20071728 Ver 1_Application_20071012

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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPETT
GOVERNOR SECRETARY
October 10, 2007
N.C. Division of Water Quality
Transportation Permitting Unit O ~ ~ ~ ~)
2321 Crabtree Blvd./Suite 250 !•~
Raleigh, NC 27604-2260
Attention: Mr. Rob Riding, NCDOT Project Coordinator
Subject: Secondary road improvements to SR 1124 (Otha Mangum Road) from
SR 1004 (Old Hwy 75) to SR 1215 (W. Lyon Station Road) in Granville
County. WBS element SC.039035.
The North Carolina Department of Transportation (NCDOT) proposes to upgrade and
pave SR 1124 (Otha Mangum Road) from SR 1004 (Old Hwy 75) to SR 1215 (W. Lyon
Station Road) in Granville County (Figures 1-7). Total project length is 1.88 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
1 124 is scheduled to be paved as part of the Secondary Roads Construction Program.
Impacts to Waters of the United States
Site 3 (STA 87+16) -Waters of US
Construction at this site will impact an UT to Ledge Creek [NCDENR-DWQ Index No.
27-10-(0.5), Best Usage Classification WS-II HWQ NSW; HUC 03020201] (Figure 3) in
the Neuse River Basin. The existing structure conveying the creek is a 30-inch pipe that
is 52 feet long (see Photographs 4 and 5). This pipe will be replaced with a pipe that is
60 feet long. Centering this pipe within the right-of--way width will require a channel shit
on the inlet end of this pipe with a stream loss of 41 feet. The stream on this side of the
roadway isn't very well defined. The ditch line is essentially the stream bed. Additionally
rip rap armoring with be used to stabilize the bends and tie in points, of the channel shift,
not to exceed 25 linear feet. On the outlet end of this pipe there is a deep scour hole.
Division 5, 2612 N. Duke Street, Durham, NC 27704
Phone: [phone] Fax: [phone]

2
NCDOT proposes to repair this scour hole by using large stone and restoring the stream
channel elevation with a total stream impact of 19 feet (this distance includes both 4 feet
of extra pipe length plus the remaining scour repair length). Then the new pipe will be
installed and the surrounding fill slope and stream banks will be armored with rip rap for
stabilization, not to exceed 15 linear feet concurrently. During the construction of the
project, the NCDOT proposes to temporarily dewater the work zone (if necessary) for
approximately 3 days. This will involve the temporary placement of sandbags 45ft upstream
and 19ft downstream of construction. If necessary, to maintain water flow during
construction, water upstream of construction will be temporarily pumped out by a hose and
conveyed downstream of the construction activity where it will be allowed to filter through
vegetation before flowing into the stream. Any effluent from the work area will be pumped
into a prefabricated silt bag allowing water to slowly filter out of the bag in a dispersed
matter and the sediment to be captured in the bag. Once the stream has been dewatered, the
pipe will be repaired. The materials used for dewatering will be removed after construction.
No other sites on this project involve stream impacts. Sites 1, 2, 4, and 5 impact
ephemeral channels and protected buffers. Therefore the Site 3 impacts are the only
stream impacts associated with this project.
Riparian Buffer Impacts
The construction of this project involves 5 sites with buffer impacts (see Photographs 1,
2, 3, 6, 7, 8, and 9). The features at these sites are ephemeral channels and/or ponds that
are depicted on both the recent version of the Stem (1974/1987) topographic quadrangle
(Figure 1) as well as on the Soil Survey of Granville County (USDA-SCS 1992) (Figure
2). Site totals and mitigation requirements are presented in the following table (Table 1).
Table 1. Buffer Impacts/Mitigation for SR 1124 Otha Mangum Rd -Granville County
Site Zone 1
Impact
(sq ft) Minus
Wetlands
in Zone 1
(sq ft) =Zone 1
Buffers (not
wetlands) (sq
ft) Zone 1 Buffer
Mitigation
Required
(3:1 ratio) Zone 2
Impact
(sq ft) Minus
Wetlands
in Zone 2
(sq ft) =Zone 2
Buffers (not
wetlands)
(sq ft) Zone 2 Buffer
Mitigation
Required
(1.5:1 ratio)
1 1,001 0 1,001 N/A 438 0 438 N/A
]b 754 0 754 2,262 649 0 649 973
2b 0 0 0 0 742 0 742 1,113
3 472 0 472 N/A 328 0 328 N/A
3b 416 0 416 1,248 0 0 0 0
4 854 0 854 N/A 504 0 504 N/A
5 1,416 0 1,416 N/A 490 0 490 N/A
Sb 1,637 0 1,637 4,911 1,073 0 1,073 1,609
Totals 6,550 0 6,550 8,421 4,224 0 4,224 3,695
#- perpendicular impacts
b- parallel impacts
* N/A =Impact is "allowable" without mitigation as per table of uses.
Total Buffer Impact for Project: 10,874 square feet

