20001499 Ver 2_Application_20120110

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A-$
N C Dept of ENR I
JAN 05 2012
Winston Salem
Regional Office

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a N C Dept of ENR
® Alcoa Power Generating Inc JAN 0 5 2012
Yadkin Division
r
AL.COA Post Office Box 576 Winston -Salem
Badin North Carolina 28009 0576 Rmlonal Offloe
Application for Activity Permit for Reservoir and Shoreline Alteration
(Excavation, Dredge, and Fill)
Pnnt ortype all information below and return to APGI Yadkin Division P O Box 576 Highway 740 Badin N C 28009
SECTION ONE — BACKGROUND INFORMATION (to be completed by the applicant)
1 Full Name (adjoining property owner) f o R e u r -ru y irk C A 0/4)a S
2 Permanent Mailing Address np r p 3 lip l h Al i° ;; 13 t.
3 Local Address (if different)
4 Telephone (Business) NIA (Permanent) 336 !y 7 5 99.3 / (Local) 331- - A/5 % ' `l 2 66.10
5 Fax No and E mad (optional) t)r
ec � � n S �r
6 Reservoir��ar. rl Ur t_ r lrr 7 Township _ =W� 8 County 1iAt�aA Shy
9 Subdivision'
a ran 1-1 r r S 10 Section 1!425 � n r r f �� t (� r, u c +c) Ji 1' 7 2q L.
11 Lot No 1 n q 12 Tax Map No '96
13 Directions to property (if necessary use the enclosed drawing sheet to provide us a map to the site) CQ C, t I n n ##
4; it v -- A n 0 nrr»c 1
U
14 Is the shoreline along the property descnbed above designated as a High Cultural Probability Zone in Yadkin s Shoreline Management Plan (leave blank if
you do not know) ❑ Yes ;J No
SECTION TWO— INFORMATION FOR RESERVOIR AND SHORELINE ALTERATION (attach the following to the applrcabon)
1 Map of the reservoir area where the excavation is proposed applicant must attach a map of the area of the reservoir and adjoining shoreline property owned
by the applicant where excavation is proposed The map must dearly exhibit the area of the proposed excavation and to what depth (contour elevation) the
excavation is proposed ' ' oLe Ifv0-1 l,;J e j
2 Descnption of the planned excavation applicant must attach a written descnphon of the planned excavation including an estimate of the reservoir bottom to be
modified and the amount of matenal to be removed from the reservoir Se.- (k-K%e-kT4
3 Plan for disposal of excavated matenal applicant must attach a wntten descnpbon of their plans for disposing of the excavated sediment No sediment may
be disposed of within the FERC project boundary (655 foot contour) or on property owned or managed by Yadkin or Alcoa Se P� 1-t Ac!h c�
4 Resource impacts assessment applicant must attach a bnef written descnption of the potential impacts of the proposed excavation activity on surrounding
reservoir resources including impacts to water quality and fish habitat If there is any vegetation growing in or around the area of proposed excavation it
should be noted and the areas of vegetation should be photographed and photos included with application See- "+2-ch a,J
5 Schedule for conducing the proposed excavation applicant must attach a written schedule for completing the proposed excavation See 1R+fC c.h eJ
6 Agency Approvals applicant must attach copies of written concurrence with the proposed excavation from the following agencies (refer to Instructions for
Application forAcb* Permit for Reservoir and Shoreline Excavahonr .Sec FAA 4a c h -ec(
U S Army Corps of Engineers
North Carolina Division of Water Quality - 0-h e & a ALkCXS eJ �f o -a4a 00 — Cf1tcL#
North Carolina Department of Cultural Resources (required in High Cultural Probability Zones )
7 Non-refundable permitting fee applicant must include a check or money order made payable to APGI Yadkin Division in the amount of $100 00
SECTION THREE (to be completed by the applicant)
I hereby apply for a pemnt to perform the above - described shoreline alteration at I-Rgh Rock Reservoir I agree to abide by all applicable regmu ements of
Yadkm s Shoreline Management Plan, the conditions of theAletwityPernutforReservoir and ShorehneAlterakon (Excavation Dredge and F111) and other
Yadkin procedures and requirements I also agree that no work will begin until I reeve anAckvdy Permit signed by Yadlan.
