20031103 Ver 1_COMPLETE FILE_20030904

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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
September 9, 2003
Caldwell County
DWQ Project #: 03-1103
Jerry S. Bradshaw
Post Office Box 537
Patterson, NC 28661
Subject Property: 3751 Linaka Lane
NO WRITTEN CONCURRENCE NEEDED

Dear Mr. Bradshaw:
You have our approval, in accordance with the attached conditions, to impact waters for the purpose of
replacing a bridge as you described in your application dated August 1, 2003. After reviewing your
application, we have decided this fill is below the threshold for written authorization as long as all
conditions of General Water Quality Certification Number 3402 are met, which may be viewed on our
website at http://h2o.enr.state.nc.us/ncwetlands.
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.
Violations of any condition herein set forth may result in revocation of this Certification and may result
in criminal and/or civil penalties. This Certification shall become null and void unless the above
conditions are made conditions of the Federal 404 and/or coastal Area Management Act Permit.

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:/th2o.enr.state.nc.us/ncwetlands
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, 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 Division of Water Quality under Section 401 of the Clean Water
Act. If you have any questions, please telephone John Dorney at 919-733-1786 or Mike Parker at our
Asheville Regional Office at 828-251-6208.
Sincerely,
Alan W. Klimek, P.E., Director
JRD/bs
Attachments
cc: Corps of Engineers Asheville Field Office
Asheville DWQ Regional Office
File copy
Central Files
WQC #3402
This General Certification Is Issued In conformity with the requirements of Section 401,
Public Laws 92-500 and 95-217 of the United States and subject to the North Carolina Division of
Water Quality_ (DWQ) Regulations in 15A NCAC 2H, Section .0500 and 15A NCAC 2B .0200 for
the discharge of fill material to waters and adjacent wetland areas or to wetland areas that are not
a part of the surface tributary system to Interstate waters or navigable waters of the United States
(i.e., isolated wetlands) as described in 33 CFR 330 Appendix A (B) (18, 39, 41, 42, 43 and 44) of
the Corps of Engineers regulations (i.e., Nationwide Permit No. 39) and for the Riparian Area
Protection Rules (Buffer Rules) in 15A NCAC 26.0200. This Certification replaces Water Quality
Certification Numbers 3106 and 3108 issued on February 11, 1997, and Water Quality
Certification Number 3287 Issued on June 1, 2000 and Water Quality Certification Number 3362
Issued March 18, 2002.. This WQC is rescinded when the Corps of Engineers re-authorizes
Nationwide Permits 18, 39, 41, 42, 43 or 44 or when. deemed appropriate by the Director of DWQ...
The State of North Carolina certifies that the specified category of. activity will not violate
applicable: portions of Sections 301, 302, 303, 306 and 307 of the Public Laws 92-500 and 95-217
If conducted in accordance with the conditions hereinafter set forth.
Conditions of Certification:
1. Enumerating and Reporting of Impacts:
• Streams - Impacts to streams as determined by the Division of Water Quality shall be
measured as length of the centerline of the normal flow channel. Permanent and/or
temporary stream Impacts shall be enumerated on the entire project for all Impacts
regardless of which 404 Nationwide Permits are'used. Stream relocations and
stream bed and/or bank hardening are considered to be permanent stream Impacts.
Any activity that results in a loss of use of stream functions including but not limited to.
filling, relocating, flooding, excavation, dredging and complete shading shall be
considered stream Impacts. Enumeration of Impacts to streams shall Include streams
enclosed by bottomless culverts, bottomless arches or other spanning structures
when a 404 Permit is used anywhere in a project unless the entire structure
(Including construction impacts) spans the entire bed and both banks of the stream,
Is only used for a road, driveway or path crossing, and is not mitered to follow the
stream pattern. Impacts for dam footprints and flooding will count toward the
threshold for stream impacts, but flooding upstream of the dam will not (as long as no
filling, excavation, relocation or other modification of the existing stream dimension,
pattern or profile occurs) count towards mitigation. requirements. Any filling,
excavation, relocation or other modification of the existing stream (other than
flooding) must re-establish the same dimensions, patterns and profiles of the existing
channel (or those of a stable reference reach If the existing channel is unstable) to
the maximum extent practical.
• Wetlands - Impacts to wetlands as determined by the Division of Water Quality shall
be measured as area. Permanent and/or temporary wetland Impacts shall be
enumerated on the entire project for all Impacts regardless of which 404 Nationwide