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: Unavoidable parallel buffer impacts will be mitigated by
payment to EEP. All compensatory mitigation requirements will be assimilated on a
quarterly basis and provided to the Ecosystem Enhancement Program (EEP) for their
acceptance.
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 Endangered Species Act. As of October 2007, the dwarf wedgemussel
(Alasmidonta heterodon), smooth coneflower (Echinacea laevigata), and harperella
(Ptilimnium nodosum) .are listed as federally protected species in Granville County.
Please note that the bald eagle (Haliaeetus leucocephalus) was recently delisted. The UT
to Ledge Creek at Site 3 is small and within the headwaters of its drainage system.
Therefore, it does not provide suitable habitat for mussel fauna, nor do they provide
suitable habitat for harperella. Otha Mangum Road is not adjacent to nor is it surrounded
by open water suitable of supporting foraging habitat for the bald eagle. As being
adjacent to a large managed area for rare plants, the roadway shoulders along Otha
Mangum Road do provide some habitat for smooth coneflower. Therefore the entire
project limits were searched by a `plant by plant' survey for the presence or absence of
smooth coneflower by NCDOT biologists on 07/19/07. No specimens were observed.
Additionally, a review of the Natural Heritage Program database (last updated July 2007)
revealed no occurrences of protected species within the project limits. Therefore, based
on lack of suitable habitat observed during the site visit and the NHP database review,
biological conclusions of No Effect have been rendered for each of these species.
Historical Compliance
This project has been screened by all pertinent parties to ensure historic compliance.
Summary
NCDOT proposes to upgrade and pave SR 1124 (Otha Mangum Road) in Granville
County. Permanent and temporary impacts to surface waters are proposed. Additionally
temporary concurrent dewatering is proposed at Site 3. The project will also involve
impacts within protected buffers within the Neuse River Basin.

4
Application is hereby made for a NCDENR-DWQ Section.. 401 Water Quality
Certification (WQC) No. 3627 and riparian buffer authorization for above-described
activities. An automated payment procedure has 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 procedure will provide payment to
the NCDWQ by charging the permit application fee of $200.00 directly to the appropriate
NCDOT WBS element SC.039035. Apre-construction notification is attached with this
request.
Per General Condition 27 [Notification provision], the USAGE is not copied on this
permit request. The proposed activities meet the conditions of the Department of the
Army Section 404 Nationwide Permit (NWP) 14 and the proposed impacts do not exceed
the 1/10 acre of loss of Waters of the United States. Additionally this project does not
involve impacts to a special aquatic site. Therefore we intend to comply with all
applicable NWP conditions during construction of this project, working under NWP 14
with no notification required to the USAGE.
If you have any questions or need additional information, please contact Ms. Heather
Montague at [phone].
Sincerely,
~~ ~ t~
J.W. Bowman, P.E.
Division Engineer
cc: Ms. Tasha Johnson, NCDOT District 2 Engineer
Mr. Mike Harris, NCDOT Granville County Maintenance Engineer
Mr. Tim Robbins, NCDOT Roadside Environmental Field Ops Tech

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Phot~grapl~ ~~ . ~~~ew of Site 1 looking W towards Old 75, pond is on left ha~~d side of picture.
SR 1124 Otha Mangum -Granville County

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Photograph 3. View of Site 2 dry cross line outlet, buffers surrounding pond.
SR 1124 Otha Mangum -Granville County
Photograph 2. View of Site 2: dry cross line outlet looking S towards pond.