1
/!I'e- y.. !/. r/ II It i/` r f t //- y 4011
Applicants Signature - '334 Z- 1 S_ 19 a 9 Date
334 -D-tS )9'71
Page 1 of 2
White Copy — Yadkin Canary Copy — Applicant Pink Copy — Other

Instructions for Application for Activity Permit for Reservoir and Shoreline Excavation
(Excavation, Dredge, and Fill)
Instructions
To be considered for an Activity Permit for Reservoir or Shoreline Alteration (Excavation Dredge and Fill) the adjoining property owner (or a duly authorized
representative) must return to Yadlan a fully completed application letters of concurrence from the appropriate agencies if necessary and a check made out to
APGI Yadkin Division forthe proper application fee Please consult Yadkin s Shoreline Management Plan and Shoreline Stewardship Policy for detailed
information regarding Yadkin s procedures and requirements governing admbes in the reservoirs along the shoreline or in the Yadkin-managed buffer (this
information is available online at wvwv yadlaninc com)
Yadkin will sign and return to you the Activity Permit for Reservoir and Shoreline Alteration after Yadlan has reviewed the documents to ensure that the
proposed activity will be in compliance with the Shoreline Management Plan the Shoreline Stewardship Policy and all other applicable Yadkin policies
procedures and requirements You (the adjoininq property owner) may not commence work until such time as you have received from Yadkin the Adivity
Permit for Reservoir and Shoreline Alteration
Requirements
Alteration of the existing reservoir bottom or shoreline such as removal addition or fill (other than Yadkin-approved stabilization measures) or
modification of rocks soil sand and sediment (including dredging and excavation) is prohibited on Narrows Tuckertown and Falls reservoirs
On High Rock Reservoir in recognition of the high rate of sedimentation that occurs Yadkin may permit excavation of reservoir sediments to maintain or
create recreational boat access to private piers Excavation at High Rock Reservoir is by wntten permit only in accordance with the following standards
All excavation must have pnor written approval from the US Army Corps of Engineers and the North Carolina Division of Water Quality (NCDWQ) For
further information regarding these approvals you should contact these agencies directly at the following addresses
Army Corps of Engineers
Davidson County
Montgomery County
Rowan or Stanly County
U S Army Corps of Engineers
U S Army Corps of Engineers
US Corps of Engineers
Mr John Thomas Program Manager
Mr Allen S Davis Program Manager
Mr Steve Chaplin Program Manager
6508 Falls of the Neuse Road
Post Office Box 1890
151 Patton Avenue Room 143
Suite 120
Wili-ungton N C 284021890
Asheville N C 28801 -5006
Raleigh N C 27615
North Carolina Division of Water Quality
Davidson County
Rowan County
Ms Cindr Bell
Mr Todd St John
4401 Reedy Creek Road
4401 Reedy Creek Road
Raleigh N C 27607
Raleigh N C 27607
Excavation of the reservoir in areas adjacent to shoreline that has been designated as a High Cultural Probability Zone in Yadlan s Shoreline
Management Plan requires pnorwrrften approval from the North Carolina Department of Cultural Resources ( NCDCR) For further information regarding
this approval you may contact the NCDCR at the following address
NC Department of Cultural Resources
Office of State Archaeology
Dr Billy Olrver Archaeologist
109 East Jones Street
Raleigh, NC 27601 2807
5 Only excavation in the dry is permitted and must be performed when the reservoir is drawn down sufficiently to access the excavation site No dredging
(in the wet) is permitted in conjunction with the construction or maintenance of private piers
6 The excavation must not after the reservoir shoreline at normal full -pool elevation (655 feet at High Rock Reservoir)
7 No excavation is allowed in areas of wetland vegetation
8 Excavation may not occur during the months of March through June because of potential impacts to fish spawning
9 The shape and depth of the excavation must be such that waiter will drain freely from the excavation when the reservoir level drops below the level of the
