20031089 Ver 1_COMPLETE FILE_20030829

O?O? W AT ,?9pG
D "C
Michael F. Easley, Governor
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
October 6, 2003
DWQ# 03-1089
Rutherford County
Mr. Gerald Lipscomb
P.O. Box 902
Forest City, NC, 28043
APPROVAL of 401 Water Quality Certification with Additional Conditions
Dear Mr. Lipscomb:
You have our approval, in accordance with the attached conditions, to grade and fill 0.10 acre of wetlands in order to
construct a driveway to the Gerald Lipscomb property in Rutherford County, as described in your application received by the
Division of Water Quality on August 29, 2003, and in additional correspondence received September 30, 2003. After
reviewing your application, we have determined that this fill is covered by General Water Quality Certification Number 3402,
which can be viewed on our web site at http:Hh2o.enr.state.nc.us/ncwetlands. This Certification allows you to use
Nationwide Permit Number 39 when it is issued by the U.S. Army Corps of Engineers. In addition, you should get any other
federal, state or local permits before you go ahead with your project including (but not limited to) 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 only valid for the purpose and design that you 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 condition listed below:
1. Deed notifications or similar mechanisms shall be placed on all lots with remaining jurisdictional wetlands and waters or
areas within 50 feet of all streams and ponds on the property. These mechanisms shall be put in place within 30 days of
the date of this letter or the issuance of the 404 Permit (whichever is later). A sample deed notification format can be
downloaded from the 401/Wetlands Unit web site at htto://h2o.enr.state.nc.us/ncwetlands ;
2. An additional condition is that a final, written stormwater management plan shall be approved in writing by this Office
before the impacts specified in this Certification occur per condition no. 3 in General Certification 3402. You are required
to obtain prior approval of this plan prior to any development of the site beyond that directly associated with the road
crossing. The stormwater management plan must include plans and specifications for stormwater management facilities
that are appropriate for surface waters classified as Class C and deigned to remove 85% TSS according to the most
recent version of the NC DENR Stormwater Best Management Practices Manual. These facilities must be designed to
treat the runoff from the entire project, unless otherwise explicitly approved by the Division of Water Quality. Also, before
any permanent building is occupied at the subject site, the facilities (as approved by this Office) shall be constructed and
operational, and the stormwater management plan (as approved by this Office) shall be implemented. The structural
stormwater practices as approved by this Office as well as drainage patterns must be maintained in perpetuity. No
changes to the structural stormwater practices shall be made without written authorization from the Division of Water
Quality;
The above condition shall apply unless it is demonstrated in writing to the satisfaction of this Office that the impervious
area of the entire, built-out project shall be less than 30% and that there are no areas of concentrated impervious area
over 30% within the project such as, but not limited to, commercial areas, multi-family, clubhouses, maintenance
areas, etc.
A State Stormwater Permit (15 A NCAC 2H .1000) can be considered to meet this condition.
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://h2o.enr.state.nc.us/ncwetlands)
Customer Service #: 1-877-623-6748
Mr. Gerald Lipscomb
Page 2 of 2
October 6, 2003
3. You are required to return the attached Certification of Completion form to notify DWQ when all work included in the 401
Certification has been completed.
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 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 Kevin Barnett in our Asheville Regional Office at 828-251-6208 or Cyndi Karoly in the
Central Office in Raleigh 919-733-9721.
Sincerely,
?i Alan W. Klimek, P.E.
AW K/cbk
Attachments
cc: Corps of Engineers Asheville Regulatory Field Office
Asheville DWQ Regional Office
Central Files
File Copy
Chris Waters, 152 East Main St., Forest City, NC, 28043
031089
Yes ? No ? 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.
Zonc* 1111pact Rcquircd
Mulliplicr
- Mitigation
-t- (scFtarc fcctl -- ---------- --
- -
-
1 ---- l
3
---- -- --
Total
* Y,one 1 calends out 30 fist lvgvndicufar front near 1XIA of channel.. Zonc 2 esleuds an
additional 20 lint from the cdge of 7.onc I .
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 26 .0242 or.0260.