SR 1124 Otha Mangum -Granville County
Photograph 4. View of Site 3: scow hole, looking upstream at outlet of su~~ x~r.
Photograph 5. View of Site 3 downstream of scour hole, very smart cnannei.

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Photograph 6. View of Site 4 looking'E towards SR 1215, pond is on right hand side of picture.
SR 1124 Otha Mangum -Granville County
Photograph 7. View of Site 4 looking S towards Yond, up niu trom pipe inlet.

Photograph 8. View of Site 5 looking E towards SR 1215, pond is on right hand side of picture.
SR 1124 Qtha Mangum -Granville County
Photograph 9. View of Site 5 looking S up hill from pipe inlet towards cond.

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Project Study Area
SR 1124 Otha Mangum Road
Granville County
USDA-SCS (1992}
Figure 2 1:24,000

Note:
,;)":-;;, Proposed rip rap
-ETF Existing Transporation Facility
SITE
STA 13+65
SR 1124 Otha Mongum Rd
T ephemeral channel
(no Jurlsidictional stream)
r
. '
r ~
W (219 SF)1 ~ (331 SF)1 (331 SF)1 ~ (219 SF)1 W
N - N
ETF ' ETF
~~
~~
- ~ r - - - - - - - - - - - - - - - - - - - - - - - - - - -
22fit~gravel ~~ 52ft 20fit~paved 60fit
proposed
roadway width ;; p)pe roadw~y width right-of-way
- - -~_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _'z = _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _-
,~ -
ETF ETF
m i 6~
ti (352 SF)// r.~ (339 SF)1 i ~ (754 SF)// B2) (297 SF>// ~
~' - ~ i
------ ---------- --------------------- ------- -----------
~ephemeral channel
~ (no Jurisid)cttonal stream)
_-
U ~~ - -~
~~'~ `.
POND ~~
~ -
~ -
~~ ~
`` _ /' ~,
~ _ _ _ J

SITE I - Construction Plan
SR 1124 Otha Mangum Road
Granville County
Figure 3
I" = 30"
0/02/07
/ /

Note:
,:i ;-;;~ Proposed rip rap
-ETF Existing Transporotion Facility
SITE 2
STA 25+83
Sit 1124 Otha Mongum Rd
ETF
~~
------------- --
22ft~gravel ~~ 52ft 20ft~paved
~~ proposed roadway width
roadway width pipe
~~
- - _ - - - - - - - - - - - ~ r _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
r -+l----------------------------
T~ r~
.~
FTF ~~ ETF
dry crossllne
•~ ,~
r~ >~
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POND I
I
I
I
I
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i
60ft
right-of-way
m
1
a

SITE 2 - Construction Plan
SR 1124 Otha Mangum Road
Granville County
Figure 4
I" = 30"
10/02/07
-ETF

Note:
SITE 3
STA 87+16
SR 1124 Otha Mangum
ETF-
Placement
for
„r;,a;;) Proposed rip rap
® Fill In Surface Waters
-ETF Existing Transporation Facility
Placement of Impervious dike ~ Proposed stone for repair
for dewatering
Rd
(19ft~
stream
W impact)~~
rN W
N ~
____________ N --------- --------------~1
1 (84 SF)1 I (178 SF)1
repair /
r scour I
i~ ~ hole
~~sbsV~
~ N
~~ N
-- -------------------------------------E TF-----------------
~ (178 SF)1 (84 SF)1
_"r _
~~
~~
~~
FrF
roadway width ~ ~ pipe roa w ~y right-of-way
_~~
~~
~~ ETF
22ft~gravel 60ft 20ft paved 60ft
proposed d width
/ (84 SF)1 ~- (210 SF)// ,~,~,~-,~-,~si~.q~,
-~ ---------- ---------------- q---------- r~ `~
N _
/
channel shift
(41ft of stream loss)
of impervious dike
dewatering
SITE 3 - Construction Plan
SR 112q Otha Mangum Road
Granville County
Figure 5 I" = 30"
10/02/07
(116 SF)1 (76 SF)1
------ ---------- ----------------------------------------------------
---(206 SF)// w m
N N