excavation
10 All excavation must be placed landward of the normal full -pool elevation (655 feet at High Rods Reservoir)
11 Individuals conducting the excavation are responsible for disposing excavated materials in compliance wrfh North Carolina Department of Environment
and Natural Resources ( NCDENR) For further information regarding the disposal of excavated matenals you may contact NCDENR at (704) 663 -1699
12 Yadkin reserves the nght to require pnor testing of sediment in the area to be excavated and reserves the right to deny permission for excavation based on
the test results
Page 2 of 2
White Copy — Yadkin C-mary Copy — Applicant Pink Copy — Other

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CATHERINE S McADAMS
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HEALING SPRINGS TOWNSHIP
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NORTH CAROLINA
TAX MAP 9A
P Q 8 PG 50
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BLOCK 7
MAP NO 7
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PARCEL 909
SECTION 9
L-3476
Lot 909
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JUNE 2000
`OSU"
D ^D PEFERENCE D8 103-* PG 6710
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R A BY COORDINATE METHOD
,TtO OF PRECISION t 10 000
MICHAEL D HAG E 5tJ
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LEXING_0 i [ C 27
336 2 3 7450
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office USP ()lily
Foim V41sIOn Ma6h OS
UBAC% Action 11) No Der - q 2
— (If any prttticulai it�ni is iwl apPlitabte to llus oJect p]`Qooi 'Not O O cab c"� 'N/All V --
-- ----_— __ =------ .._.._
p'rocebsiitg
1 Check all of the apptoval(s) i equested for this pioject im 19 Section 404 elMit ® Riparian of Watershed Buf %t Rules
� Section 10 Permit
❑ 401 Water Quality Ceitificatton Isolated WetWid Peiluit from DWQ
Li picss 401 Watot Quality Cc'titication
2 Natsonwidc,, Regional of eneial Permit Nlintbci ) Requested
3 If this notification t5 soltly a coin tesy copy hecausc written approval ioi the 4 `
is not iequued, check hete [] 01 Ceztircation
4 If Payment into the North C«tolina Ecosystcrn Enhancement Piogiam (NCFLIP) is proposed
for mitigation of unpacts, attach the acceptance letter from NCEEP, complete section VIII,
and check her c []
S If your ptoJcct is located to any of Noith Catolina's twenty coastal counties (listed on page
4), and the proJcct is within a Noith Carolina Division of Coastal Manabement Atca of
Envnonntental Coneein (see the top of page 2 for fui Chet details), check here ❑
Applicant I11fo1 niatloll
1 Ownci /ApplictntInfoiniation D P @t� W
Name
Mailing Addi ess _._ �0 �63 o x S � � � �`� w►Y►_s_____ _ - -__ _ - -� A pl- � �- 221112 _
p
ENR WATER`Q-0 ALITY -"
l clephotic Numbe�1g�Z --- I {{
L -mail Addiess C _ ax Nuinbot —3-3L g8 S- y 3 57 — '-
2 Agent/Consultant Information (A signed and dated copy of the Agent Authoii?atiOn lett
must bf, attached if the Agent has Signatory authority for the owner /applicant) el
Name
Company Afr it itioir
Mailing Addtcss
l? marl Addtcss Pax Nuinboi
PILIc 5 of i I

III P1Ojec€ Infolznflifon
Attach a vicinity nilip cleatly shownlg the 10Cdt1O11 of the ptopcity with respect to local
landmarks such as towns, tivels, and toads Also plovlde a detailed site plan bhowrrzg plopelty
boundaries and development plans in relation to sutiounding props itles Both the vicinity map
and site plan must include a scale and north allow The bpectltc footpiitlib of all buildings,
impervious surfacts, 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 plopelty
boundatics outlined Plan dtawings, or other maps may be included at tic, applicant's discretion,
so long as the plopelty is clearly defined Iol adminishative and distribution purposes, the
TJSAC133 requires information to be submitted on sheets no larger than ll by 17 inch format,
however, 1?WQ may accept papc,iwoik of Suzy size DWQ prefers full -size construction
drawings iathei than a sequential sheet version of the full -sire plans Ii cull srce plans are