N/A
X. 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.
There is currently no imnervirntc art a nn t6c o;to 'Pt,
a.,??. ue ?otai acrea a on site equals approximately 20 acres with 0.86 acres being
wetlands. The use of sediment--fence-_will be used to protect the surface waters and
during wetlands
Uraditl?.
X1. Sewage Disposal (DWQ Only)
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.
The future site will dispose of its wastewater into an existing Town of Forest City sewer line
Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (I 5A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Pagc M of 12
?oF WATF9p Michael F. Easley, Governor
William G. Ross Jr., Secretary
7 North Carolina Department of Environment and Natural Resources
> r- ?p /'? Alan Klimek, P.E., Director
O C ! Division of Water Quality
/ Coleen H. Sullins, Deputy Director
rv Division of Water Quality
11
September 9, 2003
DWQ # 03-1089
Rutherford County
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
Gerald Lipscomb
Post Office Box 902
Forest City, NC 28043
Subject Property:
Dear Mr. Lipscomb:
On August 29, 2003 the Division of Water Quality (DWQ) was notified by receipt of your application regarding
your plan to fill wetlands or waters for the purpose of constructing a driveway entrance in Rutherford County.
Approval from DWQ is required to disturb these areas. Please provide 7 copies of the following information and
refer to the DWQ # listed above in your reply. Please show these on maps of suitable scale (for instance 1" = 100
feet) so we can begin to determine your projects' compliance with 15A NCAC 2H.0500.
1. Please provide detail for the stormwater management practices as required by GC 3402.
2. Please specify the percent of project imperviousness area based on the estimated built-out conditions.
3. Please complete Sections X and XI on the application.
Please telephone Bob Zarzecki at 919-733-9726 if you have any questions or would require copies of our rules or,
procedural materials. This project will remain on hold as incomplete in accordance with 15A NCAC 2H
.0505(c). The processing time for this application will begin when this information is received. If we do not
hear from you by writing or by fax at [phone] within three (3) weeks we will assume you no longer want
to pursue the project and will consider it withdrawn.
Sincerely,
JRD/bs
V Y_
hn R. Dorney
1 Water Quality ertification Program
cc: Asheville DWQ Regional Office
Asheville Corps of Engineers
Central Files
File Copy
Odom & Associates, 152 East Main Street, Forest City, NC 28043
t
'+i
J?
0-011 t ,
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://h2o.enr.state.nc.us/ncwetlands)
Customer Service #: 1-877-623-6748
I
Odom ?VETIMVS140 A
&Associates I'll ?F
Engineering, Inc. SEP j v 0003
4VATERQUALIIYSECTI
QN
September 22, 2003
Bob Zarzecki
f1p
Division of Water Quality t401 Wetlands Certification Unit
1650 Mail Service Center
Raleigh, N.C. 27699-1650
RE: DWQ#03-1089 (Gerald Lipscomb Property)
Dear Mr. Zarzecki:
This letter is in reference to your letter dated September 9, 2003 regarding the above
project.
The stormwater management practices that will be used during the installation of the
culvert will be to line the banks with sediment fence to keep any sediment from entering
the creek. We do not know what the future use of the property will be so future
stormwater management practices are unknown. The remaining information is provided
in the revision to page 10 of the DWQ permit.
If you need any other information please let us know.
Sincerely,
6)'I"? CHRIS WATERS
152 East Main Street • Forest City, North Carolina 28043 0 [phone] • Fax [phone]
Yes ? No ? 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 --- - -- --?-
/,one I emends out 0 leet pertvndicular from near bank of channel, /,one 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 15A NCAC 2B .0242 or.0260.
X. 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.
There is currently no impervious area on the site The proposed impervious area would e% al
0.07 acres. The total acreage on site equals approximately 20 acres with 0.86 acres being
wetlands. The use of sediment fence will be used to protect the surface waters and wetlands
during grading.
XI. Sewage Disposal (DWQ Only)
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.
The future site will dispose of its wastewater into an existing Town of Forest City sewer line
Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Page 10 of 12
Yes ? No ? 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 butler
multipliers_
Zonc*
Impact
(square feet) Multiplier
Required
rlitihalion
- - 2
'1'01111
1.5
" /,one 1 extends out 3(I fix l pc?x 01 F,41- fi >m near Ikmk of channel: /Onc 2 eztcnils an
additional 20 beet from the edge of /one 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 15A NCAC 2B .0242 or.0260.
