20040288 Ver 1_COMPLETE FILE_20040226

CF W ATF? Michael F. Easley, Governor
?
Q William G. Ross Jr., Secretary
0 G North Carolina Department of Environment and Natural Resources
`
r Alan W. Klimek, P.E., Director
-{ Division of Water Quality
O 'C Coleen H. Sullins, Deputy Director
Division of Water Quality
April 7, 2004
DWQ# 04-0288
Mr. Richard B. Johnston Wilkes County
Mountain Resource Company
902A Curtis Bridge Road
Wilkesboro, NC 28697 WETLANDS /4(N GROUP
APPROVAL of 401 Water Quality Certification with Additional Conditions
Dear Mr. Johnston: APP 1 7.0 0 4
WATER ??r(? Y S
You have our approval, in accordance with the attached conditions, to place permanent fill in
perennial stream in order to construct a low-water bridge for access to your property located on Elk Creek
Road in Wilkes County, as described in your application received by the Division of Water Quality (DWQ) on
February 20, 2004. After reviewing your application, we have determined that this fill is covered by General
Water Quality Certification Number 3404 which can be viewed on our web site at
http://h2o.enr.state.nc.us/ncwetiands. This Certification allows you to use Nationwide Permit Number 14
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 fills for this project
(now or in the future) exceed 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. Construction activities in the stream channel are prohibited during the fish-spawning season of May 1st
through July 15th in order to prevent off-site sedimentation from impacting fish eggs and fry downstream
of the site.
2. Sediment and erosion control measures shall be installed along the stream in any area where soil is
disturbed. These measures shall adhere to the design standards required for sensitive watersheds (15A
NCAC 4B .0024) and shall be maintained until the project is complete.
3. Heavy equipment shall be operated from the stream banks rather than in the channel in order to prevent
sedimentation and pollution of the stream. Petroleum spill containment equipment must be readily
available on-site whenever mechanized equipment is operated streamside.
4. Where concrete is used, the work must be accomplished in such a manner that wet concrete does not
come into contact with stream water.
SM
N. C. Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (http://It-o.enr.state.nc.us/newet]ands)
Customer Service #: 1-877-623-6748
5. Where stream banks are disturbed by construction, they must be restored to a natural condition and
revegetated with appropriately sized native plants in order to provide long-term bank stability and stream
shading.
6. If riprip is required for scour protection, it shall be limited to the minimum amount specified by appropriate
engineering calculations. Riprap may only be used below the normal high water level. The original
grade and elevation of the stream's cross-section must be maintained. Riprap placed in the stream
bottom must be inserted into the bottom matrix to a depth sufficient to provide the thickness of riprap
required for scour protection. The elevation of the stream bottom must not be increased by the
placement of riprap. Placement of riprap must not result in destabilization of the streambed or-banks
upstream or downstream of any crossing.
7. 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 §401 Certification has been completed. This certificate
should be returned to the 401/Wetlands Unit of the NC Division of Water Quality at the address listed on
the bottom of the first page. Along with the Certificate of Completion, please send photographs upstream
and downstream of the low-water bridge 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 1508 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 or Cyndi Karoly in the Central Office in Raleigh 919-733-9721.
Sincerely,
Alan W. Klimek, P.E.
AWK/cdl
Attachments
cc: Ms. Andrea Wade, U. S. Army Corps of Engineers, Raleigh Regulatory Field Office
Winston-Salem DWQ Regional Office
Central Files
Wetlands/401 File Copy
Mr. Hugh Hanchey, 3512 Mt. Zion Road, Ferguson, NC 28624
? N1 A TF Michael F. Easley, Governor
0 RpG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
April 7, 2004
DW Q# 04-0288
Wilkes County
Mr. Richard B. Johnston
Mountain Resource Company
902A Curtis Bridge Road
Wilkesboro, NC 28697
APPROVAL of 401 Water Quality Certification with Additional Conditions
Dear Mr. Johnston:
You have our approval, in accordance with the attached conditions, to place permanent fill in 36 linear feet of
perennial stream in order to construct a low-water bridge for access to your property located on Elk Creek
Road in Wilkes County, as described in your application received by the Division of Water Quality (DWQ) on
February 20, 2004. After reviewing your application, we have determined that this fill is covered by General
Water Quality Certification Number 3404 which can be viewed on our web site at
http://h2o.enr.state.nc.us/ncwetlands. This Certification allows you to use Nationwide Permit Number 14
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 fills for this project
(now or in the future) exceed 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. Construction activities in the stream channel are prohibited during the fish-spawning season of May 1 st
through July 15th in order to prevent off-site sedimentation from impacting fish eggs and fry downstream
of the site.
2. Sediment and erosion control measures shall be installed along the stream in any area where soil is
disturbed. These measures shall adhere to the design standards required for sensitive watersheds (15A
NCAC 4B .0024) and shall be maintained until the project is complete.
3. Heavy equipment shall be operated from the stream banks rather than in the channel in order to prevent
sedimentation and pollution of the stream. Petroleum spill containment equipment must be readily
available on-site whenever mechanized equipment is operated streamside.
4. Where concrete is used, the work must be accomplished in such a manner that wet concrete does not
come into contact with stream water.

