20031153 Ver 1_COMPLETE FILE_20030915

October 8, 2003
Cleveland County
DWQ Project No. 03-1153
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
Mr. Pete Moore, Director
Cleveland Home Heatlth Agency
1268 Fallston Rd.
Shelby, NC 28150
Dear Mr. Moore:
On September 18, 2003, the NC Division of Water Quality (DWQ) received your application for a General
401 Water Quality Certification to impact 453 linear feet of streams in order to construct a pond at the Senior Citizen
Home Health Center in Cleveland County. Mr. Alan Johnson of the DWQ Mooresville Regional Office has
conducted a thorough inspection of the site in accordance with 15A NCAC 2H .0506.
In your application, it was not clear if the proposed pond was part of the current project. During the
inspection it was noted that housing was currently under construction at the site. Should the impervious area at the
construction site exceed 30%, a stormwater management plan is required. Please provide documentation/calculation
for the impervious area (if less than 30% impervious) or the location of any proposed stormwater management
practices that are designed to achieve 85% Total Suspended Solids (TSS) removal.
Until the information set forth in this letter is provided, this office is requesting (by copy of this letter) that the
Army Corps of Engineers place this project on hold. Also, this project will be placed on hold for our processing due
to incomplete information (15A NCAC 2H.0507(h)).
Thank you for your prompt attention to this matter. Questions regarding stormwater requirements should be
directed to Mr. Todd St. John in Raleigh at [phone]. If you have any other questions, please contact Alan
Johnson or me at [phone].
Sincerely,
D. Rex Gleason, P.E.
Water Quality Regional Supervisor
cc: Steve Chapin-ALOE
Wetlands Unit
Dave Odum-Odum Associates
File Copy
[Fwd: senior center project]
Subject: [Fwd: senior center project]
Date: Mon, 29 Sep 2003 11:46:52 -0400
From: Alan Johnson <[e-mail]>
Organization: NC DENR - Mooresville Regional Office
To: [e-mail]
since Todd is out. Thought I would forward my message to him on to you
( or you can pass it on to someone else). The PCN is for pond
construction, 126 ft dam foot print and 260 ft of flooded stream. As
far as the pond is concerned I see no problem, but he had questions
about stormwater.
Thanks
AJ
Thanks
AJ
Alan Johnson - [e-mail]
%TITLE%
North Carolina Dept. of Environment & Natural
Div. of Water Quality
919 N. Main St.
Mooresville, NC 28115
Ph: [phone] Fax: [phone]
Resources )al
?v
C
Subject: senior center project
Date: Mon, 29 Sep 2003 11:31:56 -0400
From: Alan Johnson <[e-mail]>
Organization: NC DENR - Mooresville Regional Office
To: [e-mail]
The project you just sent down for a pond (#03-1153), You had
stormwater questions. The county owns the land, the pond is going to
be built at an existing development (Senior Center). Hard impacts are
less than 150 ft. I would think it is ok. But I don't understand your
stormwater concern/question. Just called the director and apparently
the site is relatively new, he mentioned finishing construction on some
of the housing units in December. I guess they had funds left over and
the pond would be a nice touch. No other impacts on site to streams.
comments.
thanks
AJ
Alan Johnson - [e-mail]
%TITLE%
North Carolina Dept. of Environment & Natural Resources
Div. of Water Quality
919 N. Main St.
Mooresville, NC 28115
Ph: [phone] Fax: [phone]
1 of 2 9/29/03 11:56 AM
Triage Check List
Date: f? Project Name: -
DWQ#: /af
County: G.
To: ? ARO Mike Parker ? WaRO Tom Steffens
? WiRO Noelle Lutheran
V1MVRO O Ken Averitte
Alan Johnson ? WSRO Daryl Lamb
? RRO Steve Mitchell
From: _ Telephone : (919)-?
The file attached is being forwarded to your for your evaluation.
Please call if you need assistance..
? Stream length impacted
? Stream determination
? Wetland determination and distance to blue-line surface waters on USFW topo maps
? Minimization/avoidance issues
? Buffer Rules (Meuse, Tar-Pamlico, Catawba, Randleman)
? Pond fill
Mitigation Ratios
? Ditching
? Are the stream and or wetland mitigation sites available and viable?
? Check drawings for accuracy
? Is the application consistent with pre-application meetings?
? Cumulative impact concern

