20050262 Ver 1_Complete File_20050211

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Michael F. Easley, Governor

Ms. Elizabeth Provancha
Mar- Lou AIm, LLC
1137 Northside Terrace
Asheboro, North Carolina 27203

~ William G. Ross Jr., Secretary
<::>~ North Carolina Department of Environment and Natural Resources

W~~ Alan W. Klimek, P.E. Director
~~.i. Division of Water Quality

//,\a ~1' ~& March 10, 2005
tt}~ ./ a ~ DWQ# 05-0262
~lb'9):: ~O.n ~~ Randolph County
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APPROVAL of 401 'Vater Quality Certification with Additional Conditions

Dear Ms. Provancha:

Mar-Lou Ann, LLC has our approval, in accordance with the attached conditions, to impact by excavation,
and to place permanent fill in, 60 linear feet of perennial stream in order to remove three existing reinforced
concrete pipe culverts and replace them with two larger culverts 60 feet long in a section of Taylors Creek
crossing under Scaly Bark Lane in the Meadowdale Acres subdivision located off Walker Road in Asheboro,
Randolph County, as described in your application received by the Division of Water Quality (DWQ) on
February 11, 2005. After reviewing your application, we have determined that this activity is covered by
General Water Quality Certification Number 3494, which can be viewed on our web site at
http://h20.enr.state.nc.us/ncwetlands.This Certification allows you to use Nationwide Pennit Number 3 when
it is issued by the U.S. Army Corps of Engineers. In addition, you should secure any other applicable federal,
state or local permits before you proceed with your project, including (but not limited to) those required by
Sediment and Erosion Control, Non-Discharge, and Water Supply Watershed regulations. Also, this approval
will expire when the accompanying 404 permit expires unless otherwise specified in the General Certification.

This approval is valid only for the purpose and design that you have described in your application. If you
change your project, you must notify us in writing, and you may be required to send us a new application for a
new certification. If the property is sold, the new owner must be given a copy of the Certification and
approval letter and is thereby responsible for complying with all conditions. If total wetland fill for this
project (now or in the future) exceeds one acre, compensatory mitigation may be required as described in 15A
NCAC 2H .0506 (h). For this approval to be valid, you must follow the conditions listed in the attached
certification, as well as the additional conditions listed below:

1. The following impacts are hereby approved as long as all other specific and general conditions of this
Certification are met. No other impacts, including incidental impacts, are approved:

Amount Approved Plan Location or Reference
Streams 60 linear feet Scaly Bark Lane crossing at Taylors Creek,
Meadowdale Acres, Asheboro, Randolph County

N~Iihcarolina
;vl1tllrnllu

North Carolina Division of Water Quality
Wetlands Certification Unit 1650 Mail Service Center
2321 Crabtree Blvd.
Customer Service Number: 1-877-623-6748

Raleigh, NC 27699-1650
Raleigh, NC 27604-2260

Phone [phone] FAX [phone]
Internet httpl/h2o enr statenc us/nC'J,etlands

An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper

Ms. Elizabeth Provancha
Page 2
March 10, 2005

2. Appropriate sediment and erosion control measures which equal or exceed those outlined in the most
recent version of the North Carolina Sediment and Erosion Control Planning and Design Manual or the
North Carolina Surface JvfiningManual (available from the Division of Land Resources at NCDENR
regional offices or the central office), whichever is more appropriate, shall be designed, installed and
maintained properly to assure compliance with the North Carolina water quality standards that are
applicable to Class C waters as described in 15A NCAC 02B .0211 Fresh Surface Water Quality
Standards For Class C Waters. Such measures must equal or exceed the requirements specified in the
most recent version of the North Carolina Sediment and Erosion Control Manual. These measures must
be maintained on all construction sites, borrow sites, and waste pile (spoil) sites, including contractor
owned and leased borrow pits, which are associated with this project.

3. If concrete is used with any fill material, it shall not be allowed to come in contact with surface waters
until it has cured.

4. Upon finishing the project, the Applicant shall fill out and return the enclosed "Certificate of
Completion" to notify NCDWQ when all work included in the 9401 Certification has been completed.
This certificate should be returned to the Wetlands/401 Certification Unit of the NC Division of Water
Quality at the address listed on the form. Along with the Certificate of Completion, please send
photographs upstream and downstream of the culvert site to document correct installation.