N/A
X. 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
downstrearn from the property.
There is-currently no impervious area on the site. The-proposed impervious area would equal
0.07 acres. The total acrea e_ on site equals- = pproxint 20 acres with 0.86 acres being
wetlands..The use of sediment tence_w_ill be_ used to._protect the surface waters and wetlands
during-grading.
X1. Sewage Disposal (DWQ Only)
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.
The future site will dispose of its wastewater into an existin6 Town of Forest City sewer line.
Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (I 5A NCAC 2H .0500) or any Buffer- Rules.)
Yes ? No
Page W of 12
Yes ? No
? If you answered "yes", provide the following information:
Identify the square feel and acreage of impact to each zone oi'the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
1 m act
Zone* p Multiplier Required
-- - - ---- - - - -( square feet
------ ------------- Mitigation--
---- - --- 3
- --- ------------- - ---
- -?--- -- - - - - 1
Total
/.one 1 extends out 30 tint lvgviidicitha ti ona near think of channel Zone 2 extends an
additional 20 feel from the edge of Zone I
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.
N/A
X. 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.
There is currently no impervious area. on the site. The proposed impervious area would equal
0.07 acres. The total acreage on site equals- roximate_. ly__20 acres with 0.86 acres beinr:
wetlands. The use of sediment fence-will be used to protect. the surface waters and wetlands
during gradin1
Xl. Sewage Disposal (DWQ Only)
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.
The future site will dispose of its wastewater into an existing Town of Forest City sewer line.
Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Page W of 12

Office Use Only: Form Version April 2001
USACE Action ID No. DWQ No. All n 4 Pa
- - - - Z$ 1 V
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing WETI. r1!i.pi ((.%[t()Up
1. Check all of the approval(s) requested for this project: 4U(i x (V
® Section 404 Permit
? Section 10 Permit YVATERQUALIIYSECTION
® 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: Nationwide 39
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 Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name: Gerald Lipscomb
Mailing Address: P.O. Box 902
Forest City, NC 28043
Telephone Number:- [phone] Fax Number:
E-mail Address:
2. Agent 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: Odom & Associates
Mailing Address: 152 East Main Street
Forest City, North Carolina 28043
Telephone Number: [phone] Fax Number: [phone]
E-mail Address:
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: Gerald Lipscomb Property
2. T.I.P. Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN):
4. Location
County: Rutherford Nearest Town: Forest City
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.):
Hwy 74 Bypass East just past Daniel Road. Site is directly across from the Entrance to Wal-
Mart and Right beside the Future entrance to Lowes Home Improvement Warehouse that is
presently being constructed
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 of the site at the time of this application:
Commerical
7. Property size (acres): Approximately 20 acres
8. Nearest body of water (stream/river/sound/ocean/lake): Bracketts Creek
9. River Basin: Broad
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
Page 4 of 12
10. Describe the purpose of the proposed work:
To construct a driveway entrance to access property, otherwise the property would be land
11. List the type of equipment to be used to construct the project:
Front-end loader, concrete truck
12. Describe the land use in the vicinity of this project:
IV. Prior Project History
Commerical
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
N/A
V. Future Project Plans
Are any 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: N/A
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. 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
Page 5 of 12
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
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no) Distance to
Nearest Stream
(linear feet
Type of Wetland***
1 Grading 0.10 Yes 53 Freshwater Wetlands

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 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.eov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: 0.86
Total area of wetland impact proposed: 0.10
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet)
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)

List each impact separately and ioentity 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 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.topozone.com,
www.mapyuest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
Page 6 of 12
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact
Site Number

indicate on ma
Type of Impact* Area of
Impact

(acres)
Name of Waterbody
(if applicable) Type of Waterbody
(lake pand estuary, sound,

bay, ocean, etc.
N/A

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): N/A
Size of watershed draining to pond: N/A Expected pond surface area: N/A
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, 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 creek must be crossed in order to gain access to properties above the future Lowes entrance
Page 7 of 12
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 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/ncwetlands/stnngide.html.
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.