?? '

G
Office Use Only: ®? Version April 2001
USACE Action ID No. DWQ No. 3 i 1 53
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 fil=l ADS 1401 U"V
1. Check all of the approval(s) requested for this project: JEP 1 6 2003
® Section 404 Permit
? Section 10 Permit ATEA QUALITY SECTION
® 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: Pete Moore-Director of Cleveland Home Health Agency
Mailing Address: 1268 Fallston Road Shelby, N.C. 28150
Telephone Number: 704-484-4408 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: Odom & Associates
Company Affiliation: Consulting Engineer
Mailing Address: 152 East Main Street
Forest City, North Carolina 28043
Telephone Number: [phone] Fax Number: [phone]
E-mail Address:
Page 3 of 12
115
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: Senior Center Pond
2. T.I.P. Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): 26833
4. Location
County: Cleveland Nearest Town: Shelby
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): Fallston Road to entrance of
Home Health Center, directly across from Ross Grove Church 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 of the site at the time of this application:
Currently the land is not used.
7. Property size (acres): 7.71
8. Nearest body of water (stream/river/sound/ocean/lake): Hickory 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 htti)://h2o.enr.state.nc.us/admin/maps/.)
Page 4 of 12
10. Describe the purpose of the proposed work: To build a dam creating a pond for aesthetic
purposes
11. List the type of equipment to be used to construct the project: dozer, front end loader,
compactor
12. Describe the land use in the vicinity of this project: rural/residential
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
N/A
V. Future Project Plans
Are any 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**
(yes/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
N/A

List each impact separately and identity 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.gov.
*** List a wetland type that best describes wetland to he 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:
Total area of wetland impact proposed:
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
(indicate on map)
Type of Impact* Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Im act Perennial or
Intermittent?
(please specify)
1 Culvert 126 UT to Hickory Creek 3 ft. Intermittent
2 Ponding 327 UT to Hickory Creek 3 ft. Intermittent

* 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 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.Wozone.com,
www.mapguest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 453
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 map)
Type of Impact* Area of
Impact

(acres)
(if Name p Waterbody
applicable) Type of Waterbody

(lake, pond, 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.): dam/embankment
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): aesthetic
Size of watershed draining to pond: 82 Expected pond surface area: 1.02 acres
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 purpose of construction was for aesthetic purposes. No other options were possible to
gain similar effects.
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/strmgide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
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.nc.us/wm/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
IX.
Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ? No
X.
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 (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 213 .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
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
constnintinn rlatec to nllnw _nrncpccina times fnr
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* (squImpact are feet) Multiplier Mid t on
1 3
2 1.5
Total
Gone 1 extends out 3U teet perpendicular trom near bank of channel; Gone 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.
N/A
X1. 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
X1I. 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
X1I1. 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
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152 EAST MAIN STREET PROJECT NUMBER SHEET
FOREST CITY, N.C. 28043
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FOREST CITY, N.C. 28043
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NOTE, CONTRACTOR TO FOLLOW ALL
GUIDELINES SET BY MANUFACTURER
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JOB NAME: SENIOR CENTER POND
LOCATION: SHELBY, N.C.
SCALE:1" = 50'
DATE: 8-13-03
PROJECT NUMBER
DESCRIPTION: DETAILS
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ODOM & ASSOCIATES ENGINEERING, INC.
NC Division of Water Quality
Reimbursable Expenses
l 7?
RECINED,
MB Checking
ODOM & ASSOCIATES ENGINEERING, INC.
NC Division of Water Quality
Reimbursable Expenses
DWQ Permit
b?' 0?-
DWQ Permit

MB Checking
4551
9/12/2003
NETIODS1401Moop
SEP I ' 2003
TS UALITYSECTO
ON
475.00
475.00
4551
9/12/2003
475.00
475.00
51N311 (12102) 186325