Note:
;;r";-;;) Proposed rip rap
-ETF Existing Tronsporation Facility
SITE 4
STA 99+86 ~
SR 1124 Otha Mangum Rd ephemeral channel
1 ' ~ (no )urisidlctional stream)
v : \ ~
m ~ , ~ w
---------- ---------------- ---------
"' (162 SF>1 (275 SF>1 ~ ~ (275 SF>1 - (162 SF)1
ETF- - - - - - - - - - - - - - - - - - - = 1= - - - - - - - - - - - - - - - - - - - - - - - - - - - ETF
22ft~gravel 20ft~poved 60ft
60ft
roadway width proposed roadw ~y width right-of-way
' pipe
_ _ _~_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ T1~- _ - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
ETF ~ (90 SF)1 ~ (152 SF)1 ~n.~ (152 SF)1 ~ (90 SF)1 ~ E T F
_______________ N~_________ ~______________; ~______________ ~__________N ________________________________________________.
1 ~ ~ I ~
> 1
> 1
ephemeral channel
(no Jurlsidicttonal stream)
POND
SITE 4 - Construction Plan
SR 1124 Otha Mangum Road
Granville County
Figure 6 i" = 30"
10%02/07

Note:
~;;r";r;;) Proposed rip rap
-ETF Existing Transporation Facility
SITE 5
STA 105+68
SR If24 Otho Mangum Rd
ephemeral channel
tno Jurisidictional stream)
> ,
> '
. ~ti
W (245 SF)1 m (438 SF)1 :~ (438 SF)1 w (245 SF>1 W
N N ~~ N
ETF ETF
---~_____ _____________;i 52ft =___________= 20fit~paved===
22fit gravel ;; 60ft
~~ proposed roadway width
roadway width ;; pipe ~ right-of-way
~~
- - - - - - - - - - - - - 1~ - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
ETF ETF
~ W (1637 SF)// a' ~
ti (442 SF)// ~' (540 SF)1 ~~ ephemeral channel N (631 SF)// N
T ~ tno Jurisidtctional stream)
_---------"1
~----
~ ~
~' ,
POND 1
,1
,1
,1
,\
~~ ~
SITE 5 - Construction Plan
SR 1124 Otha Mangum Road
Granville County
I" = 30"
0/02/07
~ i

Office Use Only:
USACE Action ID No.
Form. Version March OS
2 0 0 7 1 7 2 8
DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. Processing
l . 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:_ non-reporting NWP 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 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: NCDOT Division 5 J. W. Bowman
Mailing Address: 2612 N. Duke St. Durham NC 27704
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: wbowman(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 9

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.
Name of project: Proposed u rading_and paving SR 1124 (Otha Mangum Road) in
Granville County.
2. T.I.P. Project Number or State Project Number (NCDOT Only):_
WBS Element No SC.039035
3. Property Identification Number (Tax PIN): N/A
4. Location
County: Granville Nearest Town: Butner
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): From I-85 N, take the
Hwy 56 Exit (Exit 191 Butner/Creedmoor Exit). At the top of the ramp, make a left onto
Hwy 56 and travel West towards Butner. Once you cross back over I-85, take the first right
(by Hardee's) onto SR 1215 W. Lyon Station Rd. Travel North approximately 2.0 miles and
make a left onto SR 1124 Otha Mangum Road.
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):
Site 1:36.1883°N 78.7372°W
Site 2: 36.1861 °N 78.7344°W
Site 3: 36.1732°N. 78.7254°W
Site 4: 36.1741 °N 78.7214°W
Site 5: 36.1740°N, 78.7193°W
6. Property size (acres): 13.67 acre (Project is 1.88 mi long)
Name of nearest receiving body of water: Sites 1, 3, 4, S=UTs to Ledge Creek
Site 2 = UT to Picture Creek
Page 2 of 9

