20071511 Ver 1_Application_20070906

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
September 20, 2007
Polk County
DWQ Project No. 20071511
Bridge No. 202 on SR 1151
State Project No. 14B.107511
APPROVAL of 401 WATER QUALITY CERTIFICATION with ADDITIONAL CONDITIONS
Mr. Chris Lee, EI, Bridge Maintenance Engineer
NCDOT, Division 14
178 Henry Bird Rd.
Whittier, NC 28789
Dear Mr. Lee:
You have our approval, in accordance with the conditions listed below, for the following impacts for the
purpose of replacing Bridge No. 202 over an unnamed tributary to Green River on SR 1151 in Polk
County:.
Stream Imlgacts in the Broad River Basin
Site Permanent Fill Temporary Fill in Permanent Fill in 'Temporary Fill Total Stream Stream
in Intermittent Intermittent Perennial Stream in Perennial Impact Impacts
Stream (linear Stream (linear ft) (linear ft) `Stream (linear ft) (linear ft) Requiring
ft) Mitigation
'near ft
l A 0 0 0 25 25 0
1B 0 0 0 25 25 0
Total 0 0 0 50 50 0
Total Stream Impact for Project: SO linear feet.
The project shall be constructed in accordance with your application dated received September 6, 2007.
After reviewing your application, we have decided that these impacts are covered by General Water
Quality Certification Number 3627. This certification corresponds to the General Permit 31 issued by the
Corps of Engineers. 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.
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
properly 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 1501inear feet,
compensatory mitigation maybe 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.
N~one~Carolina
Transportation Permitting Unit ~''µtuCa~~i/
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] FAX [phone] Internet: h~:/Ih2o.enr.state.nc.us/ncwetlands
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Condition(s) of Certification:
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
Placement of culverts and other structures in waters, streams, and wetlands shall be placed below the
elevation of the streambed by one foot for all culverts with a diameter greater than 48 inches, and 20
percent of the culvert diameter for culverts having a diameter less than 48 inches, to allow low flow
passage of water and aquatic life. Design and placement of culverts and other structures including
temporary erosion control measures shall not be conducted in a manner that may result in dis-
equilibrium of wetlands or streambeds or banks, adjacent to or upstream and down stream of the
above structures. The applicant is required to provide evidence that the equilibrium is being
maintained if requested in writing by DWQ. If this condition is unable to be met due to bedrock or
other limiting features encountered during construction, please contact the NC DWQ for guidance on
how to proceed and to determine whether or not a permit modification will be required.
2. If concrete is used during construction, a dry work area shall be maintained to prevent direct contact
between curing, concrete and stream water. Water that inadvertently contacts uncured concrete shall
not be discharged to surface waters due to the potential for elevated pH and possible aquatic life and
fish kills. -
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. The dimension, pattern and profile of the stream -above and below the; crossing shall not be modified.
Disturbed floodplains and streams shall be restored to natural geomorphic conditions.
5. The use of rip-rap above the Normal High Water Mark shall be minimized. Any rip-rap placed for
stream stabilization shall be placed in stream channels in such a manner that it does not impede
aquatic life passage.
6. The Permittee shall ensure that the final design drawings adhere to the permit and to the permit
drawings submitted for approval.
7. All work in or adjacent to stream waters shall be conducted in a dry work area. Approved BMP
measures from the most current version of NCDOT Construction and Maintenance Activities manual
such as sandbags, rock berms, cofferdams and other diversion structures shall be used to prevent
excavation in flowing water.
8. Heavy equipment shall be operated from the banks rather than in the stream channel in order to
minimize sedimentation and reduce the introduction of other pollutants into the stream.
9. 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.
10. No rock, sand or other materials shall be dredged from the stream channel except where authorized by
this certification.
~ne CaiOtlTla
Transportation Permitting Unit ~ ~'*tuCa~~/
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] FAX [phone] Internet: http:/lh2o.enr.state.nc.uslncwetlands
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WAT Michael F. Easley, Governor
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OC~ QG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
`
~ ~ Coleen H. Sullins, Director
Division of Water Quality
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11. Discharging hydroseed mixtures and washing out hydroseeders and other equipment in or adjacent to
surface waters is prohibited.
12. The permittee and its authorized agents shall conduct its activities in a manner consistent with State
water quality standards (including any requirements resulting from compliance with §303(d) of the
Clean Water Act) and any other appropriate requirements of State and Federal law. If DWQ
determines that such standards or laws are not being met (including the failure to sustain a designated
or achieved use) or that State or federal law is being violated, or that further conditions are necessary
to assure compliance, DWQ may reevaluate and modify this certification.
13. All fill slopes located in jurisdictional wetlands shall be placed at slopes no flatter than 3:1, unless
otherwise authorized by this certification.
14. A copy of this Water Quality Certification shall be maintained on site at the construction site at all
times. In addition, the Water Quality Certification and all subsequent modifications, if any, shall be
maintained with the Division Engineer and the on-site project manager.
15. The outside buffer, wetland or water boundary located within the construction corridor approved by
this authorization shall be clearly marked by highly visible fencing prior to any land disturbing