If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You
must act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition
which conforms to Chapter l50B 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 Daryl Lamb in the DWQ Winston-Salem Regional Office at 336-
771-4600, extension 293.

Sincerely,

~;:;;:

/- Alan W. Klimek, P.E.

A WKlcdl

Attachments

cc: Andrea Wade, U. S. Anny Corps of Engineers, Raleigh Regulatory Field Office
Winston-Salem DWQ Regional Office
Central Files
Wetlands/401 File Copy
Hiram J. Marziano, Marziano & Minier, P. A., P. O. Box 4428, Asheboro, NC 27204

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Michael F. Easlcy, Governor

William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources

Alan W. Klimck, P.E. Director
Division of Water Quality

March 10, 2005
DWQ# 05-0262
Randolph County

Ms. Elizabeth Provancha
Mar-Lou Ann, LLC
1137 Northside Terrace
Asheboro, North Carolina 27203

APPROVAL of 401 'Vater Quality Certification with Additional Conditions

Dear Ms. Provancha:

Mar-Lou Ann, LLC has our approval, in accordance with the attached conditions, to impact by excavation,
and to place permanent fill in, 60 linear feet of perennial stream in order to remove three existing reinforced
concrete pipe culverts and replace them with two larger culverts 60 feet long in a section of Taylors Creek
crossing under Scaly Bark Lane in the Meadowdale Acres subdivision located off Walker Road in Asheboro,
Randolph County, as described in your application received by the Division of Watcr Quality (DWQ) on
February 11, 2005. After reviewing your application, we have determined that this activity is covcred by
Gcneral Water Quality Certification Number 3494, which can be viewed on our web site at
http://h20.enr.statc.nc.us/ncwctlands.This Certification allows you to use Nationwide Pern1it Number 3 whcn
it is issued by the U.S. Army Corps of Engineers. In addition, you should secure any other applicable federal,
state or local permits before you proceed with your project, including (but not limited to) those required by
Sediment and Erosion Control, Non-Discharge, and Water Supply Watershed regulations. Also, this approval
wiII expire when the accompanying 404 permit expires unless otherwise specified in the General Certification.

This approval is valid only for the purpose and design that you have described in your application. If you
change your project, you must notify us in writing, and you may be required to send us a new application for a
new certification. If the property is sold, the new owner must be given a copy of the Certification and
approval letter and is thereby responsible for complying with all conditions. If total wetland fill for this
project (now or in the future) exceeds one acre, compensatory mitigation may be required as described in l5A
NCAC 2H .0506 (h). For this approval to be valid, you must follow the conditions listed in the attached
certification, as well as the additional conditions listed below:

I. The following impacts are hereby approved as long as all other specific and general conditions of this
Certification are met. No other impacts, including incidental impacts, are approved:

Amount Approved Plan Location or Reference
Streams 60 linear feet Scaly Bark Lane crossing at Taylors Creek,
Meadowdale Acres, Asheboro, Randolph County

Onl!
NOftbCarolina
Antllmll!!

North Carolina Division of Water Quality
Wetlands Certification Unit 1650 Mail Service Center
2321 Crabtree Blvd.
Customer Service Number: 1-877-623-6748

Raleigh, NC 27699-1650
Raleigh. NC 27604-2260

Phone [phone] FAX [phone]
Intemet httpl/:h2oenrstatenc.us/nco'letlands

An Equal Opportunity/AffinnaUve Action Employer - 50% Recycled/10% Post Consumer Paper

Ms. Elizabeth Provancha
Page 2
March 10, 2005

2. Appropriate sediment and erosion control measures which equal or exceed those outlined in the most
recent version of the North Carolina Sediment and Erosion Colltrol Planning and Design Manual or the
North Carolina Slllface Mining Alalllta! (available from the Division of Land Resources at NCDENR
regional offices or the central office), whichever is more appropriate, shall be designed, installed and
maintained properly to assure compliance with the North Carolina water quality standards that are
applicable to Class C waters as described in 15A NCA C 02B .0211 Fresh Surface Water Quality
Standards For Class C Waters. Such measures must equal or exceed the requirements specified in the
most recent version of the North Carolina Sedimellt and Erosion Control Manual. These measures must
be maintained on all construction sites, borrow sites, and waste pile (spoil) sites, including contractor
owned and leased borrow pits, which are associated with this project.

3. If concrete is used with any fill material, it shall not be allowed to come in contact with surface waters
until it has cured.