8. River Basin: Neuse
(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 1124 (Otha Mangum Road). The NCDOT will also
dewater Site 3 if necessary. Rip rip armoring will be used to stabilize stream and/or channel
banks and fill slopes as necessar~EcLuipment may include excavator backhoe bulldozer
~-ader, and crane.
11. Explain the purpose of the proposed work: The project is part of the secondary road paving
program. The existing_~ravel 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. 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
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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: Existing_pipes will be replaced and
channel banks and/or stream banks will be armored as necessary for stabilization. Site 3 will
be dewatered if necessarydurin~ construction.
2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/dranage, etc. For dams,
ePr~aratPly list imnactc l1nA to tenth Rtn1Ct11rP, and flnCl(jin~_
Located within Distance to Area of
Wetland Impact Type of Wetland 100-year Nearest Impact
Site Number Type of Impact (e.g., forested, marsh, Floodplain Stream (acres)
(indicate on map) herbaceous, bog, etc.) (yes/no) (linear feet)
N/A N/A N/A N/A N/A N/A
Total Wetland Impact (acres) N/A
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 acreage, multiply length X width, then divide by 43,560.
Stream Impact
Perennial o Average Stream
Impact Length Area of
Number Stream Name Type of Impact ~
Intermittent Width Before
(linear feet) Impact
(indicate on ma) . Im act (acres)
1.0
Site 3 UT to Fill at Inlet Intermittent 41 0.0009
Ledge Creek (channel shift)
Fill at Outlet
19
(repair scour) 0.0004
25
Rip Rap armoring (25ft 0.0006
at Inlet overlapping)
Rip Rap armoring 15 0.0001
at Oultet (1 Oft extra
overla in
Temporary 65 0.0014
dewatering concurrent
Total Stream Impact (by length and acreage) 65 0.0014
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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
Name of Waterbody Type of Waterbody Area of
Site Number (if applicable) Type of Impact (lake, pond, estuary, sound, bay, Impact
(indicate on map) ocean, etc.) (acres)
N/A
Total Open Water Impact (acres) N/A
6. List the cumulative impact to all Waters of the U.S. resulting from the protect:
Stream Impact (acres): 0.0014
Wetland Impact (acres): NONE
Open Water Impact (acres): NONE
Total Im act to Waters of the U.S. (acres) 0.0014
Total Stream Im act (linear feet): 65
7. 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 USAGE.
N/A
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.): 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. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It maybe 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
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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 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 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.
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
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.
Unavoidable parallel impacts to protected riparian buffers within the Neuse River Basin will
be miti atg_ed by using EEP. All compensatory mitigation requirements will be assimilated on
a quarterly basis and provided to the Ecosystem Enhancement Program (EEP) for their
acceptance.
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
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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 http://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): N/A
Amount of buffer mitigation requested (square feet): 12,116 SF
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)
1. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) 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.
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 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 )? Yes ® No ^
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.
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Site Zone 1
Impact
(sq ft) Minus
Wetlands
in Zone 1
(sq ft) =Zone 1
Buffers (not
wetlands)
(sq ft) Zone 1 Buffer
Mitigation
Required
(3:1 ratio) Zone 2
Impact
(sq ft) Minus
Wetlands
in Zone 2
(sq ft) =Zone 2
Buffers (not
wetlands)
(sq ft) Zone 2 Buffer
Mitigation
Required
(1.5:1 ratio)
1 1,001 0 1,001 N/A 43 8 0 43 8 N/A
lb 754 0 754 2,262 649 0 649 973
2b 0 0 0 0 742 0 742 1,113
3 472 0 472 N/A 328 0 328 N/A
3b 416 0 416 1,248 0 0 0 0
4 854 0 854 N/A 504 0 504 N/A
5 1,416 0 1,416 N/A 490 0 490 N/A
Sb 1,637 0 1,637 4,911 1,073 0 1,073 1,609
Totals 6,550 0 6,550 8,421 `, 4,224 0 4,224 3,695
#- perpendicular impacts
b- parallel impacts
* N/A =Impact is "allowable" without mitigation as per table of uses.
Total Buffer Impact for Project: 10,874 square feet
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. EEP payment
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 froth
the property. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. ExistingL 5.01 acre impervious surface (avg 22
foot wide gravel road) of 13.67 acre total proiect size. Proposed: 4.55 acre impervious surface
(proposed 20 foot wide asphalt paved road) of 13.67 acre total project size. The new impervious
surface is 0.46 acre less than existing. All areas not paved will become vegetated shoulders, ditches
and back slopes
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.
This protect 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
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XIV. 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
l~ttp:/,~h2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description:
Up r~ adin~ this dirt road will not result in additional development.
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).

~ V Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 9 of 9