Permits are used. Any activity that results in a loss of use of wetland functions
including but not limited to filling, excavating, draining, and flooding shall be
considered wetland impacts. Enumeration of Impacts to wetlands shall Include
activities that change the hydrology of a wetland when a 404 Permit is used
anywhere in a project.
F,
1
WQC #3402
Lakes and Ponds - Impacts to waters other than streams and wetlands as
determined by the Division of Water Quality shall be measured as area. Permanent
and/or temporary water Impacts shall be enumerated on the entire project for all
Impacts proposed regardless of which 404 Nationwide Permits are used. Any activity
that results-In a loss of use of aquatic functions including but not limited to filling and
dredging shall be considered. waters Impacts.
Application Thresholds - Stream, wetland and water Impacts that exceed any of the
thresholds below require a complete application and written concurrence to use this
Certification:
• Total stream Impacts of greater or equal to 150 cumulative feet of stream length for
the entire project require written notification to and approval by the Division of Water.
Quality, and/or
• Impacts to waters of equal to or greater than 1/3 of an acre require written notification
to and approval by the Division of Water Quality, and/or
•. Wetland Impacts of greater or equal to 1/3 of an acre east of 1-95 and 1/10 of an acre
west of I-95 require written notification to and approval by the Division of Water
Quality except as specified below. Any Impacts to wetlands adjacent to waters
designated as ORW, SA, WS-I, WS-11 or Trout or are designated as a North Carolina
W........v_...._ .... _,......or..NatlnnaLWIId and-Scenic Rluer.and.wetlands classified.as SWL an. d/or.UWL as - -- well as wetlands described In 15A NCAC 2H .0506 (e) require a complete application
and written concurrence from the Division of Water Quality to use this Certification.
These thresholds apply for the entire project regardless of the.n umber of Nationwide
Permits applicable to the Certification that are Issued by the USACE for the project;
• Written notification to DWQ is required for all applications that propose to use
Nationwide Permit 18. This notification requirement will be satisfied by providing two
(2) copies of the PCN form to DWQ-at the same time that the PCN form is sent to the
US Army Corps of Engineers. A formal application and fee is not required unless
DWQ decides that an Individual Certification will be required for the project. In this f
case, the applicant will be notified in writing from DWQ within 30 days of the receipt
of the written notification.
• Proposed fill or substantial modification'of any amount of wetlands classified In
accordance with .15A NCAC 2B.01 01 (e)(7) as Unique Wetlands (UWL) shall require
written concurrence from the Division of Water Quality;
2. Impacts to any stream length in the Neuse, Tar-Pamlico or Randleman River Basins (or
any other major river basins with Riparian Area Protectlon Rules [Buffer Rules) in effect at
the time of application) requires written concurrence for this Certification from DWQ In
accordance with 15A NCAC 213.0200. Activities listed as "exempt" from these rules do not
need to apply for written concurrence under this Certification. New development activities
located in the protected 50-foot wide riparian areas (whether jurisdictional wetlands or not)
within the Neuse and Tar-Pamlico River Basins shall be limited to "uses" Identified within
and constructed in accordance with 15A NCAC 213 .0200. All new development shall be
located, designed, constructed, and maintained to have minimal disturbance to protect
water quality to the maximum extent practicable through the use of best management
practices;
3. Irrespective of other application thresholds in this General Certification, all Impacts to }
perennial waters and their associated buffers require written approval from DWQ since
such-Impacts are allowable as provided in 15A NCAC 2B. 0212 (WS-1), 26.0213 (WS-II),
28.0214 (WS-III) and 26 .0215 (WS-IV). Only water dependent activities, public projects
and structures with diminimus Increases in Impervious surfaces will be allowed as outlined
in those rules. All other activities require a variance from the delegated local government
and/or the NC Environmental Management Commission before the 401 Water Quality
Certification can be processed. In addition, a 30 foot wide vegetative buffer for low
density development or a 100 foot wide vegetative buffer for high density development
WQC #3402
must be maintained adjacent to all perennial waters except for allowances as provided
under the Water Supply Watershed Protection Rules. For the purposes of this condition,
perennial waters are defined as those shown as perennial waters on the most recent
USGS 1:24,000 topographic map or as otherwise determined by local government
studies;
4. Additional site-specific stormwater management requirements may be added to this
Certification at DWQ's discretion on a case by case basis for projects that have or are