N/A
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 401/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.enr.state.ne.us/m/index.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): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ? No
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
IX. Proposed Impacts on Riparian and Watershed Buffers (DWQ 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.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify N/A )?
Page 9 of 12
Yes ? No ? 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
Gone 1 extends out 3U 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 15A NCAC 2B .0242 or .0260.
X. 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.
N/A
XI. Sewage Disposal (DWQ Only)
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.
N/A
Violations (DWQ Only)
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
Page 10 of 12
XII. 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).
3
kt/Agdiit's Signatdre / Nate
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
US Army Corps of Engineers Avery Clay Jackson Polk
151 Patton Avenue Buncombe Cleveland Lincoln Rowan
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 Johnston Rockingham
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes
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
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page 11 of 12
Fax: [phone]
Cumberland New Hanover Scotland
US Fish and Wildlife Service / National Marine Fisheries Service
US Fish and Wildlife Service US Fish and Wildlife Service National Marine Fisheries Service
Raleigh Field Office Asheville Field Office Habitat Conservation Division
Post Office Box 33726 160 Zillicoa Street Pivers Island
Raleigh, NC 27636-3726 Asheville, NC 28801 Beaufort, NC 28516
Telephone: [phone] Telephone: [phone] Telephone: [phone]
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
Telephone: [phone]
Fax: [phone]
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kernersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
Page 12 of 12
K? 10?a 103 N,
DWQ to be a suitable method to meet the mitigation requirement. This 2ntribution will satisfy our compensatory mitigation requirements.
Until the WRP receives and clears your check (made payable to: DE -Wetlands Restoration Program Office), no Impacts specified in this
Authorization Certificate shall occur. Mr. Ron Ferrell should be cc acted at [phone] if you have any questions concerning payment
into the WRP. You have one month from the date of this approv to make this payment. For accounting purposes, this Authorization
Certificate authorizes payment Into the Riparian Buffer Res ration Fund to meet the following compensatory mitigation
requirement:
Compensatory Mitigation Required River and Subbasin Number
Stream feet
Wetlands acres
Waters acres
Buffers (square feet
The following condition Is recommended when a stormwater man ement plan is required. This typically applies to projects that are over
30% Impervious or have concentrated areas of development with roject that are over 30% Impervious. It is recommended that the need
for a stormwater management plan be established prior t uing any approvals. The applicant should also demonstrate that there are
adequate space allotted for the proposed BMP and that BMP appropriate to the stream classification Is used (i.e. wetlands, pond with
forested filter strip,o-r bloretentlon In sensitive watersheds 's).
,,?Wr(tten Stormwater Management Plan (Final Plan Needed)
An additional condition Is that a final, written stormwater management plan (Including a signed and notarized Operation and M intenance
Agreement) shall be approved In writing by this Office befem the I-p-a-ispeclueo in er Condition No. q In GC
o`r's No.3yU2 A The stormwater management plan must Include plans and specifications for stormwater management facilities that are
ppropr a e for surface waters classified as"(_' and designed to remove 85% TSS according to the most recent version of the NC DENR
Stormwater Best Management Practices Manual. These facilities must be designed to treat the runoff from the entire project, unless
otherwise explicitly approved by the Division of Water Quality. Also, before any permanent building is occupied at the subject site, the
facilities (as approved by this Office) shall be constructed and operational, and the stormwater management plan (as approved by this Office)
shall be Implemented. The structural stormwater practices as approved by this Office as well as drainage patterns must be maintained In
perpetuity. No changes to the structural stormwater practices shall be made without written authorization from the Division of Water Quality.
_
--
The above condition shall apply unless it is demonstrated in writing to the satisfaction of this Office that the impervious area of the entire,
built out project shall be less than 30% and that there are no areas of concentrated impervious area over 30% within the project such as, but
not limited to, commercial areas, multi family, clubhouses, maintenance areas, etc.
ere s all be no direct discharges tom fairways, t e areas, or greens.
A State Stormwater Permit (1 A NCAC 2H .1000) can be considered to meet this condition.