4. Upon finishing the project, the Applicant shall fill out and return the enclosed "Certificate of
Completion" to notify NCDWQ when all work included in the 9401 Certification has been completed.
This certificate should be returned to the Wetlands/40l Certification Unit of the NC Division of Water
Quality at the address listed on the form. Along with the Certificate of Completion, please send
photographs upstream and downstream of the culvert site to document correct installation.

If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You
must act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition
which conforms to Chapter l50B 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 Daryl Lamb in the DWQ Winston-Salem Regional Office at 336-
771-4600, extension 293.

Sincerely,

Alan W. Klimek, P.E.

A WK/cdl

Attachments

cc: Andrea Wade, U. S. Army Corps of Engineers, Raleigh Regulatory Field Office
Winston-Salem DWQ Regional Office
Central Files
Wetlands/40l File Copy
Hiram J. Marziano, Marziano & Minier, P. A., P. O. Box 4428, Asheboro, NC 27204

MEMORANDUM

TO:

John Dorney
Non-Discharge Branch

Regional Contact: Daryl Lamb
WQ Supervisor: Steve Terlrler
Date:

SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS

Facility Name Scaleybark Lane c/o Mar-Lou Ann, LLC
.

Project Number 05 0262
Recvd From APP
Received Date 2/11/05

County Randolph
County2
Region \Vinston-Salem

Recvd By Region

Project Type culvert replacement

Certificates

Permit Wetland Wetland Wetland Stream
Type Type Impact Score Index

Stream
Class

Prim. Supp.

Acres
Basin Req.

Feet
Req.

I 3 I Stream IOY @N I I 13-2-3-5 rc-I 130,709. I I
I I IOY ON I I r--I I I I

Miti~ation
MitigationType

Wetland
Type Acres

Feet

r

Is Wetland Rating Sheet Attached? 0 Y @ N Did you request more info? 0 Y @ N
Have Project Changes/Conditions Been Discussed With Applicant? @ YON

Is Mitigation required? 0 Y @ N Recommendation: 0 Issue @ Issue/Cond 0 Deny

Provided by Region: Latitude (ddmmss) 353947 Longitude (ddmmss) 795245

Comments:

A site visit was made on 03/09/05. The applicant is requesting authorization to use NW #3 from the
USACE Based on the applicant's description of the project. the use of WOC #3494 for the proposed
impacts does not require written concurrence from DWO Nonetheless, the applicant has submitted
a PCN and is requesting a full review This project entails the replacement of three undersized RCP
culverts on a residential road crossing of Taylor Creek. located just southwest of Asheboro No
change in the size of the existing impact is proposed The current culverts are 60 feet long No rip
rap dissipater pads are present nor are any planned According to the applicant the current crossing
has been flooded several times in the past five years because the existing culverts are not large
enough to handle a 25-year storm flow The existing three culverts will be replaced by two larger
culverts sized to handle stream flow from a 50-year storm The road is dirt with a gravel covering in
the area of the crossing No new impervious surfaces will be created The work will be done within a
three day period to minimize road closure All excavation and

cc:

Regional Office
Central Office

Page Number 1

Facility Name Scalcybark Lane c/o Mar-Lou Ann, LLC

County Randolph

Project Number 05

0262

Regional Contact:
Date:

Daryl Lamb
3/10/2005

Comments (continued from page 1):
installation work will be done from the road bed No construction equipment will be placed on the
banks or in the channel of Taylor Creek No rip rap will be placed on the banks or in the channel of
the stream. WSRO will issue authorization. with additional conditions, to use WOC #3494 for this
impact

cc:

Regional Office
Central Office

Page Number 2

Triage Check List

Date:

2/14/05

Project Name: ScaleyBark Lane

DWQ#: 05-0262
County: Randolph

To: Daryl Lamb, Winston-Salem Regional Office

60-day processing time:

2/11/05

4/11/05

From: Cyndi Karoly Telephone: [phone]

The file attached is being forwarded "to your for your evaluation.
Please call if you need assistance.

