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HomeMy WebLinkAbout20080543 Ver 1_Application_20080326y ,,. STwi[ N d .w ° ~o ~ ~.. •@ ~.:.~• STATE OF NORTH CAROLINA DEPARTMENT OF TRANSPORTATION MICHAEL F. EASLEY LY"NDO TIPPETT GOVERNOR SECRETARY March 18, 2008 N.C. Division of Water Quality Transportation Permitting Unit 2321 Crabtree Blvd./Suite 250 O ~ o ~ 4 3 Raleigh, NC 27604-2260 Attention: Mr. Rob Riding, NCDOT Project Coordinator Subject: Secondary road improvements to SR 1506 (Vaughan Ginn Road) from SR 1507 to end of state maintenance in Warren County. WBS element SC.093043. The North Carolina Department of Transportation (NCDOT) proposes to upgrade and pave SR 1506 (Vaughan Ginn Road) from SR 1507 to end of state maintenance in Warren County (Figure 1 - 3). Total project length is 0.7 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 1506 is scheduled to be paved as part of the Secondary Roads Construction Program. Impacts to Waters of the United States Site 1- The project crosses a perennial stream, UT to Big Branch, [NCDENR-DWQ Index No. 28-79-25-3, Best Usage Classification C NSW'; HUC 03020102] in the Tar Pamlico River Basin. The existing structure conveying the creek is an 18-inch pipe that is 30 feet long (see Photographs 1 and 2). This pipe will be replaced with a 36-inch pipe that is 60 feet long. Permanent impacts at the site associated with the pipe replacement total _ 30ft of surface water fill, plus a total of 20 feet of ri rap is proposed along the stream banks. The work zone at this site will be temporarily dewatere for approximately 3 days. As necessary, to maintain water flow during construction, water upstream of the sandbags wiil 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. Once the stream has been dewatered, the pipe will be replaced. Il~~~ ,. ~~~~ ~~,~Q ~~~,x ~~ ..ro,,,~ Q~~g~~ry,• "may Division 5, 2612 N. Duke Street, Durham, NC 27704 Phone: (919) 220-4600 Fax: (919) 560-3371 2 Temporary concurrent impacts to the stream from this activity will result in dewatering 50 linear feet of .stream. The materials used for dewatering will be removed after construction. Site 2- The project crosses a perennial stream, UT to Big Branch, [NCDENR-DWQ Index No. 28-79-25-3, Best Usage Classification C NSW; HUC 03020102] in the Tar Pamlico River Basin. The existing structure conveying the creek is a 30-inch pipe that is 37 feet long (see Photographs 3 and 4). This pipe will be replaced with a pipe that is 60 feet long. Permanent impacts at the site associated with the pipe replacement tota 23ft of surface water fill, plus a total of 20 feet of rip rap is proposed along the stream banks. The work zone at this site will be temporanl-y -dewatered for approximately 3 days. As necessary, to maintain water flow during construction, water upstream of the sandbags 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. Once the stream has been dewatered, the pipe will be replaced. Temporary concurrent impacts to the stream from this activity will result in dewatering 43 linear feet of stream. The materials used for dewatering will be removed after construction. Riparian Buffer The activities at both sites involve road crossings of a stream that is subject to the Tar Pamlico River Buffer Rules. The intermittent tributaries to Big Branch, at Site 1 and at Site 2, are depicted on the most recent version of the Macon (USGS 1970) topographic quadrangle (Figure 1). Construction impacts at Site 1 total 1_818 ft2 in Zone 1 and 1,225 ft2 in Zone 2 (totaling 50 lft of riparian buffer impacts). Construction impacts at it~2 total 1,421 ft2 in Zone 1 and 924 ft2 in Zone Z (totaling 43 lft of riparian buffer impacts). Waters of the U.S. 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 Mitigation: Due to the minimal impacts proposed, no mitigation requirements are anticipated. Therefore, NCDOT proposes no compensatory mitigation. Protected Species Plants and animals with federal classifications of Endangered, Threatened, Proposed Endangered and Proposed Threatened are protected under provisions of Section 7 and Section 9 of the ESA.. As of March 2008, there are two federally protected species listed for Warren County. They include dwarf wedgemussel (Alasmidonta heterodon) and the Tar spinymussel (Elliptio steinstansana). The intermittent streams at these pro}ect sites are small and within the headwaters of it's system and does not provide suitable habitat for mussel fauna. Please note