20072018 Ver 1_Application_20071211

Office Use Only:
USACE Action ID No.
(If airy particular item is not
L Processing
DWQ No.
to this project, please enter
-7 Form Version March OS
l /~~(~ ~t.U~S
or "N/A".)
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: 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
1. Owner/Applicant Information -
Name: Greg Burns. P E / NCDOT /Acting Division Engineer
Mailing Address: Boa 1150
Favetteville. NC 28302
Telephone Number: 910-437-2611 Fax Number: 910-486-1959
E-mail Address: gburnsna,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: James J. Rerko PWS
Company Affiliation: NCDOT /Division Environmental Officer
Mailing Address: Bog 1150
Favetteville. NC 28302
Telephone Number: 910-437-0208 Fax Number: 910-486-1959
E-mail Address: iirerko andotstate nc us
Updated 11/1/2003
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. ff possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and MRCS 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: NC 41 from SR2110 to SR 1004
2. T.I.P. Project Number or State Project Number (NCDOT Only): R 5017 WBS#41519
3. Property Identification Number (Tax PIN):
4. Location
County: Robeson Nearest Town: Lumberton
Subdivision name (include phase/lot number):
Directions to site (include road numbers/names, landmarks, etc.):Travel south I-95 to exit
22. NC 211. Travel along NC 211 aagrogimately 3 miles. turn left onto NC 41 Project
be ins at the end of the eaistin~ three-lane section
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): 34.6459 °N 78.9241 °W
6. Property size (acres): 38 acres
7. Name of nearest receiving body of water: Jackson Swamp
8. River Basin: Lumber River
(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/adminlmaps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: NC 41 is a 24 foot wide arterial roadway with a mig of
commercial. residential and aQricultrual uses
Updated 11/1/2005
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10. Describe the overall project in detail, including the type of equipment to be used: NCDOT
proposes to provide two foot paved shoulders and three turn lanes to reduce traffic
hazards. The typical equipment necessary to complte the work consists of front end
loaders, graders, trackhoes .dump trucks and eventually a saving machine.
11. Explain the purpose of the proposed work: To improve safety along the NC 41 corridor.
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.Richard Spencer (COE) and Ken Averitte fDWO) reviewed the
ro'ect 08/29/07
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.
None
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.
Updated 11/1/2005
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Provide a written description of the proposed impacts:Permit Site #1 consists of
lengthening the existing culvert 18.01 feet and alacement of fill material within 0.022
acres of wetlands. Permit Site #2 will lengthen the existing SOLF 18" RCP by 30
additional feet to accommodate a turn lane.
2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
separately list impacts due to both structure and flooding.
Wetland Impact
Site Number
(indicate on map)
Type of Impact Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.) Located within
l00 Y~
Floodplain
es/no Distance to
Nearest
Stream
'ear feet Area of
Impact
(acres)
Permit Site #1 Fill Bottomland Hardwood Yes 0 if 0.022

Total Wetland Impact (acres) 0.022
3. List the total acreage (estimated) of all existing wetlands on the property:0.022 acres
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 ~~~
Number
indicate on ma
Stream Name
Type of Impact Perennial or
Intermittent? Average
Stream Width
Before Im ct Impact
Length
'ear feet Area of
Impact
acres
Permit Site #1 Jackson Swamp Culvert Perennial 15 ft 18.01 0.006
Permit Site #1 Jackson Swamp Rip-rap Perennial 15 ft 30 0.013
Permit Site #2 UT to Jackson Sw Culvert Intermitten 4 ft 30 0.002

Total Stream Impact (by length and acreage) 78.01 0.021
5. Individually list all open water impacts (including lakes, .ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U. $.). Open water impacts include, but are not limited to
fill, excavation, dredging, floodins~, drainage, bulkheads. etc.
Open Water Impact Name of Waterbody Type of Waterbody Area of
Site Number (~ applicable) Type of Impact (lake, pond, estuary, sound, bay, Impact
indicate on ma) ocean, etc. acres
Updated 11/1/2005
Page 4 of 8

Total Open Water Impact (acres) N/A
6. List the cumulative impact to all Waters of the U. S. resulting from the nr~iect~
Stream Im act acres : 0.021
Wetland Im act acres : 0.022
O en Water lm act acres : N/A
Total Im act to Waters of the U. S. acres 0.043
Total Stream Im act linear feet : 78.01
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 USACE.
8. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ^ uplands ^ stream ^ wetlands
Describe the method of construction (e.g., daln/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Current land use in the vicinity of the pond:
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
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.The culverts on this project
were lengthened in order to provide a safe condition for the traveling public Minimal
work is proposed in the permit site locations
VIII. Mitigation
Updated 11/1/2003
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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 (see DWQ website for most current
version.).
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.
Mitigation is not required
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 http://www nceep net/pages/inlieureplace 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):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount ofNon-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Updated 11/1/2005
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IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure. of public (federaUstatellocal) funds or the use of
public (federaUstate) land? Yes ® No ^
2. ff 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 cleazly 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 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 multinliers_
Zone* ~~~ Required
uare feet) Multiplier Miti lion
l 3 (2 for Catawba)
2 1.5
~ Total ~ I
' Zone 1 exterxis out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additiona120 feet from the edge of Zone I.
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. __
Updated 11/1/2003
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XI. Stormwater (required by DWQ)
Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss
stormwater controls proposed in order to protect surface waters and wetlands downstream from
the property. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious levelAn Erosion and Sedimentation Control Plan
has_, been developed for this aroiect and the NCDOT will utilize standard BMIP's
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.
NIA
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 ^
X1V. 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
httn://h2o.enr state nc us/ncwetlands. If no, please provide a short narrative description:
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).
~.
ApplicandAgent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Updated 11/1/2003
/2 ' 7-02
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