20060324 Ver 1_COMPLETE FILE_20060327

\ NA TF9O Nlichacl F. Easley, Governor
61 William G. Ross Jr., Secretary
'in P North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
March 9, 2006
DWQ Project # 06-0324
Person County
Mr. Thomas Warren, Jr., Assistant City Manager
City of Roxboro
P. O. Box 128
Roxboro, NC 27573
Subject Property: City of Roxboro: Depot Street Sewer
Ut to Marlowe Creek [030205, 22-58-12-6, C]
Approval of 401 Water Quality Certification with Additional Conditions
Dear Mr. Warren:
You have our approval, in accordance with the attached conditions and those listed below, to place fill
within or otherwise impact 30 linear feet of stream for the purpose of sewer outfall relocation at the
subject property, as described within your application dated February 17, 2006 and received by the N.C.
Division of Water Quality (DWQ) on February 27, 2006. After reviewing your application, we have
decided that the impacts are covered by General Water Quality Certification Number(s) 3374 (GC3374).
The Certification(s) allows you to use Nationwide Permit(s) 12 when issued by the US Army Corps of
Engineers (USACE). In addition, you should obtain or otherwise comply with any other required federal,
state or local permits before you go ahead with your project including (but not limited to) Erosion and
Sediment Control, and Non-discharge regulations. Also, this approval to proceed with your proposed
impacts or to conduct impacts to waters as depicted in your application shall expire upon
expiration of the 404 or CAMA Permit.
This approval is for the purpose and design that you described in your application. If you change your
project, you must notify us and you may be required to send us a new application. If the property is sold,
the new owner must be given a copy of this Certification and approval letter and is thereby responsible for
complying with all conditions. If total fills for this project (now or in the future) exceed one acre of
wetland or 150 linear feet of stream, compensatory mitigation may be required as described in 15A
NCAC 2H .0506 (h). This approval requires you to follow the conditions listed in the attached
certification and any additional conditions listed below.
The Additional Conditions of the Certification are:
1. Impacts Approved
The following impacts are hereby approved as long as all of the other specific and general
conditions of this Certification (or Isolated Wetland Permit) are met. No other impacts are
approved including incidental impacts:
Amount Approved nits Plan Location or Reference
Stream 30 linear feet PCN page 8 of 13
401 Oversight/Express Review Permits Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone]/ FAX [phone]/ Internet: htto://h2o.enr.state.nc.us/ncwetlands
N? 7l.?I?.u,L,? Carolina
N/ YNtnm!!y
p
City of Roxboro
Page 2 of 3
March 9, 2006
2. Erosion & Sediment Control Practices
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:
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.
3. No Waste, Spoil, Solids, or Fill of Any Kind
No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or riparian areas beyond
the footprint of the impacts depicted in the Pre-Construction Notification. All construction
activities, including the design, installation, operation, and maintenance of sediment and erosion
control Best Management Practices, shall be performed so that no violations of state water quality
standards, statutes, or rules occur.
4. No Sediment & Erosion Control Measures w/n Wetlands or Waters
Sediment and erosion control measures shall not be placed in wetlands or waters to the maximum
extent practicable. If placement of sediment and erosion control devices in wetlands and waters
is unavoidable, they shall be removed and the natural grade restored within six months of the date
that the Division of Land Resources has released the project.
5. Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable
Buffer Rules, and any subsequent modifications, the applicant is required to return the attached
certificate of completion to the 401/Wetlands Unit, North Carolina Division of Water Quality,
1650 Mail Service Center, Raleigh, NC, 27699-1650.
6. Anti-Seep Collar
Anti-seep collars shall be installed at intervals no less than 150 feet apart at wetland crossing #2.
Violations of any condition herein set forth may result in revocation of this Certification and may result in
criminal and/or civil penalties. The authorization to proceed with your proposed impacts or to conduct
impacts to waters as depicted in your application and as authorized by this Certification shall expire upon
expiration of the 404 or CAMA Permit.

City of Roxboro
Page 3 of 3
March 9, 2006
If you do not accept any of the conditions of this Certification (associated with the approved wetland or
stream impacts), 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, which conforms to Chapter 150B of
the North Carolina General Statutes to the Office of Administrative Hearings, 6714 Mail Service Center,
Raleigh, N.C. 27699-6714. 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 telephone Ian McMillan or Cyndi Karoly in the Central Office in
Raleigh at 919-733-1786 or Eric Kulz in the DWQ Raleigh Regional Office at 919-791-4200.
Sincerely,
11-1r, Alan W. Klimek, P.E.
AWK/ijm
Enclosures: GC 3374
Certificate of Completion
cc: Steven Bailey, Coulter-Jewell-Thames, 111 West Main Street, Durham, NC 27701
USACE Raleigh Field Office
Eric Kulz, DWQ Raleigh Regional Office
DLR Raleigh Regional Office
File Copy
Central Files
Filename: 060324CORoxboroDepotStrectSewer Person)401
Coulter Jewell Thames-
111 WEST MAIN STREET
DURHAM, NORTH CAROLINA 27701
p919.682.0368 191 9.688.5646
PI:Iii nino for t I I u Iuturc.
February 24, 2006
401 Oversight and Express Permits Unit
N.C. Division of Water Quality
2321 Crabtree Blvd, Suite 250
Raleigh, NC 27604
Re: City of Roxboro Sewer Improvements - Depot Street
Pre-Construction Notification - Neuse River Buffer Impacts
Person County, North Carolina