1 educed t0 a small scale such that the final vc rsron is illegible, the applicant will be rnfolmed that
the piojeet has been placed on hold until decipherable naaps ate provided
i Name of project - -ELAxaYi-% io h� - $ edl ntien-kz
2 TIP PloJect Nuillbel of State Ptojec t Number (NC:DO F Only)_
3 Property Identih(,at'On Numbor O ax PIN) _mil she .� , � O L- 1 o� _
4 Location
County Ncatest Town _
Subdivision name (include phase /lot number)
D1lections to site (include toad liumbeis /names, landmarks, etc)
Site cooidmates (Z -,ol lrncai projects, such as it toad or utility line,
separately lists the cooidin rtes fol each Giossing of a distinct wateibody)
Dccun1I Dcgt(,(.S (G dlgrtb 11n11111min-) oN ojkr
att,telz a sheet that
G Pr opet ty S1i(, (a(,r cs) _ y q,.,—
7 N iiiic. of nc, a cst lccclvnlg bexly of watel _ , n-..�n��
H-1
Rive r Basin
(Note –this plus be 0110 of North Carolina's seventeen designated major liver
River Basin map 1s avallablc at ht[l / /h2o en1 state tic us /aclr -a .1 1,, )
basins 1 he
9 Desetrbe the existing conditions on the site and general land use, in the vlclnrty of the prglec,t
at the time of tills appltc'ttron I r 1,,,,ao _1 _1. ►-.o _ _ _ 1 i I r- I
Pape 6 of 12

10 T)"01 'be the ovGldll P,01CGt in detail, including the typ(, of (quipI11W1t to be used
i'1�1...
1 17xplailr the ptu post. of the proposed work
IV Prio1 Pl olect ilistoly w
If lunsdicttonal cletermniatroils alld /ol peilmts have been loquestcd and /or obtained for this
pioJcct (Including all ptioi phases of the same subdivision) in the past, please explain Include
the USA.CL Action ID Numbei, DWQ Plolect Numbei, application date, and date peilmts and
cei tircations were issued or withdrawn Provide photocopies of previously issued peiinits,
ceitircatiolls of other usef�ril lnfolmation Desciibe previously appioved wetland, stxcam and
buffci impacts, along with associated mitigation (where apphcablc) If this is a NCDOT piolcct,
list and describe pctnlits issued for pitol segments of the same T I P protect, along with
con stn uctlon schedule.
IC.Ca�rc � w .- ,... _ , y-+ t-PY1 1'L�� O P�+� ��j •�" -
V r+iltlu a P1 oaea P1a11s _
Aie any future permit requests anticipated for this piolect? If so, desGiibe the anticipated woilc,
a11c1 provide JUSt7frCatlorl for the exclusion of t1118 work floin the cuilclnt application
Sr:cl. � i,•,, e,,�- . ,1 d s i.(.
VI P1 oposed lrmparts to Watei s of the United States /Witten s Of flu, State
It is the applicant's (or agent's) responsibility to deteinime, dchineatc, and map •it1 irnpact5 to
wctlannds, open water, acid shear channels associated with the pioject Lach impact must be
listed seNldely in the tables below (G g, ciilveit installation should bG listed separately fxorn
ltprap dissip act pads) Be salt, to indicate if an impact is temporary All proposed impacts,
pt,imancnt and tcmpotary, must be listed, and must be labekd and clearly identifiable on an
accompanying sits, plan All wetlands and waters, and all sticauls (inteimittent and perennial)
sllould be shown on a delineation n1ap, wllether 01 not impacts are proposed to these systems
Wetland and stream evdluatlon and delineation folms should be included as ap pro date
Pllotogtaphs may be included at the applicant's discretion If this proposed impact is stilctly for
wetland of stream mitigation, list and describe the impact in Section VIII below If additional
space is needed for listing of descilptlotl, please attach a separate sheet
l Provide d written desciiption of tllc ploposed impacts _ f
1) Hge 7 of 12

2 Individually list wetland impacts Iypes of impacts include, but Luc not limited to
mecllalli/ed clearing, grading, fill, excavation, flooding, ditching/dratnage, etc Fot darns,
sc� �tcly hst Impacts due to both structure anti lloodii ^- `_
We iland Irnpaet ocated wrrtiuu Distance to Area of
91 ft, Number Z ype of Impact e Type of Wetland
( g, forested marsh 100 Ycar Nearest Ini act
(rrrdzcate on map) p
hwbaceouh, bog, elc) Floodplaw Stic81n (acres)
(VPr/nnl /1...
