20031104 Ver 1_Complete File_20030904

Certificate of Completion
DWQ Project No.: 03- XW 4 County: "40h. 4 nny.10K u
Applicant: y\ 6&
Project Name: C 0 Q-\-GS 'ao g VIOU Sy
Date of Issuance of 401 Water Quality Certification: I 1 -1, OLD
Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules, and any
subsequent modifications, the applicant is required to return this certificate to the 401/Wetlands Unit, North
Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC, 27699-1621. This form may be
returned to DWQ by the applicant, the applicant's authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
Applicant's Certification
I, ?A\ . 'R. 60Q,?I-eS , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature: ?T--) LU (JS M Date: (e I'u I O`Y
Agent's Certification
I, , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
WETLANDS 14(?1 GROUP
Signature: Date:
JUL o 7 2004
If this project was designed by a Certified Professional WATER QUALITY SECTION
I, , as a duly registered Professional (i.e.,
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized to
observe (periodically, weekly, full time) the construction of the project, for the Permittee hereby state that,
to the best of my abilities, due care and diligence was used in the observation of the construction such that
the construction was observed to be built within substantial compliance and intent of the 401 Water Quality
Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature: Registration No.: Date:
\o?pF w H r??QG
ri _
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
January 12, 2003
Montgomery County
DWQ Project #: 03-1104
APPROVAL OF 401Quality Certification with ADDITIONAL CONDITIONS
Nell R. Coates
5270 Woodrun on Tillery
Mt. Gilead, NC 27306
Subject Property: Lot# 1292 on Lake Tiller
Dear Mr. Coates:
You have our approval, in accordance with the attached conditions and those listed below, to place fill
within or otherwise impact approximately 0.1033 acres of waters for the bulkhead and 0.0275 for the
boathouse and dredging on Lake Tillery for the purpose of constructing a boat house and seawall as
described within your application dated September 4, 2003. After reviewing your application, we have
decided that this fill is covered by Nationwide Water Quality Certification Number 3373, which may be
viewed on our website at http://h2o.enr.state.nc.us/ncwetlands. This certification allows you to use
General Permit Number 198200030 when the Corps of Engineers issues it. 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, Coastal Stormwater, Non-Discharge and Water Supply
Watershed regulations. This approval will expire when the accompanying 404 or CAMA 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 except as
modified below. If you change your project, you must notify us and you may be required to send us a
new application. If the property is sold, the new owner must be given a copy of this 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) (6) and (7). This approval shall expire when the corresponding
Nationwide Permit expires or as otherwise provided in the General Certification. For this approval to
be valid, you must follow the conditions listed in the attached certification and any additional
conditions listed below.
Conditions of Certification:
Upon completion of the project, the applicant shall complete and return the enclosed
"Certification of Completion Form" to notify DWQ that all the work included in the 401
Certification has been completed. The responsible party shall complete the attached form and
return it to the 401/Wetlands Unit of the Division of Water Quality.
t
I;-Dr:,
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.ne.us/ncwetlands
Page 2
Mr. Coates
January 12, 2004
2. This project is for the installation of a bulkhead to prevent further erosion of the property due
to wave action. The use of mech a nical equipment on the beach must be minimized.
3. Equipment and materials may be?offloaded to the beach at the bulkhead site, but steps must be
taken to keep all equipment out of the reservoir.
Violations of any condition herein set forth may result in revocation of this Certification and may result
in criminal and/or civil penalties. Thi Certification shall become null and void unless the above
conditions are made conditions of the Felera1404 and/or coastal Area Management Act Permit.
