20011891 Ver 1_COMPLETE FILE_20011228

401 comments
Subject: 401 comments
Date: Wed, 06 Feb 2002 10:07:41 -0500
From: "J. Todd Kennedy <[e-mail]>
Organization: NC DENR - Division of Water Quality
To: mike horan <[e-mail]>
CC: Cyndi Karoly <[e-mail]>, Steve Zoufaly <[e-mail]>,
Milt Rhodes <[e-mail]>
I have reviewed twelve 401 applications for the Local Government
Assistance Unit. Comments for four projects are provided below.
1) 020110-JKS Assoc.
Eagle Mtn. subdivision in Wake Co.
Swift Creek is a WS III watershed
Public road crossings are allowable where no practicable-alternative
exists. They must minimize built upon surface area, direct runoff away
from surface waters and maximize the use of BMPs (15A NCAC 02B .0215).
A thirty-foot, vegetative buffer must be maintained along the perennial
stream.
2) 020100-Chatterjee
Pond construction in western Wake Co.
UT to Panther Creek is in a WS IV watershed.
Since the UT is intermittent, Water Supply Watershed rules do not apply.
Buffers are highly recommended.
on page 12 of the application, the applicant writes, "Effort will be
made to direct runoff from impervious areas to the pond for treatment." "
The pond is being constructed for irrigation and aesthetics. Therefore;
it is recommended that runoff receive treatment via filter strip or
other appropriate mechanism prior to entering the pond. Stormwater
should not be directly discharged into the pond.
3) 020086-Englert Egon (_401 Issued)
Shoreline stabilization with steps
Lake Norman is WS IV.
Shoreline stabilization'is not prohibited. At present the Unit is
working with local governments to .. determine the,appropriate methods for
installing steps at shorelines. Please forward projects of this type to
the.Unit'.for comment prior to-issuance of 401 certification until 'the

,
issue is .resolved. Thank you.
4}):011891=Ronnie Scarborough (401 Issued)
Seawall,'-boathouse and pier construction.
Lake ;.Tillery is :WS IV . ,

The`Unit"is currentlk working,to resolve `'issues regarding whether the .
proposed "boathouse".: qualifies ;as a water, dependent structure (and ;thus
t,.
allowable)' in its current form. We;will:contact the .401 Unit if we have
further "comments.

Notes:
WS IV watershed classification =(15A NCAC 02B .`0216) ?t

J. Todd Kennedy
'
NC DENR--Water
Quality--Planning
X
919.733.5083 x555

I of t
;'1x7/02 6:17 A

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MIGIICCI F. casiey, Uuveniur
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D.
Acting Director
Division of Water Quality
January 27, 2002
Montgomery County
DWQ Project #: 01-.1891
APPROVAL OF 401Quality Certification
Ronnie Scarborough
527 North Clodfelter Road
High Point, NC 27265 "
Dear Mr. Scarborough:
You have our approval, in accordance with the attached conditions and those listed below, to place fill material in
342 square feet of waters for the purpose of stabilizing hte shoreling of lot 9, Emerals Shores subdivisionas you described
in your revised application dated January 16, 2002. After reviewing your application, we have decided that this fill is
covered by General Water Quality Certification Number 3280. This certification allows you to use Nationwide Permit
Number 030 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
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 ai'e 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 Ken Averitte at our Fayetteville Regional Office at
910-486-1541.
Attachment
cc: Corps of Engineers Wilmington Field Office
Fayetteville DWQ Regional Office
File copy
Central Files
Wetlands/401 Unit 1650 Mail Service Center Raleigh, NC 27699-1650 Ph: [phone] Fax [phone]
AIA*
Customer Service
1 800 623-7748
ti. .
ILE COPY
DWQ # 01-1891
Montgomery County
Dear Mr. Dorney
After our conversation on Monday January 14, 2002; I understand that I did not clearly define the location
of the shoreline stabilization measures. I have enclosed a drawings and description of the request.
I need a total seawall structure of 114 feet. 10' long on the left side of an exiting structure and 104' feet
long on the right side of the 24x16 structure.
The Seawall will be 3' high and will have Riprap placed at the base on the waterward side (3) feet out on a
2:1 slope.
I hope this drawing and explanation is what you needed. Please call at 336-373-7192 if you have any more
questions.
Best Regards
Ronnie Scarborough
527 North Clodfelter Rd.
High Point, N.C. 27265
Ph: 336-373-7192