anticipated to have Impervious cover of greater than 30 percent. Site-specific stormwater
management shall be designed to remove 85% TSS according to the latest version of
DWQ's Stormwater Best Management Practices manual at a minimum.
Additionally, In watersheds within one mile and draining to 303(d) listed waters, as well as
watersheds that are classified as nutrient sensitive waters (NSW), water supply waters
(WS), trout waters (Tr), high quality waters (HQW), and outstanding resource waters
(ORW), the Division shall require that extended detention wetlands, blo-retention areas,
and ponds followed by forested filter strips (designed according to latest version of the NC
DENR Stormwater Best Management Practices Manual) be constructed as part of the
stormwater. management plan when a site-specific stormwater management plan is
required.
For streams classified as Water Supply, High Quality Waters and Outstanding Resource
Waters; post-construction, on-site stormwater management shall be required as
appropriate and as outlined in 15A NCAC 2B .0104(m) and 2H .1000 to .1007,
respectively, In addition to that required in this General Certification.
Alternative designs may be requested by the applicant and will be reviewed on a case-by- .
case basis by the Division of Water Quality.
Approval of stormwater management plans by the Division of Water Quality's other:
existing state stormwater programs including appropriate local programs are sufficient to
satisfy this Condition as long as the stormwater management plans meet or exceed the
design requirements specified In this condition. This condition applies unless more
stringent requirements are in effect from other state water quality programs.
• Unless specified otherwise in the approval letter, the final, written stormwater
management plan shall be approved in writing by the Division of Water Quality's
Wetlands Unit before the Impacts specified in this Certificatlon.occur.
• The 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 or other structure is occupied at the subject site,
the facilities (as approved by the Wetlands Unit) shall be constructed and operational,
and the stormwater management plan (as approved by the Wetlands Unit) shall be
Implemented.
• The structural stormwater practices as approved by the Wetlands Unit 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.
5. Compensatory stream mitigation shall be required at a 1:1 ratio for not only perennial but
also intermittent stream Impacts that require application to DWQ in watersheds classified
as ORW, HQW, Tr, WS-1 and WS-II unless the project is a linear, publicly-funded
transportation project, which has a 150-foot per-stream Impact allowance;
6. In accordance with North Carolina General Statute Section 143-215.3D(e), any
application for a 401 Water Quality Certification must include the appropriate fee. If a
WQC #3402
project also requires a CAMA Permit, one payment to both agencies shall be submitted
and will be the higher of the two fees;
7. In accordance with 15A NCAC 2H .0506 (h) compensatory mitigation may be
required for Impacts to 150 linear feet or more of streams and/or one acre or more of
wetlands for an entire project. For linear public transportation projects, impacts equal to
or exceeding 150 feet per stream may require mitigation. In addition, buffer mitigation
may be required for any project with Riparian Area Protection Rules (Buffer Rules) in
effect at the time of application for buffer Impacts resulting from activities classified as
"allowable with mitigation" within the "Table of Uses" section of the Buffer Rules or require
a variance under the Buffer Rules. A determination of buffer, wetland and stream
mitigation requirements shall be made for any Certification for this Nationwide Permit.
The most current design and monitoring protocols from DWQ shall be followed and written
plans submitted for DWQ approval as required in those protocols. When compensatory
-mitigation Is required for a project, the mitigation plans must be approved by DWQ In
writing before the Impacts approved by the Certification occur, unless otherwise specified
In the approval letter. The mitigation plan must be Implemented and/or constructed before
any permanent building or structure on site is occupied. In the case of public road
projects, the mitigation plan must be Implemented before the road is opened to the
travelling public. Please note that If a stream relocation Is conducted as.a stream _ ._
restorafion as defined'in "rh&'1nfernal r6chrilcalGulde for Stream i?orkInNorth Carolina ,.
April 2001, the restored length can be used as compensatory mitigation for the impacts
resulting from the relocation;
8. For any project Involving re-alignment of streams, a stream relocation plan must be .
Included with the 401 application for written DWQ approval. Relocated stream designs
should Include the same dimensions, patterns and profiles,as the existing channel (or a.
stable reference reach if the existing channel is unstable), to the maximum extent
