construction. Equipment may include excavator,
backhoe, bulldozer, grader, and crane.
11. Explain the purpose of the proposed work: The project is part of the 2004-2005 secondary
road paving~ro~ram. The existing_gravel roadway will be paved with asphalt.
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.
None that are known for NCDOT activities.
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
No
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 3 of 8

1. Provide a written description of the proposed impacts See cover letter for a thoro>!«h
description of the proposed impacts at each site The NCDOT will also dewater the work
zone dunn~ constructton at Site 1
2. Individually list wetland impacts below:
Wetland Impact Area of Located within Distance to
Site Number Type of Impact* Impact 100-year Floodplain** Nearest Type of Wetland***
(indicate on map) (acres) (yes/no) Stream (linear
feet)
1,128 ft
Site 2 Fill (<0.03) Yes > 100 ft Drainageway wetland

~~~~ ~a~~~ ~~~~~a~~ acpaiateiy ana wenury temporary impacts. -mpacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, Hooding, 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 htta:!%www.fema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property: < 0.10 ac
Total area of wetland impact proposed: < 0.03 ac
3. Individually list all intermittent and perennial stream ;r„r,a~tc hPlnw•
Stream Impact
Site Number
T e of Im act*
~ p
Length of Impact V v
**
Stream Name Average Width

of Stream Perennial or

Intermittent'?
(indicate on ma) (linear feet) Before Im act (please specify)
Pipe extension 24 ft
Rip rap along

Site 1
streambank for
20 ft LJT
South Flat River IO ft perennial
stabilization only
Temporary

*
Dewatering 44 ft (concurrent)
~~~~ ~a~~~ uupau scpara[eiy ana iaennry 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.uses.~v_. Several Internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.cc»n,
www.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:_ 44 feet existing channel
impacted (fill from placement/extension of pipe and placement of rip rap along streambank
for stabilization) and 44 feet concurrent temporary impact from dewateri~
Page 4 of 8

4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and an other water of the U.S.) below:
Open Water Impact
Site Number

(indicate on ma)
Type of Impact* Area of
Impact

(acres)
Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,

bay, ocean, etc.)
N/A

List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
Hooding, 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.
All wetlands and_surface waters not affected by construction will be protected from unnecessary
encroachment during construction. Strict enforcement of Best Management Practices for the
protection of wetlands and surface waters will be enforced during construction. Only the
smallest amount of fill necessary to complete the project will be placed in waters of the United
States or protected riparian buffers.
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,
Page 5 of 8

but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/strmgide html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
N/A
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at http://h2o.enr.state.nc.us/wrp/index htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following infarmation:
Amount of stream mitigation requested (linear feet): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian 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)
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
Page 6 of 8

If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ^ No ^
X.
Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233.
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ® No ^ If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Site 1 (STA 27+36)
Zone* Impact Multiplier Required
(square feet) Mitigation
1 1,529 3 N/A
2 1,008 1.5 N/A
Total 2,537 N/A
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer 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.
Existing: 2.1 acre impervious surface (23 foot wide gravel road) of 5.45 acre total project size.
Proposed: 1.8 acre impervious surface (proposed 20 foot wide asphalt paved road) of 5.45 acre total
project size. The erosion control plan for this project is desi~rted for 900 cubic feet of storage per acre.
Erosion and sediment control devices along the project are comprised of temporary silt basin (Type B),
temporary rock silt check ~Type B), rock pipe inlet sediment trap_(Type A), and temporary silt fence.
The NCDOT proposes to install temporary erosion and sediment control devices in Zone 1 and Zone 2
Page 7 of 8

of the riparian buffer. Specifically, the NCDOT will place temporary rock silt checks (Type A) and
temporary silt fence in Zone 1, with temporary rock sediment dam, Type B in Zone 2. The temporary
structures will be removed once the vegetation has been established and then seeded with a seed mixture
of fescue and bahia grass. Please note that the placement of these structures are within the 60 right-
of-way width and their associated impacts are listed above.
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.
The project will not generate wastewater.
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).
N/A G~

7
%3 G
Date
(Agent's signatutKe is valid only if an authorization letter from the applicant is provided.)
Page 8 of 8

Appendix One
(Photographs of each site)

Photograph 1. View from above inlet at Site 1.
Photograph 2. View from below outlet at Site 1.

~:;,. ,sue.

:. '' _-
~:~.`,..
r4 , y._.
• -
i;
`r
., f.#~
. . ~ ...
Photograph 3. View of wetland leading to pipe, along south ditch line at Site 2.
Photograph 4. View of wetland leading from pipe, north of roadway at Site 2.