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?F WATFj? Michael F. Easley, Governor
0 William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D.
O 'C Acting Director
Division of Water Quality
Cl)
January 9, 2002
DWQ #01-1891
Montgomery County
CERTIFIED MAIL- RETURN RECEIPT REQUESTED
Ronnie Scarbough
527 North Clodfelter Road
High Point, NC 27265
Dear Mr. Scarborough:
On December 28, 2001, the Division of Water Quality (DWQ) was notified by receipt of your application regarding your
plans to impact an unspecified amount of shoreline on Lake Tillery at Lot 9, Emerald Shores subdivision for the purpose of
stabilizing the shoreline of your lot in Montgomery County. Approval from DWQ is required to disturb these waters. Please
provide seven copies of the following information and refer to the DWQ number listed above in your reply.
1. The location of the proposed shoreline stabilization measures must be shown on a map.
Please call Todd St. John, Bob Zarzecki or me at [phone] 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 15 A NCAC 2H .0505 (c).
The processing time for this application will begin when this information is received. If we do not hear from you within three (3)
weeks of the receipt of this letter, we will assume that you no longer want to pursue this project and will consider it withdrawn.
Cc Fayetteville DWQ Regional Office
Wilmington Corps of Engineers
Central Files
File Copy
Wetlands/401 Unit 1650 Mail Service Center Raleigh, NC 27699-1650 Ph: [phone] Fax: [phone]
N E[+?t
Customer Service
1 800 623-7748
Sincerely yours,
t Michael F. Easley
Governor
William G. Ross, Jr. Secretary
;? n f Department of Environment and Natural Resources
r' Kerr T. Stevens
Division of Water Quality
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
DWQ#01-
?p??tle ?C:.??b?a rn(!Y County
Dear
On 1, the ivision of Water Quality (DWQ) w otified by receipt of your applications regarding
your plans to impact fwi-o shoreline on Lake at for the purpose of stabilizing the shoreline
of your lot in Mecklenburg C nty. Approval from DWQ I required to impact these waters. Please provide seven copies
of the following information nd refer to the DWQ number listed above in your reply.
1. The location-of the proposed shoreline stabilization measures must be shown on a map.
Also the Catawba River buffer rules became effective on June 30, 2001 and allow shoreline stabilization
measures within the protected buffers along Lake James. We are concemed that construction of these
shoreline stabilization measures will result in excessive impact to the protected buffers. Please provide
details on how you plan to install these shoreline stabilization measures, what measures you will take to
minimize impact to the buffers and then how and when you plan to replant the unavoidably impacted portions
of these buffers.
Please call Todd St. John, Bob Zarzecki or me at 733-1786 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
within three (3) weeks of the receipt of this letter, we will assume that you no longer want to pursue this project and will
consider it withdrawn.
Sincerely yours,
A t John Domey
Cc: tille DWQ Regional Office
1i1 ftshev+Ne Field Office Corps of Engineers
11?t1 File copy
Central files
ANINYRI
Customer Service Division of Water Quality 1650 Mail Service Center Raleigh, NC 27699-1650 [phone]
1 800 623-7748
FILE COPY