N. C. Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (hitp:11h2o.enr.state.nc.us/ncwctlands)
Customer Service #: 1-877-623-6748
5. Where stream banks are disturbed by construction, they must be restored to a natural condition and
revegetated with appropriately sized native plants in order to provide long-term bank stability and stream
shading.
6. If riprip is required for scour protection, it shall be limited to the minimum amount specified by appropriate
engineering calculations. Riprap may only be used below the normal high water level. The original
grade and elevation of the stream's cross-section must be maintained. Riprap placed in the stream
bottom must be inserted into the bottom matrix to a depth sufficient to provide the thickness of riprap
required for scour protection. The elevation of the stream bottom must not be increased by the
placement of riprap. Placement of riprap must not result in destabilization of the streambed or banks
upstream or downstream of any crossing.
7. 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 §401 Certification has been completed. This certificate
should be returned to the 401/Wetlands Unit of the NC Division of Water Quality at the address listed on
the bottom of the first page. Along with the Certificate of Completion, please send photographs upstream
and downstream of the low-water bridge 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 1506 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 or Cyndi Karoly in the Central Office in Raleigh 919-733-9721.
Sincerely,
Alan W. Klimek, P.E.
AW K/cdl
Attachments
cc: Ms. Andrea Wade, U. S. Army Corps of Engineers, Raleigh Regulatory Field Office
Winston-Salem DWQ Regional Office
Central Files
Wetlands/401 File Copy
Mr. Hugh Hanchey, 3512 Mt. Zion Road, Ferguson, NC 28624
MEMORANDUM
TO: John Dorney Regional Contact:
Non-Discharge Branch WQ Supervisor:
Date:
SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS
Facility Name Elk Creek Bridge
Project Number 04 0288
Recvd From APP
Received Date 2/26/04 Recvd By Region
Project Type build a low water bridge (coffer dam) for horse and
Certificates
Permit Wetland Wetland Wetland Stream
Type Type Impact Score Index
County Wilkes
County2
Region Winston-Salem
Stream
Class Acres Feet
Prim. Supp. Basin Req. Req.
Stream Impacts (ft.)
E 0
F 14 Stream O YO IV F_-12-24-(10) I ORW 30,701. F - 36.00 36.00
Mitigation Wetland
MitigationType Type Acres Feet
Is Wetland Rating Sheet Attached? O Y ON Did you request more info? O Y (ON
Have Project Changes/Conditions Been Discussed With Applicant? Q Y O N
Is Mitigation required? O Y OQ N Recommendation: O Issue * Issue/Cond O Deny
Provided by Region: Latitude (ddmmss) 036 07 8.77 N Longitude (ddmmss) 081 28 42.63 W
Comments:
access to ap plicant's pas ture land. Currently. vehicles and horsebac k riders cross directly through
the stream. Impacts will consist of three concrete ilk tars, one located along each bank and one in
the center of the stream channel. The two outside pillars will be 2' by 12' and the center pillar will be--
3' by_12'. Co ffer dams w ill be used in the stream to allow construction of the pillars. Total stream
impact will b e 36 If. Low- water bridge will be placed where there is a n existing wet crossings. T
e
bridge will be - 6' wide a nd 60' long. The USACE has made a site vi h
sit and indicated that the bridge
will be an im provement o ver the existing crossing and should result in less disturbance to the stream.
This is a sim IRe eject w ith a small footprint. Authorization to use W OC #3404, with additional
conditions, w ill be issued by WSRO,
cc: Regional Office
Central Office Page Number 1
f
ay ,
North Carolina Wildlife Resources Commission
(;haves K. 1`1111wood, I'AccutlvC I)irecto I'
MEMORANDUM
TO:
FROM:
DATE:
SUBJECT
Andrea Wade, Permit Coordinator
Raleigh Office, U.S. Army Corps of Engineers
Ron Linville, Regional Coordinator
Habitat Conservation Program
February 20, 2004
Original Signed
by I R. Lirtviile
Review of an application by Mountain Resource Company, NWP 14, Elk
Creek Bridge, Wilkes County
Hugh Hanchey is requesting a letter of concurrence from the North Carolina
Wildlife Resources Commission (NCWRC) to obtain a 404 permit from the U.S. Army
Corps of Engineers. The NCWRC has reviewed information provided by the applicant,
and field biologists on our staff are familiar with habitat values of the project area. These
comments are provided in accordance with provisions of the Clean Water Act of 1977
(33 U.S.C. 466 et. seq.) and the Fish and Wildlife Coordination Act (48 Stat. 401, as
amended; 16 U.S.C. 661-667d).
The proposed project is to install a spanning bridge over Elk Creek in the
Ferguson area near Darby Road to access horse pasture that is presently accessed by
fording the creek. Due to stream width, it is indicated that a middle pier for the bridge
will be required in or near midstream. Smallmouth bass are present in the area. These
waters are relatively flashy so our opinion is that a spanning structure is preferable.
Based on the information provided by the applicant and our information on the
range of trout in the project area, we do not believe this project will cause significant
effects to waters supporting trout. Therefore, we do not object to the project as proposed
providing the following conditions are required:
1. Instream activities are prohibited during the fish spawning season of May 1
through July 15 to prevent off-site sedimentation from impacting fish eggs and fry
downstream of the site.
Mailing Address