D Stream length impacted
D Stream determination
D Wetland determination and distance to blue-line surface waters on USFW topo maps
Minimization/avoidance issues
D Buffer Rules (Neuse, Tar-Pamlico, Catawba, Randleman)
D Pond fill
D Mitigation Ratios
Ditcltlng
D Are the stream and or wetland mitigation sites available and viable?
D Check drawings for accuracy
D Is the application consistent with pre-application meetings?
Cumulative impact concern
D
D
D

Comments: As per our discussion regarding revision of the triage and delegation processes,
please review the attached file. Note that you are the first reviewer, so this file will need to be
reviewed for administrative as well as technical details. If you elect to place this project on hold,
please ask the applicant to provide your requested information to both the Central Office in
Raleigh as well as the Asheville Regional Office. As we discussed, this is an experimental, interim
procedure as we slowly transition to electronic applications. Please apprise me of any
complications you encounter, whether related to workload, processing times, or lack of a "second
reviewer" as the triage process in Central had previously provided. Also, if you think of ways to
improve this process, especially so that we can plan for the electronic applications, let me know.
Thanks!

I

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Pre-Construction Notification (PCN) Application Form

For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General 'Vater Quality Certifications, and Riparian Buffer and 'Vatershed Buffer Rules

This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
hUn:/ /www.saw.usace.army.mil/wetlands/Permapp.htm.

The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at http://www.saw.usace.armv.mil/wetlands/regtour.htm. or contact one of the field
offices listed at the end of this application. The website also lists the responsible project manager for
each county in North Carolina and provides additional information regarding the identification and
regulation of wetlands and waters of the U.S.

The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401lWetlands Unit website at
http://h20.enr.state.nc.us/ncwetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text ofthe General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for some General Certifications is not required,
provided that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet
should contact DWQ's Central Office in Raleigh at [phone].

Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is also required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on the last page of this application).

Page 1 of 12

CAMA Coordination - If the project occurs in any of North Carolina's twenty coastal counties (listed on
the last page of this application) the applicant should also contact the North Carolina Division of Coastal
Management (OCM) at [phone]. OCM will determine whether or not the project involves a
designated Area of Environmental Concern, in which case OCM will act as the lead permitting agency.
In such cases, OCM will require a Coastal Area Management Act (CAMA) Permit and will coordinate
the 404/401 Permits.

USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office (addresses are listed at the end of this
application). Upon receipt of an application, the USACE will determine if the application is complete as
soon as possible, not to exceed 30 days. This PCN form is designed for the convenience of the applicant
to address information needs for all USACE Nationwide, Regional or General permits, as well as
information required for State authorizations, certifications, and coordination. Fully providing the
information requested on this form will result in a complete application for any of the USACE
Nationwide, Regional or General permits. To review the minimum amount of information that must be
provided for a complete PCN for each USACE Nationwide permit, see Condition 13,65 Fed.Reg. 12893
(March 9, 2000), available at http://www.saw.usace.army.millwetlands/nwpfinaIFedReg.pdf.
Proeessing times vary by permit and begin once the application has been determined to be complete.
Please contact the appropriate regulatory field office for specific answers to permit processing periods.

401 'Vater Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the ~ivision of Water Quality, 401lWetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina ~ivision of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at http://h20.ehnr.state.nc.us/ncwetlands/fees.html. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. Ifwritten approval is sought solely for Buffer Rules,
the application fee docs not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 40 1 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.

Page 2 of 12

Office Use Only:

Fonn Version April 2001

USACE Action lD No.

D\VQ No.

If any particular item is not applicable to this project, please enter "Not Applicable" or "N/ A" rather than
leaving the space blank.

I. Processing

1. Check all ofthe approval(s) requested for this project:
X Section 404 Permit
o Section 10 Permit
X 401 Water Quality Certification
o Riparian or Watershed Buffer Rules

2. Nationwide, Regional or General Permit Number(s) Requested: 3

3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: 0

4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here:

II. Applicant Information

1. Owner/Applicant Information
Name: Mar-Lou Ann, LLC
Mailing Address: 1137 Northside Terrace
Asheboro, NC 27203

Telephone Number: 336-629-9519
E-mail Address: None

Fax Number: None

2. Agent Infomlation (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name: Hiram J. Marziano
Company Affiliation: Marziano & Minier, P A
Mailing Address: P. O. Box 4428
Asheboro, NC 27204

Telephone Number: 336-629-3931
E-mail Address:[e-mail]

Fax Number: 336-629-3932

Page 3 of 12

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: Meadowdale Acres-Scaleybark Lane

2. T.I.P. Project Number (NCDOT Only): N/A

3. Property Identification Number (Tax PIN): 7639970085

4. Location
County: Randolph Nearest Town: Asheboro
Subdivision name (include phase/lot number): Meadowdale Acres
Directions to site (include road numbers, landmarks, etc.): Take NC Hwy. 49S to Billy
Walker Road take a left and proceed until stop sign. Make a left at stop sign onto Scaleybark
Lane proiect is located as you go onto gravel road.