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 1?OB of the North Carolina General Statutes to the Office of
Administrative Hearings, P.O. Box 27447, Raleigh, N.C. 27611-7447. This certification and its
conditions are final and binding unless you ask for a hearing.
This letter completes the review of the D vision of Water Quality under Section 401 of the Clean Water
Act.- If you have any questions, please te' ephone John Dorney at 919-733-9646 or Ken Averitte of our
Fayetteville Regional Office at 910-486-1541.
Sincerely,
JRD/bs
Attachments
i ek, P.
cc: Corps of Engineers Wilmington Field Office
Fayetteville DWQ Regional Office
File copy
Central Files
01/07/04 06:42pm P. 001
Randolph County JobLink
Career Center
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IRandolph County JobLink Career Center * Phone# [phone] * Fax# [phone]
JAN-7-2004 WED 16:35 TEL:[phone] NAME:DWQ-WETLANDS P. 1
01/07/04 06o42pm P. 002
The following is an abbreviated application form for those applying for a 401 Water
Quality Certification to impact FERC (Federal Energy Regulatory Commission)
regulated lake shore or bottom under the U.S. Army Corps of Engineers Permit
GP30. This Application cannot be used for wetland or stream impacts. Please
provide seven (7) copies of this application and supporting information as well as a
non-refundable application fee to the Division of Water Quality of $200.00 for
impacts of to lake bottom of less than 1 acre and $475.00 for impacts to lake bottom
of greater or equal to 1 acre.
Applications should be sent to:
Division of Water Quality Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
1. Applicant Information
1. Owner/Applicant Information
Name: N e \i V Coo. es
Mailing Address: 5 a r')Q W oadr,. n` o r. "?' \\ rc s
Telephone Number.(G41 A V13o1- L C6 a G Fax N
E-mail Address: v? r P d?? \ e S Y CAr\eo4+(}?.. e
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:
Mailing Address:
Telephone Number. Fax Number:
E-mail Address:
II. 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. You may use the diagram below to make a hand sketch of
JAN-7-2004 WED 16:35 TEL:[phone] NAME:DWQ-WETLANDS P. 2
01107/04 06:42pm P. 009
your project. Also, see the example below for guidance. Both the vicinity map and
site plan must include a scale and north arrow. The footprints of all buildings,
impervious surfaces, or other facilities. must be included.
Location
`
County:CA Y Nearest Town: M G `Ay--0CA
Subdivision name or site addr ss (include phase/lot number): 1n o<Ar&,, LcV \2q 2.
Directions to site please include road numbers, landmarks, etc. (This is not
necessary if an adequate vicinity map is included): V? oK, ?°t I z Le?e?s 4ucn r'. ,ice tin
0Cc nee Pk. "o4se,, Gtr L re&5 "%46 h\S O dacee
2. Describe the existing land use or condition of the site at
time of this
3. Property size (acres): Oeefcs
4. Nearest body of water (strearn/river/sound/oceanllake): L Ck V-C 'T ef
5. Describe the purpose of the proposed
6. List the type of equipment to be used to construct the project: S LOA\k : bAC.k? W12:1
e,(ecs, R,er)ea e,?r6 o(- , 4U ?1(e?ect? 4x?cx\ ( 4 (W%'2A-15f4 d-et ,
7. Amount of impact (including all excavation, backfill, rip rap, retaining wall ,
etc.) below the normal pool lake level in square feet or acres: 130 5 (n .
8. a. Amount of impact (including all clearing, back fill, excavation, rip rap,
retaining walls, etc.) above the normal pool lake level and 50 feet land-ward in
square feet or acres: 1 A M--
b. Please describe vegetation above the normal pool lake level and 50 feet land-
ward to be impacted (number of trees for instance): no a'r'tcs n-s uCc oW i ot. 6
Is 0
ApplicantlAgent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
JAN-7-2004 WED 16:36 TEL:[phone] NAME:DWQ-WETLANDS P. 3
01/07/04 0E:42pm P. 004
7
pieeae .appmimide r :sketch the fefprwt i g i 'arrnation en plan
(please provide dhoenslon.9 f" each, Hem, such a'a 10 ft, x 100 1) p p o "Vdatien eleming (provide dimendon )
Locadime of rip rap or fill to be placed above the Fog Pond aelevAon,
3) Location of rip rap or fill to placed below she FUR Pond elevation
4) Ttm lgcsjlqn of any propn d skmtmes mh -as building, WaI nin
waft, do sw ek. w
6) The anon of any excavation or "Aging be w±rthe Full Pond
elevation.
I,aca of construction access cerr am.
orb O nom`
P6\,OV JAN-7-2004 WED 16:36 TEL:[phone] NAME:DWQ-WETLANDS P