that the bald eagle (Haliaeetirs leucocephahss) was delisted as 3 of August 20, 2007 and is no longer protected by the Endangered Species Act. It is however, protected under the Bald and Golden Eagle Protection Act. This project will have no effect -~ on the bald eagle since no habitat is present in the project area. Additionally, a review of the Natural Heritage Program database (last updated February 2008) revealed no occurrences of protected species within the project area. Therefore, based on lack of suitable habitat observed during the 02/12/08 site visit and the NHP database review, biological conclusions of No Effect have been rendered for each species. Historical Compliance This project has been screened by all pertinent parties to ensure historic compliance. A no comment-no historic properties clearance was received from Renee Gledhill-Earley with the NCSHPO, dated 03/25/04. Summary 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 5C.093043. Apre-construction notification is attached with this request. Per General Condition 27 [Notification provision], the USACE is not copied on this permit request. The proposed activities meet the conditions of the Department of the Anny 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 USACE. If you have any questions or need additional information, please contact Ms. Heather Montague at (919)220-4632. Sincerely, J.W. Bowman, P.E. Division Engineer cc: Mr. Steve Winstead, NCDOT District 3 Engineer Mr. Dannie Sledge, NCDOT District 3 Construction Crew Mr. Tim Robbins, NCDOT Roadside Environmental Field Ops Technician Photograph 1. View of Site 1 above pipe inlet, looking East. Photograph 2. View of Site 1 below pipe outlet, looking West. SR 1506 (Vaughan Ginn Road) -Warren County .~~ ,° .: ~~ Photograph 3. View of Site 2 above pipe inlet, looking East. ~',r ~ is^. ~a, '. Ji ~_ .: .wy'~ .J+~' ~~. .. ~4`~~~ > ,. ~,.. _ '.`ice Photograph 4. View of Site 2 below pipe outlet, looking West. ~~~ °~'~ .. ,- `'~`. ~~ -'~` s- • , .: •~ w -~' SR 1506 (Vaughan Ginn Road) -Warren County ~ ~ ~. ~ / ~ w - /' ~-- ~ ~~ ~ ~../`~ ~ ~ ~~ 1 ~ 3aa r ~ ~'' ,. -~ , G .- - . , 1, `,~. ~ , ., ~, ~ r -. ~' }~ JJ.6 j .,m '` ~ Ss ' ..- f' i--mot \\v, ~~ `v ' ~~ • . _._ _ ' ~~ ~ ' i ~' ~ ~~€1 - J~~ ~ ~ _ ; 9t, 31 t 34 sf i ail r . 318 ;~ ~ ~`_' i ~ ~ n ~~ ~ ~ ~~~ ~ ~ f,~. ,~~ 94l i.. ~ ! _ , \ •__I ~ ~laR~ •~R i t i ~ / l° :,q a ~ ilk` ".,. • , ' ~ ~ i > d , '~' ill > ~~ than • ' 1 r ~ ~ ` SITE ~ ~~' ~ ~. .. .~ ~ .~.. .. ~~~ .:;~~ +Y~Ri]~ 3~` L ~~ , ~~ - ~ ~~ 1 ~ ~ ~~, , ;;, ~ j ,n"f/66 SITE 2 (Paji. 3c6 ~q,r , , ., ~ , ,... . ~ ryrq(h :~ ,- t ._. C I „' , ~ ~ 4 *1 .,: ~ r, ./' ,: , .~~ .l ~'"' `SEAS _qR[f ~- ~ `]58 , O ~ ~ "' {t w . l ,,; i _ 1 ~, ~ •~ ~~ ~~ ~ , - ~ /~ ar..~--" `-n , ., /'j ?. l _~ ~z ~ • 1 7 _ / ~.. i ; ~~/„ r `~ ~ x.736 k e > ~ „ "- 7 , _ ~ ~ . ' ~ ;~ ~ ~o . ~,.._ _ , ~ ~ w ,, , ~ ~~ ._ ~ ~. FI' J<6 ~ ~~ ~~~ ~~ ~ ~ _ ~ i Y - i; (~ is .~f ,, , r; p / ~ ' ~ / .. ? ~" {`til,,,.-* \ f (" '. ` ~ . __ j W. "'" r- _ .. ~, -.. J ' , ... JGil ~ ~ ~ ` ,; ~ ~ > ~ •, ~--~ .,,~ ~ ~ .~_ ~ ~ ~ /) a __ /~ ~ ~~~ ~ 4 ~ i .~ ' , r_ ., t i ~ .r'? /~ f 1~J 66 i ~ ,' f , • + } i; ~ r' ~ ~ f , ~. l // y ~ '~ ~~, ~ ./ ~~ ,- /~ .. f .. ,.. ` ~ - • ;. ~ ;~ ~ , ~. ~ I ~ , t _ ~ N ~ ,.. ~I ~ !~,; ~, - - ,• ~ ti. ~ ;~, ~', Copyright (C) 1998, Maptech, Inc. • Note: Placement of impervious dike fior dewatering , i~ o' m ISft fill N N ETF ~ 1 60ft ROW 14#t~gravel road y y width - - - - - - - - - - - - - - - - - - - - J E= T F ---; ' W W N N ~ rv - 15ft fill ': _~ i~ l~I ~~ ~ W W N N ,;r":-;;~ Proposed rip rap ® Fill In Surface Waters -ETF Existing Transporation Facility ' ' ETF ---------------_ 20fit~Paved -- roadway width ETF Q7 N ______________ N_____ i _____~_ Placement of impervious dike fior dewatering SIT~F i ,-, Construction Plan SR 1506 Vaughan Ginn Road Warren County Figure 2 I" = 30" 03/17/08 J Note: ~;;,",-;;, Proposed rip rap ® Fill In Surface Waters -ETF Existing Transporation Facility Placement ofi impervious dike for dewaterfng i \/ >~ 00 w ISft filll N N N ETF - - - - - - - - - - - - 60ft ROW 14ft~gravel ~~ roadway width ~~ ETF ///~.] ~ Sft fill 1 1 1 i~ r~ r ~ X ~~, •r i ~ W ~ N X X X Fence Line ETF - - - - - - - - - - - - - - - - 20ft~paved - _ ---------------- roadway width W w N N ______________ _________ N____ Placement of Impervious dike fior dewaterfng ETF SITE 2 - Construction Plan SR 1506 Vaughan Ginn Road Warren County Figure 3 I" = 30" 03/17/08__) OfflCe USe Only: Fvnn Version March 0~ USACE Action ID No. DWQ No. 2 0 0 8 0 5 4 3 (If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".) I. Processing 1. Check all of the approval(s) requested for this project: ® Section 404 Permit ® Riparian or Watershed Buffer Rules ^ Section 10 Permit ^ Isolated Wetland Permit from DWQ ® 401 Water Quality Certification ^ Express 401 Water Quality Certification 2. Nationwide, Regional or General Permit Number(s) Requested: NWP 14 (non-resorting) 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: NCDOT Division 5, J.W. Bowman Mailing Address: 2612 N. Duke St. Durham NC 27704 Telephone Number:~919) 220-4600 Fax Number: (919) 560-3371 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: Fax Number: E-.nail Address: Page 1 of 8 III. Project Information Attach a vicinity map clearly showing the location of the property with respect to local landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property boundaries and development plans in relation to surrounding properties. Both the vicinity map and site plan must include a scale and north arrow. The specific footprints of all buildings, impervious surfaces, or other facilities must be included. If possible, the maps and plans should include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion, so long as the property is clearly defined. For administrative and distribution purposes, the USAGE requires information to be submitted on sheets no larger than 11 by 17-inch format; however, DWQ may accept paperwork of any size. DWQ prefers full-size construction drawings rather than a sequential sheet version of the full-size plans. If full-size plans are reduced to a small scale such that the final version is illegible, the applicant will be informed that the project has been placed on hold until decipherable maps are provided. 1. Name of project: Proposed replacement of structures conveying unnamed tributaries to Big Branch on SR 1506 (Vaughan Ginn Road) in Warren County. 2. T.LP. Project Number or State Project Number (NCDOT Only): WBS Element SC.093043 3. Property Identification Number (Tax PIN): N/A 4. Location County: Warren Nearest Town: Vaughan Subdivision name (include phase/lot number): N/A Directions to site (include road numbers, landmarks, etc.): From the west side of Vaughan on US Hwy 158 take SR 1506 (Vaughan Ginn Road) South crossing over SR 1507 to reach unpaved portion of SR 1506. 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: 36.4248 °N 78.0039 °W Site 2: 36.4211 °N 78.0037 °W 6. Property size (acres):_5.1 (0.7 mile long_Rroject, with 60ft ri t-of--way) 7. Name of nearest receiving body of water: UT to Big Branch 8. River Basin: Tar Pamlico (Note -this must be one of North Carolina's seventeen designated major river basins. The River Basin map is available at httpa/h2o.enr.state.nc.us!adminimaps!.) 9. Describe the existing conditions on the site and general land use in the vicinity of the project at the time of this application: Site is surrounded by agricultural and wooded land. Page 2 of 8 10. Describe the overall project in detail, including the type of equipment to be used: The NCDOT will replace the existing_pipes with new Wipes: one that is 30 ft loner at Site 1 and one that is 23 feet longer at Site 2. Rip rap armoring will be added to the ends of the pipes at both sites. The NCDOT will also dewater the work sites during construction Equipment may include excavator, backhoe, bulldozer, grader and crane. 11. Explain the purpose of the proposed work: The existing structures are short and do not allow for adequate shoulder widths. 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 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: The NCDOT will replace the existing_pipes with new pipes that are longer pipe and add rip rap armoring_ at both ends. The NCDOT will aiso dewater the work zone during construction. 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 strucuare and flooding. Page 3 of 8 Wetland Impact Type of Wetland Located within Distance to Area of Site Number Type of Impact (e.g., forested, marsh, 100-year Nearest Impact (indicate on map) herbaceous, bog, etc.) Floodplain Stream (acres) i (yes/no) (linear feet) NiA N/A N/A N/A N/A N%A Total Wetland Impact (acres) NIA 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 or Average Impact Area of Number Stream Name Type of Impact Intermittent? Stream Width Length Impact (indicate on map) Before Impact (linear feet) (acres) Site 1 UT Big Branch Fill (piped length) Intermittent 2.0 30 0.0013 ~ Rip rap armoring 20 0 0009 Along stream bank . Temporary dewatering 50 conc 0.0022 2.0 Site 2 UT Big Branch Fill (piped length) Intermittent 23 0.0010 Rip rap armoring 20 0 0009 Along stream bank . Temporary 43 conc 0019 0 dewatering . Total Stream Impact (by length and acreage) 93 0.0041 ~. 