5. Site coordinates, if available (UTM or Lat/Long):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)

6. Describe the existing land use or condition ofthe site at the time of this application:
Road crossing @Taylor Creek to serve SID

7. Property size (acres): N/A

8. Nearest body of water (streamJriverlsound/oceanllake): Taylor Ck (UT to Uwharrie)

9. River Basin: Pee Dee

Page 4 of 12

(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h20.enr.state.nc.us/admin/maps/.)

10. Describe the purpose of the proposed work: Replace 3 existing culverts wl2 new culverts
in same location to eliminate flooding problems.

11. List the type of equipment to be used to construct the project:

Backhoe

12. Describe the land use in the vicinity of this project: Residential SID

IV. Prior Projcct 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 10 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.!.P. project, along with
construction schedules.
N/A

V. Future Project Plans

Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application: NI A

VI. Proposcd Impacts to 'Vaters of the Unitcd States/'Vaters 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. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream

Page 5 of 12

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. Wetland Impacts NONE

Wetland Impact Area of Located within Distance to
Site Number Type of Impact* Impact 100-year Floodplain** Nearest Stream Type ofWetland***
(indicate on map) (acres) (yes/no) (linear feet)

* List each impact separately and identify temporary impacts. Impacts include, but arc not limitcd to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://www.fema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina nay, bog, etc.)

List the total acreage (estimated) of existing wetlands on the property:
Total area of wetland impact proposed:

2. Stream Impacts, including all intermittent and perennial streams

Stream Impact Length of Average Width Perennial or
Site Number Type ofImpact* Impact Stream Name** of Stream Intermittent?
(indicate on map) (linear feet) Before Impact (please specify)
1 Culvert 60 Taylor Ck 20' Perennial

List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and aficr, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, 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.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
wWW.usgS.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.eom,
www.mapquest.eom, etc.).

*

Page 6 of 12

Cumulative impacts (linear distance in feet) to all streams on site: 60

3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S. None

Open Water Impact Area of Name of Water body Type of Water body
Site Number Type ofImpact* Impact (lake, pond, estuary, sound,
(indicate on map) (acres) (if applicable) bay, ocean, etc.)

'" List eaeh impact separately and identify temporary impacts. Impacts inelude, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, ete.

4. Pond Creation - None
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): D uplands D stream D wetlands
Describe the method of construction (e.g., dam/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 stonnwater requirement, etc.):

Size ofwatershcd 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
infonnation 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.
Since this is a renair/replacement of existing culverts. no change in impacts are planned.
Excavation equipment will not be allowed in the creek and an erosion control nlan will be in use.

Page 7 of 12

VIII. Mitigation

DWQ - In accordance with l5A 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 March 9, 2000, 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 NCWRP 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 Teclmical Guide for Stream Work in North Carolina, available at
hup:/ /h20. en r .state. nc. us/ncwetl ands/stnn gi de. htm I.

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.
Current situation: The existing road crossed Taylor Creek. The existing culverts have
inadequate capacity to pass 25-50 year stonns and the roadway has been overtapped by flood
waters three times in the past 5-6 years. This proiect will replace the culverts 2/2 larger
culverts sized for the 50 yr stonn. No additional impact to the stream will result from the
installation of the culverts. Also, by specifications no construction equipment will be
allowed in the creek to excavate for the culverts. Photos of the existing culverts are attached.

Page 8 of 12

2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 40l/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at http://h2o.cnr.statc.nc.lls/wrp/indcx.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three 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 of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):

IX. Environmental Documentation (D\VQ Only)

Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?

Yes D

No xD

If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEP A/SEP A)?
Note: If you are not sure whether a NEP A/SEP A document is required, call the SEP A
coordinator at [phone] to review current thresholds for environmental documentation.
Yes D No D

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 D No D

X. Proposed Impacts on Riparian and \Vatershed Buffers (D\VQ Only)

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.

Page 9 of 12

Will the project impact protected riparian buffers identified within l5A NCAC 2B .0233
(Neuse), l5A NCAC 2B .0259 (Tar-Pamlico), l5A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffcr Requirements), or other (please identify )?
Yes D No xD If you answered "yes", provide the following information:

Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is requircd calculate the required amount of mitigation by applying the buffer
multipliers.