? Written Stomtwater Management Plan o Approval Needed)
? Include bold line material
The final, written stormwater m ment plans (Including a signed and notarized Operation and Maintenance Agreement) dated
must be Implemen nd the stormwater management facilities shall be constructed and operational before any permanent building
is occupied at the s t site. The structural stormwater practices as approved by this Office as well as drainage patterns must be
maintained in perp ity. No changes to the structural stormwater practices shall be made without written authorization from the Division of
Water Quality.
The following conditions can used In any situation where w Is required through protected buffers. The first condition can be
used for projects that have adequa sue as part of the placation process. The second can be used when the Issue Is
not well addressed.
? Diffuse Flow (No Review)
An additional condition is that all constructed stormw onveyance outlets shall be directed as diffuse flow at non-erosive velocities
through the protected stream buffers such th t-vcll not re-concentrate before discharging Into a stream as Identified within 15A NCAC 2B
.02 (5). If this is not possible i e necessary to provide stormwater facilities that are considered to remove nitrogen. This may
require additional approval fro Office.
? Diffuse Flow (Review)
An additional condf on is that all constructed stormwater conveyance outlets shall be directed to flow in a diffuse manner at non-erosive
velocities through t entire protected stream buffers without re-concentrating. If this is not possible it may be necessary to provide
stormwater facilities th a considered to remove nitrogen. Additionally, a stormwater management plan for this project shall be provided to
this Office before any of the impac s approve 1 Mzft conducted. The plan shall specify all stormwater discharge points, plan details, and
calculations to Indicate that diffuse flow through the protect buffers or nitrogen removal as described above will be achieved.
The following are typical conditions added to all approvals unleeWlt does not make sense to add It:
? Certificate of Completion
i
The Ultra-Amazing Standard Additional Conditions Document Version 1 - June 1, 2003
The blue wording Is for your instruction and edification (i.e. don't put this In the approval, ok?). The red wording is optional lingo (don't forget to change
the color to black If used or to delete if not used). Also, please change the dollar signs to the appropriate number in the final document. The little gray
boxes need to be filled with the appropriate Information. Please note the handy dandy titles that Bob Inadvertently came up with should be used...
Impacts should be specifically listed and specifically referenced. This is necessary to ensure that only the Impacts approved are conducted and that if
any impacts beyond those specifically approved occur it will be easier to enforce the 401 Cert./Isolated Wetland Permit/Buffer Approval. Taking this
extra bit of time now saves headaches later.

Impacts Approved
The following Impacts are hereby approved as long as all of the other specific and general conditions are met. No other Impacts are
approv c u ng incidental Impacts:
Am t A roved Units Plan Location or Reference
St am feet
A s acres
Waters
Buffers (square ft.
Mitigation may be necessary when mitigation thresholds are exceeded or when certain buffer Impacts are conducted. The USACE may require
mitigation in certain circumstances that are below our threshold requirements or for the Impounded portion of streams for Instance when DWQ does
not. In those cases we cannot require mitigation. However, when DWQ does require mitigation it is recommended that our requirements be similar to
the USACE's. For streams it is anticipated that DWQ will follow the USACE's Stream Mitigation Guidelines. For wetlands we typically require at least
1:1 restoration or creation. The following condition can apply to applicants that propose on site mitigation such as stream relocation where the
relocation will meet the definition of stream restoration (i.e. the activity will mitigate for Its own Impacts). Remember to apply the ratios to the amount
of mitigation required.
? Compensatory Mitigation
Mitigation must be provided for the proposed impacts as specified in the table below. A final compensatory mitigation plan must be approved
In writing by this Office before any of the Impacts approved herein are conducted. Additionally, the compensatory mitigation plan must be
completely constructed and implemented according to the plans approved by this Office before any permanent building [road] associated
with the project is occupied [is opened]. The mitigation must be maintained according to the approved plan and permanently protected by the
use of conservation easements or similar protections. Any repairs or adjustments to the mitigation site must be made according to the
approved plan or must receive written approval from this Office to make the repairs or adjustments.
.Compensatory Mitigation Required
Stream feet
Wetlands acres
Waters acres
Buffers (square feet

The following are recommended in addition to the above when on site stream mitigation, relocation or restoration Is proposed:
? Stream Relocation (Mitigation) with Approved Plans
The stream and buffer relocation must be constructed, maintained, and monitored according to the approved plans in the application and
application modifications. Any repairs or adjustments to the site must be made according to the approved plans or must receive written
approval from this Office to make the repairs or adjustments.