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 ma) ocean, etc.) (acres) N/A Total Open ~~ ater Impact (acres) tiJA Page 4 of R 6. List the cumulative impact to all Waters of the U.S. resulting from the proiect: Stream Impact (acres): 0.0041 Wetland Impact (acres): NONE Open Water Impact (acres): NONE Total Impact to Waters of the U.S. (acres) 0.0041 Total Stream Impact (linear feet): 93 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. 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 may be useful to provide information related to site constraints such as topography, building ordinances, accessi'oility, and financial viability of the project. The applicant may attach drawings of alternative, lower-impact site layouts, and explain why these design options were not feasible. Also discuss how impacts were minimized once the desired site plan was developed. If applicable, discuss construction techniques to be followed during construction to reduce impacts. All wetlands and surface waters not affected by construction will be protected from unnecessary encroachment durin a constriction. Strict enforcement of Best Management Practices for the protection o+ we+lands 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. VIIL Mitigation DWQ - In accordance with i5A 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 Page 5 of 8 freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial streams. USAGE - 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 USAGE 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/strm~ride.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. Due to the minimal impacts associated with this project no mitigation requirements are anticipated. Therefore, no mitigation is pro op sed• 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 (919) 715-0476 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:/i~2o.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): N/A Amount of Riparian wetland mitigation requested (acres): N/A Amount ofNon-riparian wetland mitigation requested (acres): N/A Amount of Coastal wetland mitigation requested (acres): NiA Page 6 of 8 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 (919) 733-5083 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 zane of the riparian buffers. If buffer mitigation is required calculate the required amount of mitigation by applying the buffer multipliers. Site 1 Zone* Impact (square feet) Multiplier Required Mitigation 1 1,818 3 (2 for Catawba) N/A 2 1,225 1.5 N/A Total 3,043 N/A '~ Gone I extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an additional 20 feet from the edge of Zone 1. Site 2 Zone* Impact (square feet) Multiplier Required Mitigation 1 1,421 3 (2 for Catawba) N/A 2 924 1.5 Ni A Total 2,345 NJA ~` Zone I 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 l . Page 7 of 8 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 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 level. Existing: 1.2 acre impervious surface (av~ 16 foot wide gravel road) of 5.1 acre total project size. Proposed: 1.7 acre impervious surface (proposed 20 foot wide asphalt paved road) of 5.1 acre total project size. The erosion control plan for this protect is designed for 3600 cubic feet of storage per acre. Erosion and sediment control devices along the project are comprised of temporary silt basins, temporary rock silt checks, rock pipe inlet sediment traps, and temporary silt fences. 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 project will not generate wastewater. XIII. Violations (required by DWQ) Is this site in violation of DWQ Wetland Rules (1 SA NCAC 2H .0500) or any Buffer Rules? Yes ^ No Is this an after-the-fact permit application? Yes ^ No 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 http:'lh2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description: This secondary road project 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). ~,~~ "~~ .~iw~i~- a ~ ~ t tI ~ ~ 8 ~JApplicant/Agent's Signature Date (Agent's signature is valid only if an authorization letter from the applicant is provided.) Page 8 of 8