Zone* Impact Multiplier Required
(square feet) Mitigation
1 3
2 1.5
Total

* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.

If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within l5A NCAC 2B .0242 or .0260.

XI. Stormwater (DWQ Only)

Describe impervious acreage (both 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.
No addition of impervious acreage will be created. This proiect will prevent future flooding at
the existing culvert crossing based upon the 50-yr. storm

XII. Sewage Disposal (nwQ Only) - N/A

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.

XIII. Violations (nwQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?

Page 10 of 12

Yes D

No xD

Is this an after-the-fact permit application?
Yes D NoxD

XIV. 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 ofthe applicant's control).
Work schedule is intended to be rapid, so as not to take street

out of ser~~ce for more thAn three days

f:,~:'{t7 !.L{_?( ~tt'7iY<-11r' (If.... / 10/4/04
Appl{c'antJ Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell Union
US Army Corps of Engineers A very Clay Jackson Polk Watauga
151 Patton A venue Buncombe Cleveland Lincoln Rowan Yancey
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabarrus Graham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Jolmston Rockingham Wilson
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes Yadkin
6508 Falls of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers Bertie Dare Lenoir Tyrrell
Post Office Box 1000 Camden Gates Martin Washington
Washington, NC 27889-1000 Carteret* Green Pamlico Wayne
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans *Croatan National Forest Only

Page 11 of 12

Wilmington Regulatory Field Office
US Army Corps Of Engineers
Post Office Box 1890
Wilmington, NC 28402-1890
Telephone: [phone]
Fax: [phone]

Anson
Bladen
Brunswick
Carteret
Columbus
Cumberland

Duplin
Harnett
Hoke
Montgomery
Moore
New Hanover

Onslow
Pender
Richmond
Robeson
Sampson
Scotland

US Fish and \Vildlife Service / National Marine Fisheries Service

US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]

Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]

Division of Coastal Management
1638 Mail Service Center
Raleigh, NC 27699-1638
Telephone: [phone]
Fax: [phone]

Western Piedmont Region Coordinator
3855 Idlewild Road
Kernersville, NC 27284-9180
Telephone: [phone]

Mountain Region Coordinator
20830 Great Smoky Mtn. Expressway
Waynesville, NC 28786
Telephone: [phone]
Fax: [phone]

US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]

North Carolina State Agencies

Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]

CAMA and NC Coastal Counties

Beaufort
Bertie
Brunswick
Camden
Carteret

Chowan
Craven
Currituck
Dare
Gates

NCWRC and NC Trout Counties

Alleghany
Ashe
A very
Burke

Caldwell
Mitchell
Stokes
Surry

Buncombe
Cherokee
Clay
Graham
Haywood

Henderson
Jackson
Macon
Madison
McDowell

Page 12 of 12

National Marine Fisheries Service
Habitat Conservation Division
Pivers Island
Beaufort, NC 28516
Telephone: [phone]

State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
Telephone: [phone]
Fax: [phone]

Hertford
Hyde
New Hanover
Onslow
Pamlico

Watauga
Wilkes

Polk
Rutherford
Swain
Transylvania
Yancey

Pasquotank
Pender
Perquimans
Tyrrell
Washington

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~ MARZIANO & MINIER, PA.
~ CONSULTING ENGINEERS
Post Office Drawer 4428
Asheboro. North Carolina 27204-4428
Phone: [phone]
Fax: [phone]

LETTER OF TRANSMITTAL

_Attached

_Under separate cover via

_Prints
_Change Order

_Plans _Samples
_Other

_Specifications

COPIES
-,
\

DATE

NUMBER

THESE ARE;rRANSMITTED as checked below:
~For approval _Approved as submitted

_For your use
_As requested

_Approved as noted
_Returned for Correction

_Resubmit_copies for approval
_Submit_copies for distribution
_Retum_ corrected prints

_For review and comment

_For bids due

REMARKS, ~
c.~J

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n ~A n..b:-J .

\:A~I~~~!: ~~.

COPIES TO:

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~@ranr!"r- it'
. ~ L_ u U ,.::.1 ~ .
i="i="R 1 1 ?nn~

BY:

DENR - W/lib? CLl"L1TV
WETLANDS A."lD STORM'hA"fER BRANCH

~ ~, PvuiL
lANO & M R, P. A.

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