`?oF wA
o 9p
p -?
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan Klimek, P.E., Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
September 9, 2003
DWQ # 03-1104
Montgomery County
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
Nell R. Coates
5270 Woodrun on Tillery
MT. Gilead, NC 27306
Subject Property: Lot# 1292 on Lake Tillery
Dear Mr. Coates:
On September 4, 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 boathouse and sea wall in
Montgomery 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 indicate proposed lot layout as overlays on the site plan.
2. Please complete the attached Lake application. Also, please attach photos of the site.
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,
l?
f Dorney
ter Quality Certific ion Program
JRD/bs
cc: Fayetteville DWQ Regional Office
Wilmington Corps of Engineers
Central Files
File Copy

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), (hn://h2o.enr,state.nc.us/ncwetlands)
Customer Service #: 1-877-623-6748
Atli 10
Office Use Only: Form Version Fther2001
USACE Action ID No. DWQ No. n A
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
1. Check all of the approval(s) requested for this project: r
? Section 404 Permit SEP m
? Section 10 Permit 2003
J 401 Water Quality Certification
?T ?1 JLi
F1 Riparian or Watershed Buffer Rules ' 6 SECTIO?
2. Nationwide, Regional or General Permit Number(s)_Requested:
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/Applic ant 'Information
Name: Nf-\\ - R . CoakeS
Mailing Address: - 5D '10 W o o d ru r, n r, `T' , \\eXti?
Telephone Number. cl 10) 4,661 - 4 % 1 O Fax Number: L
E-mail Address:nr e-Q a\-GS Cad Y-Qo\ DN, , eCJLk
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:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
Page 5 of 12
Ill.
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 an 'd 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 Js illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: C O AVe S o 0.?1?,?.,? c. Ard Seawa\\
2. T.I.P. Project Number or State Project Number (NCDOT Only): N o? ploo\? cebl
3. Property Identification Number (Tax PIN):
4. Location
county: o r,r, Nearest T _
awn: 1`n?-.
Subdivision name include p as?hot number): W ood (Nr l.. o? ?2 q'2
Directions to site (include road numbers, landmarks, etc.): w oodruc, ©r ?ro S Qnt?
1, YJ, e'? or, Sku\a d S\eeoL,
d?o?ne? ??. - lnddr?ss'?' ??5 odoti,ee, fit.
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: L o
7. Property size (acres): • 5 q6'< 'CS
8. Nearest body of water (
9. River Basin: y G Ck\4:
(Note - this must be one of l
River Basin map is available
i
ver/sound/ocean/lake): Lckke, -T ?\\_Cy,
?y Cf ?ASI n
orth Carolina's seventeen designated major river basins. The
http://h2o.enr.state.nc.us/admin/mqps/.)
Page 6 of 12
10. Describe the purpose of the proposed work: ?UT QO'a c i n 6-nr\6? X u A Q
SCawa?\ VO \o? xc>s: rO 4 k-O 0. 0
TV-,ooW a DOY40ar% 4 Q .k:. 1no ? EXCa?? ??o,.l drecl ;? hR o.nn?n, 1Q?1
??b? ? S dt S'e C? 1 n,Gr.?r
11. List the type of equipment to be used to construct the project: •?`OIG`,O-,Dt
12. Describe the land use in the vicinity of this project: r e?.G? Grk? a?
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 o? Ar,??.cablc,
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application:
No
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
X 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***
tJ nor 'A \. c b1 c

* T ,..r
IwVau. ,cyaiaLciy aiiu iucuuiy ieuipordry impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For damn separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local:floodplain maps:' Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://www.fema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated); of existing wetlands on the property:
Total area of wetland impact proposed:
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?
-(Please specify)

i i
I
?

* L• i
?
tst each impact separately and tdenufy 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.Qov. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.tonozone.com,
www.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
I
Page 8 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, pond, estuary, sound,

bay, ocean, etc.)
bu\\t.1n t 4 A 1'D33 L.Ok\t e `C mev \ 0. R.
b0 .Oz?s Lai,eZ;\\er 1
? Lakc``? e k.

Last each impact separately and identify temporary impacts. impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation ht Oar
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.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond:
Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization) 04 A V 0? C 4 61.e,
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
VIII. Mitigation OD} n Q t cAu <,
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12
USACE - In accordance with the Final Notice
of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the; size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as. streams; and replacing losses of
aquatic resource functions and values by creating, restoring,, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
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.
i
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 beforei 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 hM://h2o.enr.state.nc.us/wW/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):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12

IX.
Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ? No ET?
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 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )I?
Yes ? No )E' If you answered "yes", provide the following information:
Identify the square feet and acreage of impact
mitigation is required calculate the required
multipliers.
to each zone of the riparian buffers. If buffer
amount of mitigation by applying the buffer
Zone* Impact
(square feet) Multiplier Required
Mitigation
1 3
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
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 2B .0242 or.0260.
XI. Stormwater (DWQ Only)
Describe impervious acreage both existing and ro osed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
`A 6? V\D0V C4We ,
XII. Sewage Disposal (DWQ Only)
i
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.
\y o? ?n?\:cgblt.
XIII. Violations (DWQ Only)
Is this site in violation of DWQ W6tland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No Er
Is this an after-the-fact permit application?
Yes ? No 2"
XIV. Other Circumstances (Optional)
It is the applicant's responsibility ? to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
(?Z
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
o i'
5270 Woodrun On Tillery
Mt.Crilead, NC 27306
January 9, 2004
Mr. Michael Horan
NC Division of Water Quality, 401 Wetlands Unit
1650 Mail Service Cepter
Raleigh, NC 27699-2260
Dear Mr. Horan:
WETLANDS/ 401 GROUP
JAN 1 3 2004
WATER QUALITY SECTION
Enclosed are the pictures to the proposed construction site for which I am applying for permit.
For your convenience the reference number given his project is DWQ 03-1144.
Thank you for your prompt responses to m requests. This has been quite a learning experience
for me given that this is not my area of expertise. Should further information be required please
do not hesitate to contact me.
Sincerely,
??ce a c?
Nell R. Coates
(9k0) 439-4810.0tome)
(336) 633=0278 (work)
DWQ#
03- I lo,i
Date Q ` ?-kO 3