activities. Impacts to areas within the fencing are prohibited unless otherwise authorized by this.--
certification.
16. The issuance of this certification does not exempt the Permittee from complying with any and a1L -
statutes, rules, regulations, or ordinances that may be imposed by other government agencies (i.e.
local, state, and federal) having jurisdiction, including but not limited to applicable buffer rules,
stormwater management rules, soil erosion and sedimentation control requirements, etc.
17. The Permittee shall report any violations of this certification to the Division of Water Quality within
24 hours of discovery.
18. Upon completion of the project (including any impacts at associated borrow or waste site), the
NCDOT Division Engineer shall complete and return the enclosed "Certification of Completion
Form" to notify DWQ when all work included in the 401 Certification has been completed.
19. Native riparian vegetation (ex. river birch, green ash, black gum, sycamore, bitternut hickory, tag
alder, pawpaw, ironwood, winter berry, doghobble, spicebush, hop sedge, broom sedge, fox sedge,
joe-pye-weed, boneset, jewel weed, soft rush, etc.) must be reestablished within the construction
limits of the project by the end of the growing season following completion of construction.
20. There shall be no excavation from, or waste disposal into, jurisdictional wetlands or waters associated
with this permit without appropriate modification. Should waste or borrow sites, or access roads to
waste or borrow sites, be located in wetlands or streams, compensatory mitigation will be required
since that is a direct impact from road construction activities.
21. Erosion and sediment control practices must be in full compliance with all specifications governing
the proper design, installation and operation and maintenance of such Best Management Practices in
order to protect surface waters standards:
None Carolina
Transportation Permitting Unit " ' --tuCat'~l~
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] FAX [phone] Internet: http~//h2o enr state.nc.us/ncwetlands
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~ WAjF Michael F. Easley, Governor
-.~~0 ~QG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
~ ~ Coleen H. Sullins, Director
> .;.1 Division of Water Quality
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a. The erosion and sediment control measures for the project must be designed, installed,
operated, and maintained in accordance with the most recent version of the North Carolina
Sediment and Erosion Control Planning and Design Manual.
b. The design, installation, operation, and maintenance of the sediment and erosion control
measures must be such that they equal, or exceed, the requirements specified in the most
recent version of the North Carolina Sediment and Erosion Control Manual. The devices
shall be maintained on all construction sites, borrow sites, and waste pile (spoil) projects,
including contractor-owned or leased borrow pits associated with the project.
c. For borrow pit sites, the erosion and sediment control measures must be designed, installed,
operated, and maintained in accordance with the most recent version of the North Carolina
Surface Mining Manual.
d. The reclamation measures and implementation must comply with the reclamation in
accordance with the requirements of the Sedimentation Pollution Control Act.
22. Sediment and erosion control measures shall not be placed in wetlands or waters unless otherwise
approved by this. Certification.
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, b714 Mail Service Center, Raleigh;' N.C. 27699. 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 Brian Wrenn at [phone]. 1
Sincerely,
~~-
~Coleen H. Sullins
Attachments (General Certification and Certificate of Completion form)
cc: Mark Davis, Division 14 Environmental Officer
David Baker, US Army Corps of Engineers, Asheville Field Office
Kathy Matthews, Environmental Protection Agency
Dave McHenry, NC Wildlife Resources Commission
Marella Buncick, US Fish and Wildlife Service
Mike Parker, DWQ Asheville Regional Office
File Copy
No°~thCarolina
Transportation Permitting Unit !lf!lCQ~~I'
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] FAX [phone] / Internet: http://h2o.enr.state.nc.us/ncwetlands
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STATE oi: NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
GOVERNQR
August 28, 2007
Mr. David Baker, NCDOT Regulatory Project Manager
U. S. Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, NC 28801-2714
LYNDO TIPPETT
SECRETARY
071511
Subject: General Regional Permit 31
Bridge Number 202 over Unnamed Tributary to Green River
SR 1151,Green River Cove Road
Polk County
State Project # 14B.107511 (DWQ Minor Permit $200.00}
Dear Mr. Baker:
The North Carolina Department of Transportation (NCDOT) is proposing to replace Bridge
Number 202 on SR 1151, over an unnamed tributary to Green River in Polk County. The
existing bridge is a single span timber beam and timber abutment structure with an overall length
of 19 feet. It was determined that in the interest of public safety and its insufficient width, that
this bridge be replaced because of deterioration due to age.
The proposed replacement will be a steel beam and timber abutment structure widened to 22' and
retaining its original length. The footers will be cut and doweled into, extending their width by
two feet on each corner. This widening of the footers will be phase one of construction, with
phase two consisting of the removal and replacement of substructure. Construction will be
phased to allow traffic to flow on half of the existing bridge while the other half is built, then
traffic will be moved onto the new half to complete construction. Sandbag cofferdams will be
used to ensure a clean, dry area, and to minimise impacts to aquatic habitats and allow the
existing stream gradients to remain as unchanged as physically possible.
The North Carolina Natural Heritage Database was checked for records of federally threatened
and endangered species. There are no records listed for the immediate vicinity of the bridge.
Whittier Bridge Maintenance, 178 Henry Bird Rd., Whittier, NC 28789Telephone(828~197-7953 Faz(828)497-6095