practical. The new channel should be constructed in the dry and water shall not be turned
Into the new channel until the banks are stabilized. Vegetation used for bank stabilization
shall be limited to native woody species, and should Include establishment of a 30 foot
wide wooded and an adjacent 20 foot wide vegetated buffer on both sides of the relocated
channel to the maximum extent practical. A transitional phase Incorporating coir fiber and
seedling establishment is allowable. Also, rip-rap, A-Jacks, concrete, gabions or other
hard structures may be allowed If it is necessary to maintain the physical Integrity of the
stream, but the applicant must provide written justification and any calculations used to.
determine the extent of rip-rap coverage requested. If suitable stream mitigation Is not
practical on-site, then stream impact will need to be mitigated elsewhere. Please note
that if a stream relocation is conducted as a stream restoration as defined In The Intemal
Technical Guide for Stream Work in North Carollna , April 2001, the restored length can
be used as compensatory mitigation for the Impacts resulting from the relocation;
9. Placement of culverts and other structures in waters, streams, and wetlands must be
placed below the elevation of the streambed to allow low flow passage of water and
aquatic life unless it can be shown to DWQ that providing passage would be impractical.
Design and placement of culverts including open bottom or bottomless arch culverts and
other structures Including temporary erosion control measures shall not be conducted In a
manner that may result in aggradation, degradation or significant changes In hydrology of
wetlands or stream beds or banks, adjacent to or upstream and down stream of the above
structures. The applicant is required to provide evidence that the equilibrium shall be
maintained if requested to do so in writing by DWQ. Additionally, when roadways,
causeways or other fill projects are constructed across FEMA-designated floodways or
wetlands, openings such as culverts or bridges must be provided to maintain the natural
hydrology of the system as well as prevent constriction of the floodway that may result in
aggradation, degradation or significant changes In hydrology of streams or wetlands;
WQC #3402
10. That appropriate sediment and erosion control practices which equal or exceed those
outlined in the most recent version of the "North Carolina Sediment and Erosion Control
Planning and.Design Manual" Or the "North Carolina Surface Mining Manual" whichever is
more appropriate (available from the Division of Land Resources (DLR) In the DENR
Regional or Central Offices) shall be in full compliance with all specifications governing
the proper design, installation and operation and maintenance of such Best Management
Practices in order to assure compliance with the appropriate turbidity water quality
standard;
11. All sediment and erosion control measures placed in wetlands and waters shall be
removed and the original grade restored within two months after the Division of Land
Resources has released the project;
12. That additional site-specific conditions may be added to projects proposed under this
Certification in order to ensure compliance with all applicable water quality and effluent
standards;
13. Measures shall be taken to prevent live or fresh concrete from coming into contact
with waters of the state until the concrete has hardened;
f4: 1f an`"eliviYofimen af'doc"ument"is required; thls'CerfI ica"tion fs riot v-a1 d"untirA-FIf df -df"`
No Significant Impact (FONSI) or Record of Decision (ROD) Is Issued by the State
Clearinghouse;
15. If this Certification is used to access building sites, all lots owned by the applicant must be
buildable without additional fill beyond that explicitly allowed under other General '
Certifications. The applicant is required to provide evidence that the lots are buildable
without requiring additional Impacts to wetlands, waters or buffers if required to do so in
writing by DWQ. For road construction purposes, this Certification shall only be utilized
.from natural high ground to natural high ground;
16. Deed notifications or similar mechanisms shall be placed on all lots with remaining i
jurisdictional wetlands and waters or areas within 50 feet of all streams and ponds. These
mechanisms shall be put in place within 30 days of the date of Issuance of the 401
Certification 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
htta://h2o.enr.state.nc.us/`nGwetlands . DWQ shall be sent copies of all deed restrictions
applied to these lots;
17. When written concurrence is required, the applicant is required to use the *most recent
version of the Certification of Completion form to notify DWQ when all work Included in the
401 Certification has been completed;
18. Concurrence from DWQ that this Certification applies to an individual project shall expire
three years from the date of the cover letter from DWQ or on the same day as the
expiration date of the corresponding Nationwide Permit 18, 39, 41, 42, 43 or 44,
whichever is sooner.