Division of Inland Fi.slicric, • 1 721 Mail Sers°ic(- Centcr • Kalchdi, NC 2 7699-1 72 1
Tclcphornc: [phone] cst. 281 1 Fax: (`)19) 715-7643
Mountain Resource Company 2 February 20, 2004
Bridge, Elk Creek
2. Stringent erosion control measures should be installed where soil is disturbed and
maintained until project completion. If appropriate for the watershed, sediment
and erosion control measures shall adhere to the design standards for sensitive
watersheds (15A NCAC 4B .0024).
3. Heavy equipment should be operated from the bank rather than in the stream
channel in order to minimize sedimentation and reduce the likelihood of
introducing other pollutants into the stream. If equipment will be in the water, it
must be new, low hour or steam cleaned and with all hydraulic lines in good
condition to prevent petroleum contamination to waters. Petroleum spill
containment equipment must be readily available on the site during all activities
within the stream and stream buffer areas.
4. If concrete will be used, work must be accomplished so that wet concrete does not
contact stream water. This will lessen the chance of altering the stream's water
chemistry and causing a fish kill. Pier construction should be accomplished in the
dry by using a temporary sandbag cofferdam.
5. To stabilize the area, disturbed banks should be restored to natural conditions and
revegetated with silky dogwood (Corpus amonum), silky willow (Salix sericea),
tag alder (Alnus serrulata), black willow (Salix nigra), sycamore (Platanus
occidentalis) or other appropriately sized native plants to provide long term bank
stability and stream shading. Note that silky dogwood, silky willow and black
willow can be planted as live stakes collected during the dormant growing season.
Cuttings should be randomly planted and done on 4 foot centers from the waters
edge to the top of the bank. Trees should be planted on 10-12 foot centers.
Stream banks in these areas should also be seeded with an approved wetland seed
mix or temporary crop of wheat or rye.
6. Runoff from the bridge should flow through vegetated filter areas along the creek
banks instead of being discharged directly to the stream.
Thank you for the opportunity to review and comment on this project. If you
have any questions regarding these comments, please contact me at 336/769-9453.
Ec: Daryl Lamb, DWQ-WSRO
r `
Office Use Onl : F r V rsion May 2002
USACE Action ID No. DWQ No.
(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 F? Riparian or Watershed Buffer Rules
F] Section 10 Permit F-] Isolated Wetland Permit from DWQ
5x401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: 'w
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: 1-1
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), 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 nformation
Name: ,-3 5?t--TTJ kw-; -??L cU
Mailing Address: ' -- ` r; ' ?
004
Telephone Number: Fax Number:
E-mail Address: V91 ER QUALITY SECTION
2. Agent/Consultant Information (A signed ar; dated copy of the Agent Authorization letter
must be attached if the Age t has signatory authority for the owner/applicant.)
Name: t t • 'Na ACompany Affiliation: • . -t"
Mailing Address:
Telephone Number: Fax Number: 33(r E-mail Address:
Page 5 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 I 1 by 17-111ch format;
however, DWQ may accept paperwork of any size. DWQ prefers frill-size construction
drawings rather than a sequential sheet version of the frill-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: w 1 K C f c` c r `'t '
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN):
4. Location
County: Nearest Town: Ee-d (A '„y v1
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): ILA c ej
5
6. Property size (acres): ? C A c r 5
7. Nearest body of water (stream/river/sound/ocean/lake): I F C-?
8. River Basin:
??? ({ r\ 11 ?'
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at littp://h2o.enr.state.nc.us/admu)/mal)s/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: i 0 ?0 ?? C r Z e 1, a(A k< ?t5 e Cj
- C, r -fit (?. u AN- 0 ck 0 c.: c ?? r c x ran Ok f e j? ? ?. o j-
a liP.' C ?t'? LX P('Q S tonr??'_t .5 .;.C r?
S-1 Ae-
Page 6 of 12
Site coordinates, if available (UTM or Lat/Long): f?) l
(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.)
10. Describe the overall project in detail, including the type of equipment to be used: r C, (AJ r)
Z, ;
-±? I
k 1'bV
(3f C?Lz E?l M MRK V?hItfC
11. Ex lain t e purpose of the proposed work:
w . CL. 1 ' ? a S C-4Ct. C C 4L5 S
fn k n r e- i2 Gt c, Gig - r, c \,- e e
IV. Prior Project History
If jurisdictional determinations and/or pen-nits 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.
k-, A-
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
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. 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
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.
Page 7 of 12
Provide a written description of the proposed impacts: F v ( c" f?) ; I 10, i
2. Individually list wetland impacts below:
Wetland Impact
Site Number
(indicate on map)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(yes/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechani zed 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://Nvww.fema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property:
Total area of wetland impact proposed:
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
(indicate on map)
Type of Impact* Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
(please specify)
G`
P , 11,X f