Iota1 Wetland Imp
ct(actes)
3 List the total acreage (estimated) of all c xisttng wetlands on the plopelty
4 Individually list all intermittent and perennial stream impacts Be sure to ictelitify tern otai
\� impacts Sheam rmpacls include, but ate not limited to placement of rill of culverts darn
constitiction, .flooding, ielocatiorl, stabtltzatton Activities (e g
walls, gabtoils, etc ), excavation, clitehing/shaighteiling, etc If she n ielocation is walls, rip -rap, crib
plans and piofilos showing the linear footprint for both the olrgnlal and 1eloated streams
_ must be included To calculate act ea e, multi 1 len th X wLS(ioaimii dth hen divide b 43,560
Sri earn Impact
NrunUet Stream Name Perennial or ge Impact Area of
ndicate on maw
Type of Impact
113t
.e idth Length Impact
�'-- — — act lrncru feet (acres)
Mal Str cam Impact (by length Ind 1c) urge)
5 Individually list all open water Impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocoan and any other W1tei Of the U S) Upen water impacts include, but are not limited to
fill, excavation, died to f, floodin , dtainae, bulkheads, etc
Open Water Impact — _
Site Number Name of Wlteibody Type of Watei body Area of
- indicate on mar Of appliczblc) 1 'Ype of Impact (lalrc pond, estuary, sound, bay Impact
ocean etc L acres
- - - - -- _ —_ _ , —_ - -- fotal Open Water Impact (acres)
1'190 8 of 12

G I.ts( the euniulaiive Impact to all Wate! , of the U 5 ! esultil]g fialn the)loleGt
Scream h11p ac�acl cs� — -
Wctland Impact (aGtas)
0 on Watt! I►n�act acics -- �"�' --~---
�--
Z oral In1t to Waters of the U S aci °-
total Stielull I�
fGPtll
T11)aCt (1!!]efll
I Isolated Waters
Do any Isolated waters exist on the piopeity`I [] Ye-3 No
DCSCixbc all impacts to isolated waters, and include the type or w ter (wetland of
the size of the pioposGd Impact (acres of Linea! foot) Please note that sileam
this section only
applies to waters that have specifically been determined to be isolated b) the USACE
8 Pond Citation /Vo
If coi]stiuctlon of a pond Is pioposGd, associated wetland and stlearn Impacts should be
ulGludect above, r!i Q,t, wctl"ulcl Lull stream Impact sections Also, 1111. pioposed pond should
be described here and ilhistiated on any maps included with this application
Pond to be cleated In (check all that apply) [] uplands
DGsciibe the method of consti action (e g , dam/embanitment,Cexcavation, inssttallatlonlCls
draw -down valve of spillway, etc ) °f
Proposed use 01 purpose of pond (e g, livestock watering, niigation, acsthetrct
local stormwater xequilement, etc ) _ , trout p 101 d,
Current land use in the vicinity of the pond _` ----- —
817G of water shed d1 aunng to pond
^_ Fxpeeted pond suI lace area
V11 impact Justification (Avoidance and MulYmlzatlotl)
10 Specifically describe nleasuies talcen to avoid the Ploposed
lnfolnlatroil related to site constraints such as too r tpily building oiclinulcc , accessibility, and
financial ti iabiltty of the project The applreant may attach diawings of altelliativc, lower fin]. pact
site layouts, and explain why these design options were not feasible Also discuss how Impacts
weW Minimized once the desired site plan was developed If 1ppliclble, discuss constluctlon
techniques to be, followed doling constiuction to reduce impacts
V111 Mitigation
DWQ In accoidallce with 15A NCAC 2II 0500, mitigation may be iequiied b (lie NC
Division of Water Quality for piolects involving gtcater than o1 equal to one, ac! c of impacts to
freshwatei wetlands of greater than of Gqual to 150 lineal feet of total Impacts to a ennial
sir Gains p
P891, 9 of 12

USACE — Ill accordance with the Final Notice of Issuance and Modlif)(Al"on of Nationwide
1'elmlts, published in tliG Federal Register on January 15, >002, mitigation will be iequned when