WQC #3402
Non-compliance with or violation of the conditions herein set forth by a specific fill project
may result in revocation of this Certification for the project and may also result in criminal and/or
civil penalties.
The Director of the North Carolina Division of Water Quality may require submission of a
formal application for Individual Certification for any project in this category of activity that
requires written concurrence under this certification, If it is determined that the project is likely to
have a significant adverse effect upon water quality or degrade the waters so that existing uses of
the wetland or downstream waters are precluded.
Public hearings may be held for specific applications or group of applications prior to a
Certification decision if deemed in the public's best Interest by the Director of the North Carolina
Division of Water Quality.
Effective date:2$ March 2003
DIVISION OF WATER QUALITY
By
Alan W. Klimek, P.E.
Director
WQC.# 3402
Certificate of Completion
DWQ Project No.:
County:
Applicant:
Project Name:
Date of Issuance of 401 Water Quality Certification:
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
1, , 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:
Date:
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.
Signature:
Date:
If this project was designed by a Certified Professional
1, , 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:
Office Use Only:
USACE
1. Processing
DWQ No. ,
item is not avvlicable to this vroiect. please enter
Fonn Version
b
or "N/A".)

1. Ch all of the approval(s) requested for this project:
Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
? 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: 39 ( m1t'fLrR Crz
3. If this notification is solely a co esy 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 (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5, if your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
H. Applicant Information
I
L.G.Jclr- plc, ?8cu?i5 n,arr?2?o? ?.lc a`SCcCoI
Owner/Applicant Information
Name: >e2QY
Mailing Address: 3 `7 S I
Telephone Number: '6a-6 - 15? - S8$"i Fax Number: J/A
E-mail Address:__
2. Agent/Consultant 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: ,A ;T1 ang 1401 ;GROU
Mailing Address: v ?S ° P - 4 200
.Alan. 11WOMM.W
Telephone Number: Fax Number:
E-mail Address:
M. Project Information
Attach a vicinity map clearly showing the location of the propert y 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 footFrints 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 MRCS 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
IJSACE 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 wi11 be informed that
the project has been placed on hold until decipherable maps are provided.
1, Name ofprQject; YAgwATe t?21??c c2 . UL C Ails -r
2. T.I.P. Project Number or State Project Number (NCDOT Only): N??1
3, Property Identification Number (Tax PIN):
4. Location
County: . UAUU. WEL-k- Nearest Town: Ls Jo? 2
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): Fa
Lc?3o?R o,?AC?n '?.c?,a?ac?k Ae?,T ya r.?+.t- IC?rra? r?'??rT
2oAr ?& ee4c Ts L,J 1,-rq 40,( ''SA( 'ang-, ?sc- cj Lz- El-- (5go - A, aw o o LAN 6?
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, Property size (acres):_ 5 Ac.QES IrnPaL"f Avxg %,j%w -14-e Le5r, -rj?n 50o
F F STr, l C e?Ek-
,>Q V!r 0 ,0, E IaC ?1 5, Dc. OF
7. Nearest body of water (stream/river/sound/oceanAake): I?fz`s? ,5 CR 4?
8. River Basin: rLo,?S ?rl-ro Yntw,, l RiaL ?T a r.l??s Do??asre M
(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/map-2L/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: _j'a NjAE k5 wt?5?4Ep f?,araY 'Ne -r, y?
?A??..15 ? t? 'f!•4?S ?2t'R . :`?GrrC ?1?8 s o: bR.1oc.'c f?GV?A,? t? T MOST
lbet . LO-A, A=& CA Ct?yr' Au. OF -nke Ar9ZA IS . C o ic-a C 3 1 JJ V i%C? E t 1?1? 1 C
AS \ c? u CA O "e 1 1J -n+E 1 K1 CL47-,c b ';)1C i'UZ S,
10. Describe the overall. project in detail, including the type of equipment to be used: A ??ck
Byw- AJ -m 2 T?2 c ?c Nol,? tn3?u, -65 t, - cti' n - , b a T-i -k tic 4 , o 13 -C cm-- k
S t Dt s 0F ?1 26 sro"J C'P-Ere, R IPPCL ox ? y, V-'? n e
wry 2 Fc?,r??1? 5 L'?IL LL ?a- 1?b. ezyz. - Co..x.2n-l' l )P Ty
it, Explain the purpose of the proposed work: To -ro n
IV, Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (i_ncluding all prior phases of the same subdivision) in the past, please explain, 1nc1_u4e
the USAGE 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 NGDQT project,
list and describe permits issued for prior segments of the same TIP, project, along with
construction schedules.
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.
Vit 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 identif ab_e 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.
1. Provide a written description of the proposed impacts: Tt?YY?Pcxzq Q.,-e t m?(Nc Y s
To St'IZcYarn'3Anlt? ?c ? e wo2.l? ?,J?u.l. `m-Yil?c ?AC,G ??.l r?e?n?
2. Individually list wetland impacts below:
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***
N ?