E F--
F7 P, ?fl
FES 2 7 ?nrl6
CENR - 'vVATE?i Ju%.Li f r
V)ETU1!-'D3 lv;p STC' ;'.9',VATER LRNICH
Please find enclosed seven (7) copies of a Pre-Construction Notification Application and associated attachments for
the City of Roxboro Sewer Improvements - Depot Street project. Also enclosed is a check for $200 to cover the
permit cost. The project will replace a section of existing gravity sewer with a new sewer. The existing sewer has
two exposed creek crossings at the area of disturbance. The new sewer will have only one crossing, and it will not
be exposed. The project includes the construction of the new sewer and the removal of the two existing creek
crossings. The Pre-Construction Notification is for a Section 404 Permit and a 401 Water Quality Certification.
Should you need additional information during review of this Project, please do not hesitate to give me a call. We
look forward to a favorable response.
Sincerely,
Coulter Jewell Thames P.A.
4 t
S even P. Bailey, P.E.
Project Engineer
Cc: Tommy Warren, City of Roxboro
3 0 3 2

E N G I N E E H I N G. P L A N N I N G . L A N D S C A P E A R C H I T E C T U R E
` tr
FEB 2 7 2006
A
Office Use Only: IYEi(At:DSFf:DSTG2t.?J?Aj ?'; rn6Vc sio3 March 05 2 4
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1
1. 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 12
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: City of Roxboro. Thomas Warren. Jr., Assistant City Manager
Mailing Address: PO Box 128. Roxboro, NC 27573
Telephone Number: 336-599-31 16 Fax Number: 336-599-3774
E-mail Address: tswarren c person. net
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-mail Address:
Page 5 of 13
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: City of Roxboro Sanitary Sewer Improvements - Depot Street Sewer
Replacement
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): 0906-19-62-9039
4. Location
County: Person Nearest Town: Roxboro
Subdivision name (include phase/lot number): NA Tax Map 11 44. Deed Book 269
Directions to site (include road numbers/names, landmarks, etc.): Take US 501 north from
Durham to Roxboro. bear right on South Main Street. turn ri?:ht on Depot Street.
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): 36.393212 ON 78.976497 °W
6. Property size (acres): Sanitary sewer easement across l+/- acre residential lot
7. Name of nearest receiving body of water: UT of Marlowe Creek to Hyco River
River Basin: Roanoke
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://Ii2o.en1-.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: There are presently two exposed sanitary sewer lines
crossing an unnamed tributarv to Marlowe Creek. These will be renlaced with a new sanitarv
sewer line under the stream and the exposed lines will be removed. The general land use in
the vicinity of the project is residential on one acre or smaller lots.
Pa,-,e 6 of 13
10. Describe the overall project in detail, including the type of equipment to be used: The
project consists of rehabilitation. repair and replacement of the existin, aced sanitary sewer
lines serving existing residences. Exposed lines will be replaced with a deeper line under the
stream. Excavators and backhoes will be used to install the sewer line.
11. Explain the purpose of the proposed work: The existing sanitary sewer line is being
replaced due to its age and exposed condition. The proposed line will serve the same
residences as the existin! sanitary sewer. which will be removed from service.
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.None.
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.
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: Approximately 30 linear feet of
stream will be disturbed due to the installation of the new sanitary sewer line under the creek
Page 7 of 13
and the removal of the two exposed lines at the same crossing point. The new crossing will
be perpendicular to the stream, while one of the two existing exposed lines is not. Ductile
iron line will be used under the stream. The stream will be restored to its existing topopraphy
and restabilized with rip rap.
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,
senarately list imnacts due to hoth structure and tloodine.
Wetland Impact
Site Number
(indicate on map)
Type of Impact Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.) Located within
100-year
Floodplain
( yes/no) Distance to
Nearest
Stream
(linear feet) Area of
Impact
(acres)
None