* List each impact separately and identify temporary impacts. Impacts include, nut are not limited to: culverts and associated nP-jap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, 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.topozonc.coni,
www.mapquest.coni, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: _3
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number
(indicate on map)
Type of Impact* Area of
Impact
(acres) Name of Waterbod
(if applicable) y Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.)

List each impact separately and identify temporary impacts. Impacts include, but are not limited to: till, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. 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): E] uplands . [] stream 0 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 stormwater requirement, etc.):
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.
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.
Page 9 of 12

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 Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/iicwetlands/strnigidc.litm1.
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 strearn 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.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at littp://li2o.enr.state.nc:rrs/wrp/index.litm. 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):
Page 10 of 12

IX.
X.
Environmental Documentation (required by DWQ)
Yes ? No
Does the project involve an expenditure of public (federal/state) finds or the use of public
(federal/state) land?
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 ?
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 ?
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.
Will the project impact protected riparian buffers identified within 15A NCAC 213 .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No [o,' 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 required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet) Multiplier Required •.
Mitigation
1 3
2 1.5
Total
* Zone I extends out 3o teet perpcnaicuiar rrom nCal udnn vi alarm. ,
additional 20 feet from the edge of Zone 1.
Page 1 1 of 12

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 15A NCAC 213 .0242 or. 0260.
XI. Stormwater (required by DWQ)
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.
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.
Vv'
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes n No
Is this an after-the-fact permit application?
Yes F? No
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 s:;irPdules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).

Applicant/1
(Agent's signature i

s bignature Date
only if an authorization letter from the applicant is provided.)
Page 12 of 12
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