There are no records for the unnamed tributary of Green River watershed. Additionally, there are
no records listed for Green River for three miles below the confluence of this unnamed tributary.
However, the white irisette (Sisyrinchium dichotomum), a federally listed plant, occurs in the
Green River watershed and there are records for this species within approximately three miles of
the project.
The areas in the footprint of the construction are grassed maintained shoulders. The habitat at the
crossing is not typical of that for the white irisette and herbaceous vegetation is relatively heavy
within the shoulder approaches to the bridge.
The disturbed area will be limited to the shoulders for staging and 3-4 feet up and downstream. of
the existing bridge. The 3-4 feet disturbance up and downstream will be digging out the existing
wingwalls for widening. The excavated material will be stored in the shoulder with silt fence
installed to prevent sedimentation.
Based on the limited scope of this project, the lack of records and lack of habitat, we believe this
project will have "no effect" on the white irisette or other threatened and endangered species.
Impacts to historic or cultural resources are not anticipated. If the State Historic Preservation
Office (SHPO) and the Office of State Archaeology determines that further investigations are
required, NCDOT will conduct the appropriate site investigations and obtain compliance from
SHPO prior to project construction.
Site No.
.Station Existing Condition Proposed Condition Net Impacts
Site lA: 5' wide free flowing stream Free flowing stream w/temporary 50 ftZ
East End with 20' wide spanning (2'W x 25'L coffer dam) and 22' Temporary
structure wide s annin structure Im act
Site 1B 5' wide free flowing stream Free flowing stream w/temporary 50 ft2
West End with ZO' wide spanning (2'W x 25'L coffer dam) and 22' Temporary
structure wide s annin structure Im act
Total Temporary Impacts for Coffer Dams Total=100 ft2
Total Permanent Impacts None
Permits Requested
NCDOT is hereby requesting authorization under Section 404 of the Clean Water Act to proceed
with the construction project outlined above. By copy of this letter, I am asking Mr. David
McHenry, Mountain Region Coordinator, of the North Carolina Wildlife Resources Commission
(NCWRC) to comment directly to you concerning the 404 Nationwide Permit request.
Also, by copy of this letter, I am requesting authorization under Section 401 of the Clean Water
Act from the North Carolina Departmerrt of Environment and Natural Resources (DENR),
Division of Water Quality (DWQ). In addition, I am requesting Mr. McHenry and Mr. Ed Ingle,
Whittier Bridge Maintenance, 178 Henry Bird Rd., Whittier, NC 28789Telephone(828)497-?953 Fag(828)497-6095

Roadside Environmental Field Operations Engineer (NCDOT), to comment directly to me
concerning this permit request.
If you have any questions or need additional information, please contact me at [phone].
Your early review and consideration will be greatly appreciated.
Sincerely,
--
~ -~
Chris Lee, EI
Division 14 Bridge Maintenance Engineer
cc: J Mr. John Hennessy, DWQ, DENR Raleigh (4 Copies)
Mr. Mike Parker, DWQ, Asheville Regional Office
Ms. Marella Buncick, Biologist, US Fish and Wildlife Service, Asheville
Mr. David McHenry, Mountain Region Coordinator, NCWRC, Waynesville
Mr. Joel Setter, P.E., Division Engineer, NCDOT, Sylva
Mr. Mark Davis, Division Environmental Officer, NCDOT
Mr. E. L. Ingle, Roadside Environmental Field Operations Engineer, NCDOT
Whittier Bridge Maintenance, 178 Henry Bfrd Rd., Whittier, NC 28789Telephone[phone] Faz(828~97-6095

Office Use Only: Form version March us
X4071 51 1
USACE Action ID No. DWQ No.
rrf amp nartic„lar item is nit a»nlicahle to this nroiect please enter "Not Avnlicable" 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 ^ Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: GP 31
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ^
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, 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: NC Department of Trans.Portation c/o C.D.Lee
Mailing Address: 178 Henry Bird Rd Whittier,~NC 28789
Telephone Number: 828-497-7953 Fax Number: 828-497-6095
E-mail Address: cdlee 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: N/A
Company Affiliation: N/A
Mailing Address: NJA
Telephone Number: N/A Fax Number: N/A
E-mail Address: N/A
f
Page 1 of $