Total Wetland Impact (acres) 0
3. List the total acreage (estimated) of all existing wetlands on the property: None
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, darn
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
Number
(indicate on ma)
Stream Name
Type of Impact
IPerennialntermittent. t? Average
Stream Width
Before Impact Impact
Length
(linear feet) Area of
Impact
(acres)
I Unnamed Tributary Temporary Intermittent 10 30 0.007

Total Stream Impact (by length and acreage) 0.007
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 ma) ocean, etc.) (acres)
Pauc 8 of 13
Total Open Water Impact (acres) 0
6. List the cumulative impact to all Waters of the U.S. resulting from the project.
Stream Impact (acres): 0.007
Wetland Impact (acres): 0
Open Water Impact (acres): 0
Total Impact to Waters of the U.S. (acres) 0.007
Total Stream Impact (linear feet): 30
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., dam/embankment, excavation, installation of'
draw-down valve or spillway, etc.): NA
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): NA
Current land use in the vicinity of the pond: NA
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 construction is being
conducted inside the existinu sanitarv sewer easement where it crosses the unnamed tributary.
There are presently two exposed sanitary sewer lines in the stream that will be replaced xvith one
sanitary sewer line under the stream. Following„ construction the stream will flow unobstructed
by exposed pipes. thus reducing erosion and blockages, and the potential of a sewer spill into the
stream from breakage of the exnosed lines will be significantly reduced.
Page 9 of 13
VIII. Mitigation
DWQ - In accordance with 15A NCAC 21-1 .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.
USAGE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Pcnnits, 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
littp://112o.enr.state.nc.us/ncwetIands/strmgide.litml.
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.
None
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 tile NCEEP
website at http://h2o.enr.state.nc.us/wrp/index.litm. 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): NA
Page 10 of 13
Amount of buffer mitigation requested (square feet): NA
Amount of Riparian wetland mitigation requested (acres): NA
Amount of Non-riparian wetland mitigation requested (acres): NA
Amount of Coastal wetland mitigation requested (acres): NA
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 E]
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 snap 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
(Meuse), 15A NCAC 213 .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.
Zone* Impact Multiplier Required
(square feet) Mitigation
I N/a 3 (2 for Catawba)
2 N/A 1.5
Total I N/A
* Zone l 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.
Page I 1 of 1 I
3. If buffer mitigation is required, please discuss what
Donation of Property, Riparian Buffer Restoration /
Riparian Buffer Restoration Fund). Please attach all
within 15A NCAC 2B .0242 or.0244, or.0260. NA
X1. Stormwater (required by DWQ)
Describe impervious acreage (existing; and proposed) versus total acreage on the site. Discuss stornlwater
controls proposed in order to protect surface waters and wetlands downstream front the property. If
percent impervious surface exceeds 20%, please provide calculations demonstrating total proposed
impervious level. Existing impervious-168 sf, proposed inlpervious-186 sf, total area in easement-32.310
sf. lnlperviot?s before construction-0.52%, after construction-0.58%.
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.
No new wastewater will be generated by this Existini; wastewater will continue to be
treated at the Roxboro Wastewater Treatment Plant.
X1II. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 21-1 .0500) or any Buffer Rules?
Yes ? No
Is this an after-t}le-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
httl7://112o.eili'.state.ilc.us/ilcwctlands. If no, please provide a short narrative description:
The proposed sewer line will parallel and replace the existing sanitary sewer line, which will be
removed from service due to its age and exposed condition. Existing residences will be
reconnected to the new line.
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).
type of mitigation is proposed (i.e.,
Enhancement, or Payment into the
appropriate information as identified
Page 12 of 13

Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Pa-e 13 of 13
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Office Use Only: Form Vcrsion March 05
DENR - VVAi Lt< QUAL17 r n ?? 0 0 3
17E1 TC?i±,{'?'1?7EftGlUi';CH ` 4
USACC Action ID No. U?VQ Ian.
(if any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. 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 12
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: City of Roxboro, Thomas Warren, Jr., Assistant City Manager
Mailing Address: PO Box 128, Roxboro, NC 27573
Telephone Number: 336-599-3116 Fax Number: 336-599-3774
E-mail Address: tswarrennperson. net
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 5 of 13
S
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: City of Roxboro Sanitary Sewer Improvements - Depot Street Sewer
Replacement
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): 0906-19-62-9039
4. Location
County: Person Nearest Town: Roxboro
Subdivision name (include phase/lot number): NA Tax Map 1 1 44, Deed Book 269
Directions to site (include road numbers/names, landmarks, etc.): Take US 501 north from
Durham to Roxboro, bear ri.,lit on South Main Street, turn right on Depot Street.
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): 36.393212 ON 78.976497 °W
6. Property size (acres): Sanitary sewer easement across 1+/- acre residential lot
7. Name of nearest receiving body of water: UT of Marlowe Creek to Ilvco River
8. River Basin: Roanoke
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://li2o.eiir.state.nc.us/adniin/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: There are presently two exposed sanitary sewer lines
crossing an unnamed tributary to Marlowe Creek. These will be replaced with a new sanitary
sewer line under the stream and the exposed lines will be removed The general land use in
the vicinity of the project is residential on one acre or smaller lots.
Pan 6 of 13
10. Describe the overall project in detail, including the type of equipment to be used: The
project consists of rehabilitation, repair and replacement of the existing aged sanitary sewer
lines serving existing residences. Exposed lines will be replaced with a deeper line under the
stream. Excavators and backhoes will be used to install the sewer line.
11. Explain the purpose of the proposed work: The existing sanitary sewer line is being
replaced due to its age and exposed condition. The proposed line will serve the same
residences as the existing sanitary sewer, which will be removed from service.
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 pen-nits issued for prior segments of the same T.I.P. project, along with
construction schedules.None.
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.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to detennine, 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: Approximately 30 linear feet of
stream will be disturbed due to the installation of the new sanitary sewer line under the creek
Page 7 of 13
and the removal of the two exposed lines at the same crossing point. The new crossing will
be perpendicular to the stream, while one of the two existing exposed lines is not. Ductile
iron line will be used under the stream. The stream will be restored to its existing topography
and restabilized with rip rap.
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,
senaratcly 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
100-year
Floodplain
(yes/no) Distance to
Nearest
Stream
(linear feet) Area of
impact
(acres)
None

Total Wetland impact (acres) 0
3. List the total acreage (estimated) of all existing wetlands on the property: None
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. multinly length X width- then divide by 43.560.
Stream Impact
Number
(indicate on ma
Stream Name
Type of Impact Perennial or
Intermittent? Average
Stream Width
Before Impact Impact
Length
(linear feet) Area of
Impact
(acres)
1 Unnamed Tributary Temporary Intermittent 10 30 0.007

Total Stream Impact (by length and acreage) 0.007
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- hulkheads_ etc_
Open Water Impact Name Water
body Type of Waterbody Area of
Site Number (if p
applicable) Type of Impact (lake pand estuary, sound bay, Im act
p
(indicate on ma ocean, etc.) (ac
res)
Page 8 of 13
Total Open Water Impact (acres) 0
6. List the cumulative impact to all Waters of the U.S. resulting from the project.
Stream Impact (acres): 0.007
Wetland Impact (acres): 0
Open Water Impact (acres): 0
Total Impact to Waters of the U.S. (acres) 0.007
Total Stream Impact (linear feet): 30
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., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): NA
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): NA
Current land use in the vicinity of the pond: NA
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
inforniation 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 construction is being
conducted inside the existing sanitarv sewer easement where it crosses the unnamed tributarv.
There are presently two exposed sanitary sewer lines in the stream that will be replaced with one
sanitary sewer line under the stream. Following construction the stream will flow unobstructed
by exposed pipes. thus reducing erosion and blockages, and the potential of a sewer spill into the
stream from breakage of the exposed lines will be significantly reduced.
Page 9 of 13
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://ii2o.enr.state.ne.us/iicwetIands/strmuide.litml.
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.
None
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 littp://112o.enr.st.ite.nc.us/wrp/index.litm. 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): NA
Page 10 of 13
Amount of buffer mitigation requested (square feet): NA
Amount of Riparian wetland mitigation requested (acres): NA
Amount of Non-riparian wetland mitigation requested (acres): NA
Amount of Coastal wetland mitigation requested (acres): NA
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
(Meuse), 15A NCAC 213 .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.
Zone* Impact Multiplier Required
(square feet) Mitigation
I N/a 3 (2 for Catawba)
2 N/A 1.5
Total N/A
* Zone 1 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.
Page 11 of 11
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 213.0242 or.0244, or.0260. NA
XL Stormwater (required by DWQ)
Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss stornawater
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 impervious-168 sf, proposed impervious-186 sf, total area in easement-32 310
sf. impervious before construction-0.52%, after construction-0.58%.
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.
No new wastewater will be generated h this project. Existing wastewater will continue to be
treated at the Roxboro Wastewater Treatment Plant.
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application? Yes ? No
XIV. 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://h 2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description:
The proposed sewer line will parallel and replace the existing sanitary sewer line which will be
removed from service due to its age and exposed condition Existing residences will be
reconnected to the new line.
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).
Page 12 of 13

2--/:? -c?s C
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 13 of 13
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200.00 Tnm .
DETACH BEFORE DEPOSITING
CITY OF ROXBORO
POST OFFICE BOX 128
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PHONE [phone] * FAX [phone]
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