? In order for this project to be used as compensatory mitigation for other specific projects you must obtain written approval from this Office. The
request should include the amount of stream length and buffer area credit requested for accounting purposes. Please specify DWQ project
No. when making your request.
? Stream Relocation/Stabllization (Mitigation) that Require Additional Approved Plans
? Include bold line material
Before any of the Impacts authorized in this Certification occur, you must provide and receive written approval from this Office for a final
stream relocation and/or stabilization plan. The plan must Include designs and specifications that meet the definition of stream restoration (or
enhancement in no relocation is proposed) according to the latest version of the Internal Technical Guide for Stream Work in North Carolina
(available at http://h2o.ohnr.state.nc.us/ncwetlands/strmgide.htmi). The stream and buffer relocation must be constructed, maintained, and
monitored according to the plans approved by this Office. Any repairs or adjustments to the site must be made according to the approved
plans or must receive written approval from this Office to make the repairs or adjustments. The relocated stream must be preserved In
perpetuity by use of a conservation easement or other similar mechanism as part of the approved plans.
The following mitigation condition can be applied when the applicant has proposed and received approval to use the WRP, EEP, or
mitigation bank. Obviously you will have to change references to the WRP If the EEP or a mitigation bank Is used.
? Compensatory Mitigation Using the Wetlands Restoration Program (WRP)
Mitigation must be provided for the proposed Impacts as specified in the table below. We understand that you wish to make a payment to a
fund administered by the NC Wetlands Restoration Program (WRP) to meet this mitigation requirement. This has been determined by the
DWQ# G 3 ?IQ
Plan Detail Incomplete
Date 103 ,. Who Reviewed:
W
? Please provide a location map for the project.
? Please show all stream impacts including all fill slopes, dissipaters, and bank stabilization on the site plan.
? Please show all wetland impacts including fill slopes on the site plan.
? Please indicate all buffer impacts on the site plan.
? Please indicate proposed lot layout as overlays on the site plan.
? Please indicate the location of the protected buffers as overlays on the site plan.
? Please locate all isolated or non-isolated wetlands, streams and other waters of the State as overlays on the site plan.
? Please provide cross section details showing the provisions for aquatic life passage.
? Please locate any planned sewer lines on the site plan.
? Please provide the location of any proposed stormwater management practices as required by GC _
Please provide detail for the stormwater management practices as required by GC 3-?C)Z.
Please specify the percent of project imperviousness area based on the estimated built-out conditions.
?? `Please indicate all stormwater outfalls on the site plan.
? Please indicate the diffuse flow provision measures on the site plan.
? Please indicate whether or not the proposed impacts already been conducted.
Avoidance and/or Minimization Not Provided
? The labeled as on the plans does not appear to be necessary. Please eliminate the or provide additional
information as to why it is necessary for this project.
? This Office believes that the labeled on the plans as can be moved or reconfigured to avoid the impacts to the
. Please revise the plans to avoid the impacts.
? This Office believes that the labeled on the plans as can be moved or reconfigured to minimize the impacts to the
. Please revise the plans to minimize the impacts.
? The stormwater discharges at the location on the plans labeled will not provide diffuse flow through the buffer because
. Please revise the plans and provide calculations to show that diffuse flow will be achieved through the entire buffer. If it
is not possible to achieve diffuse flow through the entire buffer then it may be necessary to provide stormwater management
practices that remove nutrients before the stormwater can be discharged through the buffer.
Other
? The application fee was insufficient because over 150 feet of stream and/or over 1 acre of wetland impacts were requested. Please
provide $ This additional fee must be received before your application can be reviewed.
?<Please complete Section(s) on the application.
l ? G mot- J?-?
? Please provide a signed copy of the application.
? Please provide
Mitigation
copies of the application, copies of the site plans and other supporting information.
? of compensatory mitigation is required for this project. Please provide a compensatory mitigation plan. The
plan must conform to the requirements in 15 A NCAC 2H .0500 and must be appropriate to the type of impacts proposed.
? Please indicate which 404 Permit the USACE would use to authorize this project.
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