* 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 hq://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.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property: ?l Ya
Total area of wetland impact proposed: J. A
3, individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
(indicate on ma)
Type of Impact* Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Im ct Perennial or
Intermittent?
lease specify)

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.usas.sov. Several internet sites also allow direct download and printing of USGS maps (e.g., www. o one.com,
www.mapquest.Som, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: ! it
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number

(indicate on ma)
a of Impact*
? Area of
Impact

(acres)
(if Name applicable) ) Wat Type of Watcrbody

(lake, pond, estuary, sound,
bay, ocean, etc.)

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands 0 stream ? wetlands
Describe the method of construction (e.g,, damlembankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts.. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial_ viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Aso 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.
1Dk26c.T iMP(u.rS nr STREYk1M. i'3W , 'Z?- AJO%bc-N
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 IJSACE 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/ncwetiands/strmgide.htmi.
l., 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 (es,, 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 J M ITIC+l? ?OJ Al tLpc(1 4-c?lL "?ktS ?(20'?c?
2, Mitigation may also be made by payment into the North. Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal. of a PCN, For additional information regarding the application process for the
NCWRP, check the NCWRP website at httvSh2o,enr,state. n .us&/wrQ/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):
IX.
X.
Environmental Documentation (required by DWQ)
Does the project involve an_ ex enditure of public (federal/state) funds or the use of public
(federal/state) 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 ?
PrQpQsed impacts Qn Riparian_ and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local_ buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional. Office may be included as appropriate, Photographs may also be included at the
applicant's discretion.
Will. the project impact protected riparian buffers identified within 15A NCAC 213 ,0233
(Meuse), 1.5A NCAC 2B ,0259 (Tar-Paml.i.co), i 5A NCAC 213 ,0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
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
' Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of "bone 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.
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss storm__water controls proposed in order to protect surface waters and wetlands
downstrearn from the property.
XH, Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewaterpnerated from the proposed project, or available capacity of the subject facility,
XUL Violations (required by DWQ)
Is this site in violation, of DW Wetland Rules (15A NC AC 2H ,0500) or any Buffer Rules?
Yes [I No
Is this an after-the-fact permit Application?
Yes ? No ?
XIV. Otber 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_),

Xpplicant/Agent's SignatureV V Date
's signature is valid only if an authorization letter from the applicant is provided.)
APPROVALS
APPROVAL BY: Local Govern wtal AuttaritY (when required)
EIDNATUM Tnu DATE
APPLICATION RECEIVED BY DISTRICT ENGINEER APPLICATION APPROVED BY DISTRICT ENGINEER
s#aNATUAE DATE EIDNATUNE DATE
COMMENTS:
SHOW: PROPOSED PLANS
1. LOCATION OF DRIVEWAYS DRAW OR SKETCH BELOW, OR ATTACH
2. DETAILS OF WORK, INCLUDING PIPES CONSTRUCTION PLANS FOR STREETS
3. EXISTING BUILDING, WALL, ETC. OR DRIVEWAYS.
4. PROPOSED BUILDING, WALL, ETC.
5. HIGHWAY FEATURES INDICATE
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