necessaty to Gnsule that adverse effects to the aquatte euvnonmcnt ate minimal Paetois
lm- ludtng Size and type of proposed impact and function and lelattve value of the Impacted
aquatic resourGc will be considcied in dctclmuiuig acceptability of apptopuate and practicable
mitigation as proposed Exainples of mitigation that may be appropiiatc all([ piactmable include,
but ale not limited to ieducrng the size of tlic piolect, establishing and maintaining wetland
and /oi upland vegetatGdi buffeis to protect open waters such as streams, and ieplaeing losses of
aquatic iesortrec functions and values by creating, iestorrng, enhaa nig, oi pteserving sltntlar
frinG410118 and values, preferable in the same wateishcd
ff mitigation is required foi this plolect, a copy of thG mitigation plan must be attached in oidei
foi USACL of DWQ to consider the application complete foi proGessmg Any application
lacking a regiuiecl mitigation plan or WEEP eonc.utlence sh,11 be placed on hold as incomplete
An apphGant may also Ghoosc to review the cutrcnt guidelines foi stream restoration in DWQ's
DI,1 t technical Guide foi Stream Work in North Calolinl, available tit
liitp //lr2o enr state nc us /ut~wetla%jq /sti___. sn ide htrn]
1 Provide a brief descirption of the proposed mitigation plan The da5citption should provide
as 111uGh mfoimatlon as possible, including, but not limited to site location (attach directions
and /oi map, if offsite), affected stream and iivei basrli, type and Mount (acieage/Irnear feet)
Of mitigation proposed (restoration, enhancement, cieatton, of preservation), a plan view,
picscivation mechanism (cg, deed iestaictioirs, conscivation casement, etc), and a
description of the curl ent site conditions and pioposed method of constluction Plelse attach
a separate sheet If mole space is needed n' /
MItlgation may also be made by payment into the North Caiollna Fcosystem Enhvrcomerrt
Program (NCEPP) Plcase note it is the applicant's responsibility to contact the NC.FLP at
that t ey 715-0476 to determine availability, and written apinoval from the NCLLP irid watmg
that they are writ to accept payment for the mitigation must be attached to this foinl For
suidrtional Information icgaiding the application process foi the NCEEI.1, check the NCFFP
websrte at littp / /li2o enr slate nc its /wi /tnd�x htii� if use of the NCLLiP is pioposed, Plcase
check the appropriate box on page five and piovrde the following information
Amount of stleain mitigation requested (linear feet) /
Amount of buffet mitigation requested (square feet)
Aniount of Ripaiian wetland mitigation requested. (aci es)
Amount of Non - riparian wetland mitigation requested (acres)
Amount of Coastal wetland mitigation requested (acres)
Page 10 01 12

Ix
" 'n"0111nelit,11bl0ciimeiltation (iequired by DWQ)
I Dots the plolect involve 'ul expenditure of public (fedelaYstatc /loc,al) fwlds of the use of
public (federal /state) land? Yes [] No TA
II yes, does the ploject iequlie prepalatlon of an eilvilonmental document puisuant
Iequitemeuts of the National or North Catolura Lnvuofunental Policy Act (NEPA /SEPA)?
Note if you aic not sure whethcl a NFPA /SEPA document is lequucd, call the SFPA
c,00lclulatot at [phone] to levtcw current tluesholds for elnvvonmental doeunientation
Yes ❑ No ❑
If yes, has the document review been finalized by the State Ch mingliouse? If so, plc,ase
attach a copy of the NEPA of SB11A final approval letter Yes ❑ No ❑
PI oposed linpacts oZn 111pal all and W111(cl shed Buffei s (i eq uu ed by DWQ)
It Is the applicant's (01 agent's) lesponsfbility to detefmine, delineate and neap all Impacts to
Lquited sistc and 10c. d buffers associated with the P oject The applicant must also plovlde.