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: Bridge Number 202 over Unnamed Creek on SR 1151 in Polk County,..
2. T.I.P. Project Number or State Project Number (NCDOT Only): 14B.107511
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Polk Neazest Town: Saluda
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers/names, landmarks, etc.): From Saluda take
Holbert Cove Road,~SR 11421 1 miles, then left onto Green River Cove Road (SR11511.
Travel a,~nroximately 2.1 miles to site.
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): 35.2067° N 82.2278° W
6. Property size (acres): N/A
7. Name of nearest receiving body of water: Green River (B;TrI
8. River Basin: Broad
(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: Bridge #202 in Polk County is a small single span timber
bridle that we aze nronosing to rebuild using existing and some new materials. The footers
will be doweled into extending each corner two feet to widen the structure four feet total. The
general land use in the area is residential and farmland.
Page 2 of 8

10. Describe the overall praject in detail, including the type of equipment to be used:
The bri ~e will be stage constructed to maintain traffic with each half bein removed and
replaced with concrete footers and timber abutments. Backhoe, boomtruck, pawertools,
handtools etc. will be used.
11. Explain the purpose of the proposed work:
To update the timber bridge by widening_footers, adding steel beams, and re-flooring deck.
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.
N/A
VL 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:_ ,There will be Temporary
impacts on each end bent aQproximately 10 feet in len tg_h (5 feet on each corner) due to the
dewatering_needed to extend each footer two feet. Staging areas will be limited to existing
grasssed shoulders
Page 3 of 8

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.
Wefland Impact
Site Number
(indicate on map)
Type of impact Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.) Located within
100 year
Floodplain
( s/no Distance to
Nearest
Stream
linear feet) Area of
Impact
(acres)
N/A NIA

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, ditchinglstraightening, 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 acres 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 impact
Length
linear feet) Area of
Impact
(acres)

lA East End Bent
Unnamed Tributary
Green River
Temporary Coffer
Dam
Perennial 5' stream
(2' Coffer
Dam)
25
.00115
1B West End
Bent Unnamed Tributary
Green River Temporary Coffer
Dam Pere 5', ~~
(2 Coffer 25 .00115

Total Stream impact (by length and acreage) 0 0
Total Temporary Impact (by length and acreage) 50 .00230
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, dredt~in~, 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
N/A

Total Open Water Impact (acres) N/A
Page 4 of 8

6. List the cumulative impact to all Waters of the U.S. resulting from the project:
Stream Im act acres :Tem ora .00230
Wetland Im act acres): N/A
en Water Im act acres : N/A
Total Im act to Waters of the U. S. acres) Tem ora .00230
Total Stream Im act linear feet :Tem ora 25'
6. Isolated Waters
Do any isolated waters exist on the property? ^ Yes ®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.
'1. 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
Current land use in the vicinity of the pond: N/A
Size of watershed draining to pond: N/A Expected pond surface area: N/A
VII. Lnpact 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.
Silt fence will be used around the project to reduce run-off into the stream. Any potential
impacts from offsite sedimentation from the project site will be avoided by the
implementation of ~propriate BMP's .(attached Erosion Control Diagraml
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.
Page 5 of 8

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 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.
1'f mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
http: //h2o. enr. state. nc.usJncwetlands/strmgide. html.
Provide a brief description of the proposed mitigation plan.. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
N/A
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and 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~//h2o.enr.state.nc.us/wrp/index.htm. 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): 0
Amount of buffer mitigation requested (square feet): 0
Amount of Riparian wetland mitigation requested (acres): 0
Amount ofNon-riparian wetland mitigation requested (acres): 0
Amount of Coastal wetland mitigation requested (acres): 0
VIII. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federaUstate/local) funds or the use of
public (federaUstate) land? Yes ® No ^
Page 6 of 8

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 ^
IX. 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.
2.
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify N/A )?Yes ^ No
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 multi Tiers.
*
Zone Impact
s uare feet
Mulnpher Required
Miti lion
1 3 (2 for Catawba)
2 I.5
Total
" Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additiona120 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 15A NCAC 2B .0242 or .0244, or .0260. N/A
X. 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
Page 7 of 8

the property. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. The drainage area for the small creek is
approximately 90-95% forest and woodlands. Silt fences, check dams, and other applicable
erosion control devices will be used around the project to reduce anv off-site, or in stream
sedimentation.
XI. 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.
No wastewater will be generated from the yroiect.
XII. 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
VIII. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ^ No
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/ncwetlands. If no, please provide a short narrative description:
This project involves the repair of an existing bridge_The road is not being upgraded AnX
impacts generated should be insignificant.
XIV. Qther 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).
~V/A
ApplicantlAgent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 8 of 8

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