Appendix Two
(USAGE Wetland Delineation forms/
DWQ rating sheets)

-. S~ z
DATA FORM we~~
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Determination Manual)
Project /Site: SR I Z$ o,N C7~~ ~ Date: Z~~~ /D~
Applicant /Owner: County: ~rso/1
Investigator: r ue State: ~C
Do normal circumstances exist on the site? Yes / No Community ID:
is the site significantly disturbed (Atypical situation)? Yes No / Transect ID:
Is the area a potential problem area? Yss No / Piot ID:
(explain on reverse if needed)
VEGETATION
Dominant Plant Species Stratum Indicator Dominant Plant Species Stratum Indicator
1. Micro ~ ivnt yPwti/ItkN~ µ - 9.
2._ re~,o. N G/FCW 10.
3. l~io,a,a s„o ~1. _ o ~ 11.
4.~ra. ; aOvn i ~.a- ~ WV fi4G' ~ 12.
5._ ~,-1- /.ur ro'fu nel~ ~n 1. a.. -J / ~~ 13.
6. 14.
T. 15.
8. 16.
Percent of Dominant Species that are OBL, FACW, or FAC excluding FAC-). tlb`Jo
Remarks: Wetland Vegetation Present Based Upon Greater than SO% of the Plant Species are/are not
Classified asFAC-OBL in the National List of Plant Species that Occur in Wetlands. Sample plot was taken...
w~~fc~ lax~s e~
HYDROLOGY
_ Recorded Data (Describe In Remarks): Wetland Hydrology Indicators
_ Stream, Lake, or Tide Gauge .
Aerial Photographs Primary Indicators:
Other Inundated
_ /$aturated in Upper ~12"
No Recorded Data Available _ Water Marks
_ Drift Lines
Field Observations: _ Sediment Deposits
_ Drainage Patterns in Wetlands
Depth of Surface Water: ^0"e (v-•) Secondary Indicators:
Oxidized Roots Channels in Upper 12"
De th to Free Water in Plt• -- f~,
p ) Water-Stained Leaves
ocal Soil Survey Data
Depth to Saturated Soil: ~~o (in.) ~
FAC-Neutral Test
_ Other (Explain in Remarks)
Remarks:.
f'i/G'ti~d /[yG~ ro ~~ y ~rCS~„

SOILS
Map Unit Name
(Series and Phase): Drainage Class:
Taxonomy (Subgroup): Confirm Mapped Type? Yes_ No
Profile Descriotfon:
Depth Matrix Colors ~ Mottle Colors Mottle Texture, Concretions,
inches Horizon IMunsell Moist) (Munsell Moistl. Abundance/Contrast Structure. etc.
o-z DYR Y 2 ~- - ~ S
G
/
Z-lZ• 2•S R 4 2 _ Z.SYR ~/Z ~i/ I ~~"T sif.~t4v ~~RH
Hydric Soil Indicators:
- Histosol _ Concretions
Histic Epipedon - High Organic Content in Surface Layer in Sandy Soils
_ Sulfidic Odor Organic Streaking in Sandy Soils
_ Aquic Moisture Regime Listed On Local Hydric Soils List
_jt~ducing Condretons Listed on National Hydric Soils List
_ Gleyed or Low-Chroma Colors _ Other (Explain in Remarks)
Remarks:
/~ydr~c soils ~reseh-E'
WETLAND DETERMINATION
Hydrophytic Vegetation Present? Yes / No Is the Sampling Point
Wetland Hydrology Present? Yes / No Within a Wetland? Yes / No
Hydric Soils Present? Yes / No
Remarks: Location (describe) is/is not classified as a wetland based upon the criteria set forth in the 1987
Army Corps of Engineers Wetlands Delineation Manual.
~~;f cY./ea. ~ s s~ we ri'a~l c~

s,~ Z
DATA FORM v /~
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Determination Manual)
Project /Site: SQ 1128 f~~-~t QxK~c, /~} ' Date: Z r~ a5f
Applicant /Owner. County: ~~o/I
Investigator: r oil State: NC
Do norms{ circumstances exist on the site? Yes /No Community ID:
Is the site significantly disturbed (Atypical situation)? Yes No / Transact ID:
Is the area a potential problem area? Yes No / Plot ID:
(explain on reverse if needed)
` VEGETATION
Dominant Plant Species Stratum Indicator Dominant Plant Species Stratum Indicator
1. diry-x3~~or~~t~s.. 5hr FA'Cd 9.
2. L~gu~i~aa1/t~r s racy' - ua. T ~ 10.
3. j~nr....-.~ ,%Q,Dogr~0.. ~/~ FAC- 11.
4. f~Ct r ru6r~c.vt ~ FA-C 12.
5. ~'r;.c~t r-dio~' `~ ~~ ~~-t ra- _
T Ff} 13.
6. PluS{~c~ur[ QG/OS~~OrGGS H FAL 14.
7. T n,'~r r.~s v~ve ~tn~,ns.. S!i F~IC'y- 15.
8. F~a arra /ir ,H~2+-~-- _~_ ~i9('- 16.
Percent of Dominant Species that are OBL, FACW, or FAC excluding FAC-). 37 °e
Remarks: Wetland Vegetation Present Based Upon Greater than 50% of the Plant Species arelare not
Classified asFAC-OBL in
t
he National
List of Plant Species that Occur in Wetlands. Sample plot was taken...
/
l
Gth ~~ //
la~t~s ~~~ rt5~'~,
HYDROLOGY.
_ Recorded Data (Describe In Remarks): Wetland Hydrology Indicators
- Stream, Lake,.or Tide Gauge .
Aerial Photographs Primary Indicators:
- Other _ Inundated
-Saturated in Upper 12"
_ No Recorded Data Available _ Water Marks
_ Drift Lines
Field Observations: .Sediment Deposits
_ Drainage Patterns in Wetlands
Depth of Surface Water: nD^e (in.) Secondary Indicators:

Depth to Free Water in Pit: ~ 12 (in.) Oxidized Roots Channels in Upper 12"
_Water-Stained Leaves
- Local Soil Survey Data
Depth to Saturated Soil: > I Z (in.) _FAC-Neutral Test.
Other (Explain in Remarks)
Remarks:.
/vc 5~~1 s at ~I yc~/a to J e J

. -,
SOILS
Map Unit Name
(Series and Phase): Drainage Class:
Taxonomy (Subgroup): Confirm Mapped Type? Yes_ No
Profile Description:
Depth Matrix Colors • Mottle Colors Mottle Texture, Concretions,
inches Horizon Munsell Moist (Munseil Moistl Abundance/Contrast Structure. etc.•

2-! Zt I v YR ~f Z - 5 C
Hydric Soil Indicators:
- Histosol - Concretions
_ Histic Epipedon _ High Organic Content in Surface Layer in Sandy Soils
_ Sulfidic Odor Organic Streaking in Sandy Soils
_ Aquic Moisture Regime Listed On Locai Hydric Soils List
_ Reducing Conditions Listed on National Hydric Soils List
Gleyed or Low-Chroma Colors Other (Explain in Remarks)
Remarks:
hbyl ~ y~~,z Saris re~~
P
WETLAND DETERMINATION
Hydrophytic Vegetation Present? Yes No / Is the Sampling Point
Wetland Hydrology Present? Yes No / Within a Wetland? Yes_ No
Hydric Soils Present? Yes No
Remarks: Location (describe) is/is not classified as a wetland based upon the criteria set forth in the 1987
Army Corps-of Engineers Wetlands Delineation Manual.
~ h r-5 QA'd I~ /I o~ do I~T(~~F'

-~1. i ~ f 6 { < < r~<.~a
cc~t ,, a~ .our ~e~r--orz. '
~ ~J
> >f 4` 3 > < ~Dt~~~ ;:ti< ~ ~. >Yf .Y ~ k ~ , ~ ~~i ~sPr."~ - c r~~ » ., y a
~ t c...ey ., s~~ s +Z :..•.. .~?.,~.vl~'~r+,~ae'rs~,,..~i~L1 ~ .. sue. >ta. ~ekE ~i3 ,~`~2.1s; x:~-',,,•s «. ... t< . 1i.:... <~*>.x.~Y,~iiv y. ;y~,a ~ ~ ~ G//_
. .~I w~~/a~~
Project Name SR IIZS l°i'''` ~~-~ ~ Nearest Road s''e Ii2S'
County rso~r wetland Area ~ ~• ° s ac;es Wetland tiYdth < SO f et
Name of evaluator ~{Q'r5~cr ~n~~9~-' Date 2 ~ i ~Y
Wetland Location
on pond or lake
on perennial stream
on intermittent stream
within interstream divide
other htaa~waf rl 4~iafha~C,~,~/a y
Soil series
predominantly organic -humus, muck,
or peat
predominantly mineral -non-sandy
/predominantly sandy .
Adjacent land use
(within 1/2 mile upstream, up:lope, or radius)
9~ forested/natural vegetation '~
s agriculture, urban/subur;~an '~
5 impervious surface /
Dominant vegetation
(1) __ Carey sue.
(2) _ Guc,~w9q~~
Flooding and wetness
IIydraulic factors
steep topc.~aphy
ditched or channelized
total wetland width 2100 feet
_ semipermanently to permanently
flooded nr inundated
~ seasonally flooded or imundated
intermittanly flooded or temporary
surface water
no evidence of floodin¢ or surface water
Wetland type (select one)*
Bottomland hardwood forest Pine savanna
Headwater forest Freshwater marsh
Swamp forest . ~ Bog/fen
Wet flat Ephemeral wetland
Pocosin Carol'ma Bay
Bog forest - /Other ~SrA~dwQ~crs c~ray~~~.y
______ *the rating system cannot be applied to salt or brackish marshes or stream charnels U
---------------------------------------------------
weight
Water storage Z x 4.00 =
~`'x:~f~
' `" ''°

A
Bank/Shoreline stabilization
~ x 4.00 = :i~i:' .
~~>~~~`~~'
T
Pollutant removal
~ * x 5.00 = ~:~:>:.: ~ :..
~'n ~~ ~ `v.~;
I ~ Wildlife habitat 1 x Z.00 = ''~%
Aquatic.life value ~ x 4.00 = `~~_ ~ ~~ '~
G Recreation/Education ~ x 1.00 = «{~.:
Wetland
*Add 1 point if in sensitive watershed and >10% nonpoint disturbance within 1/2 mile upstream,
u slo a or radius _______
•--------p--~-=-------------------------------------------------------------------------------------------