Justl.Gcation for these 11npacts in Section VII above All proposed Impacts must be listed herein,
aild Dust be cleatly identifiable on the accompanying site plan All buffers must be shown oil a
Map, whethcl of not impacts ate ploposed to the buffets Coilespondence from tho DWQ
Regional Office may be included as appiopltate Photographs may also be included at the
applicant's discretion
FA
�Vttt TmAcckch trparlan Uuileis identified within 15A NCAC 2B 0233
(Neuse),15A NCAC 2B 0259 (1 a1 Pamlico), 15A NCAC 02B 0243 (Catawba) 15A NCAC
2B 0250 (Randleman Rules and Water Supply Bufrcr Requitements), of other (please
Yes ❑ No N
If "Yes ", Identify the square nett au,l aweage of Impact to each /one of the lipaimn buffets
11'buffei mltlgaiion Is tcqulied calculate the tequlied amount of Innitigatfon by applying the,
buffer multipheis _
/olle� Impacl� Kcquucd
---_ _y — �sgucue feet; -- _MuItIpllal _ Mit, Alton
3 (2 roi Catawba) --
lono i exlrnds'ont 30 feet PU pc ndiculnr h om the top of the nea t�antc of e11�Innc! Lone 2 extends an
iddit[onal 20 feet from the edc of Zone, l
N Duffel mitigation is Iequned, please discuss what tyke of mitigation is pioposed (i e,
onation of Plopefty, Ripaitan Buffer Rtstotatlon / Enhancement, of Payment into the
Ripaitaii Buffel RLstolation Pwid) Please attach all applopilate infoiination as Identified
within ISA NCAC 213 0242 of 0244, of 0260
1"Ibt, I 1 or V

X1 Stal xnwater (regua (d by DWQ)
Descilbe llnpeivious acreage (existing and ploposed ) velsu
ssolinwatcl controls ploposed in older to protect sui ace watelsta dLw tg�ncol5 doe site Discuss
U10 property !f pe' Ge"t unpei viotis sur fcice exceeds 20 %, 111ease piovideil cstalculat ioln
demonstiating total pioposc,d imp(Avious level ions
XII Sewage Disposal 0 equn eel by DWQ)
Clearly detail the ultimate W atinent methods and disposition (non disclialge or dischal
wastewater generated from the p oposed project or available capacity of the sub ect f ge) of
---__ ) awlity
"T V101at10116 (1 equil eci by DWQ)
Is this site In violation of DWQ Wetland Rules (15A NCAC 211 0500) of ail Buffer Rules?
Yes ❑ No 0 y les 1
Is tlals an ap.el- the -fact permit application? Yes C] No
XIV Cumulative Impacts (i eguu ed by DWQ)
Will this project (based on past and icasonably anticipated futule Impacts ) result ill additional
development, which could Impact nealby downstieam water quality? yes Ej NOEj
if yes, please submit a qualitative of quantitative cumulative impact analysis in accoidanc
the "lost recent Noith C'aiolina Division of Wate1 unlit Po,IC ce with
htt /h2o E1?i stat c W! /ncwc,tla if IIO, please pro de a short Hall rveedesc Iotio wcbsltc at
--- -- ---- -- �_ ___ p n
XV Othel i,i1 C11111stallces (Optlolial)
It is the appllcant's responsibility to submit the application sufficrf,.ntly "I adv InGe
construction dates to allow pi0gssing time f01 these pelnnts Itowevel, ail applicant may
o f desil eci
choose to list constlaints associated with constitiction of sequencing that may Impose y
work schccitiles (e g, draw down schedules for lakes, dates associated with g11 limits on
lhleatened Species, accessibility problems, or otllci Issues outside of the a ilea ' dango and
tpp ntscontlol)
e
Applicant /Agent's 81gllatul e
(Agent's signature is valid only If 'in autholliatroil lettcj
P the 12 o1 12
Date
from the appilcant is Inovidc,d )