Who Reviewed:
Plan Detail Incomplete
? 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
? 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.
? Please provide a signed copy of the application.
? Please provide copies of the application, copies of the site plans and other supporting information.
Mitigation
? 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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Nell R. Coates
5270 Woodrun on Tillery
Mt. Gilead, NC 27306 3 Servim Type
DQ# 03-1104 - Montgomery IIRCertifiled Mail ? &4mn Mall
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2. Article Number 7002 2410 0003 0275 2397
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UNITED STATES POSTAL SERVICE First-Class Mail
Postage & Fees Paid
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Permit • Sender: Please print your name, address; and ZIP+4 in this box •
NC DENR Division of Water Quality
Wetlands/401 Certification Unit
2321 Crabtree Boulevard, Suite 250
Raleigh, NC 27604
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INTERIOR GICAL SURVEY, RESTON VIRGINIA 1996 11 1 , 1588 589~mE. 8(1°00' - 35.15' H O~ N VIRGINIA-1996 $d, oo,
35°1'+- 582 583 5' 584 585 586 87 30
80°67'30° 580 170000 FEET SCALE 1:24 000 HIGHWAYS AND ROADS
Produced by the U.S. Geological Survey * 0 i
U.S. Forest Service MN 1 5 Primary highway GIN MILES Interstate Revised by the U.S s Areas outside the National Forest System lands may not have been revised. 1000 p 1000 2000 3000 4000 5000 6000 7000 8000 9000 10 000 G ) 01 Secondary highway _ 1y
Control by USGS, NOS/NOAA and North Carolina Geodetic Survey 0° 3r FEET U S. ' Light-duty road
Compiled from aerial photographs taken 1977. Revised from aerial 7° 30' 9 MILS 5 0 KILOMETERS 1 2 19 Paved QUADRANGIELOCATION State
1000 Gravel o photographs taken 1983. Partial field check by U.S. Forest Service 1994. 133 MILS p METERS i 000 2000 6 0 North American Datum of 1927 (NAD 27). Projection and 10 000-foot ticks: County Dirt
North Carolina coordinate system (lambert conformal conic). Blue CONTOUR QV7 ERVAL 10 FEET 1 New London Composition unspecified... k unspecified...
1000-meter Universal Transverse Mercator ticks, zone 17. NATIONAL GEODE11C VERTICAL DATUM OF 1929 1 2 3 2 Badin National Forest, suitable IJDE GRID ANDCLINATION A1995 T AT CENTER OF MAGNETIC SHEET NORTH TO CONVERT FEET TO METERS MULTIPLY BY 0.3048 3 Lovejoy for passenger cars 106 Unimproved; 4 wheel drive , _ _ heel drive ====1=4WD
Worth American Datum of 1983 (NAD 83) is shown by dashed comer ticks. DE 61 The values of the shift between NAD 27 and NAD 83 for 7.5-minute 4 Albemarle I Trail 0 clearance Forest, vehicles suitable for 5 Gate........................................
intersections Non-National Forest obtainable from System lands National within Geodetic NSurveyational Forest t; NADCON software. 4 5 5 Troy high National Aquad Gilead West 394 MORROW MOUNTAIN MOUNTAIN, N. C.
L l Inhdd'mgs may exist in other National or State reservations. TFRS MAP COMPLIES WITH NATIONAL MAP ACCURACY STANDARDS 6 7 8 7 Mount ale S Mount Gilead East National Forest Trail 35080-C1-TF-024 X80-Cl-TF-024
This map is not a legal land line or ownership document. Public lands are FOR SALE BY U .S. GEOLOGICAL SURVEY ADJOINING 7.5' QUADRANGLES 1994 1994
subject to change and leasing, and may have access restrictions; check DENVER, COLORADO 80225 with local offices. Obtain permission before entering private lands. A FOLDER DESCRIBING TOPOGRAPFRC MAPS AND SYMBOLS IS AVAILABLE ON REQUEST DMA 49541 SE - SERIES V84 54 1 SE - SERIES V842
Unsurveyed land net is not official.