t1l 189 1, G'fl

4
W A TF?.
QG .
Pre-Construction Notification (PCN) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used. if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
http://www.saw.usace.g=.mil/wetlands/Perm apli htm.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at http://www.saw.usace.arrny.mil/wetlands/rep-tour. htm, or contact one of the field
offices listed at the end of this application. The website also lists the responsible project manager for
each county in North Carolina and provides additional information regarding the identification and
regulation of wetlands and waters of the U. S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://h2o.enr.state.nc.us/ncwetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. .The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for some General Certifications is not required,
provided that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet
should contact DWQ's Central Office in Raleigh at [phone].
Page 3 of 13
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is also require or projects occurring in any of North Carolina's twenty-five
counties that contain trout waters: in such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on the last page of this application).
CAMA Coordination - If the project occurs in any of North Carolina's twenty coastal counties (listed on
the last page of this application) the applicant should also contact the North Carolina Division of Coastal
Management (DCM) at [phone]. DCM will determine whether or not the project involves a
designated Area of Environmental Concern, in which case DCM will act as the lead permitting agency.
In such cases, DCM will require a Coastal Area Management Act (CAMA) Permit and will coordinate
the 404/401 Permits.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office (addresses are listed at the end of this
application). Upon receipt of an application, the USACE will determine if the application is complete as
soon as possible, not to exceed 30 days. This PCN form is designed for the convenience of the applicant
to address information needs for all USACE Nationwide, Regional or General permits, as well as
information required for State authorizations, certifications, and coordination. Fully providing the
information requested on this form will result in a complete application for any of the USACE
Nationwide, Regional or General permits. To review the minimum amount of information that must be
provided for ancomplete PCN for each USACE Nationwide permit, see Condition 13, 65 Fed.Reg. 12893
(March 9, 2000), available at httv://www.saw.usace.army.mil/wetlands/nwr)finalFedReg.pdf
Processing times vary by permit and begin once the application has been determined to be complete.
Please contact the appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. t seven collated co ies of all USACE
Permit materials to the Division of Water Quality, 401,/Wetlands.Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required.. In brief, if project impacts include less
than one acre of c tout ve wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee o ;$200 is require . If either of these thresholds is exceeded, then a fee of $475 is
required. A check made to a orth Carolina Division of Water Quality, with the specific name 'of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at httv://h2o.ehnr.state.nc.us/ncwetlands/fees.html. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U. S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 4 of 13
Office Use Only: Form Version April 2001
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
I. Processing
1. Check all of the approval(s) requested for this project:
? Section 404 Permit
Section 10 Permit
401 Water Quality Certification
? Riparian or Watershed Buffer Rules
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: ?
H. Applicant Information
1. Owner/Applicant
Name:
Mailing Address:.
Telephone Number:
E-mail Address: r
-, 3 93 - J q a Fax Number:_3.3L - r 16-9
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:
Page 5 of 13
M. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project. has been placed on hold until decipherable maps are provided.
1.Name of project: ?? ? R aAll b u, s W2 A-,#4 0? Se w w,#J l
2.T.I.P. Project Number (NCDOT Only):
3.Property Identification Number (Tax PIN): AIb , 53 a,3 G AL6b,A Alh, 1/13 q7
4.Location- l ]
County: A.. Q rvt r 1Z Nearest Town: A a; Ile A-
Subdivision na a (include phase/lot number): Fm.e r,4j "Kka r ,e .s i_o+A q
Directions to site (include road numbers, landmarks, etc.): p b 467YZ?-71Y5-a* s
r-A^? ) ns-11 ILu,4e Lj._.J.__. 7&/..1n i..ar?-?...11-04 .../ )J._J -2?. ?...lU?
-1-4ke 4efi bW </earUicev ?oei[1 4 o-t#r io wt >Yt,- e& W -O-f z W7' oar 40
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 exist}ng land use or condition of the site at the time of this application:
7.Property size (acres): 2 ,?crc
8.Nearest body of water (stream/river/sound/ocean/lake): ? c Wile j, v
9.River Basin: Yom.. d k i A/
(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/m"s/.) .
Page 6 of 13
10. Describe the purpose of the proposed work: BU,;1) B a,,.,9 ows e ?, e rti 6oC
11. List the type of equipment to be used to construct the project:_ r D a a 7c r T?,?T
12. Describe the land use in the vicinity of this project: 11ec rP ?,;A1
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.
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application:
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 13
' -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)

ype of Wetland***

!h T_s ______. __ __ i • • ..n
LASL cacn 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 hqp://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:
k 2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
(indicate on
map)
Type of
Impact* Length of
Impact
(linear
feet)

Stream Name** Average
Width of
Stream
Before
Impact
Perennial or
Intermittent?
(please specify)

L10L ca%...,uyaIA NcpatatGty and idenary temporary impacts. impacts mciude, 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.uses.eov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapguest.com, etc.).
Page 8 of 13
Cumulative impacts (linear distance in feet) to all streams on site:
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

ype of Impact*
Area.

of
Impact

(acres)

ame of Waterbody
(if applicable)

Type of Waterbody

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

i.ist eacn impact separately ana taentuy temporary impacts. impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this a plication.
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)
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.
Page 9 of 13
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final 'Notice of Issuance and Modification. of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing.- Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
hqp://h2o.enr.state.nc.us/ncwetlands/stnngide.html.
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
Page 10 of 13
2. Mitigation may also be made by payment into the Nort h Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at
http://h2o.enr.state.nc.us/wrp/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):
Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ? No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No M
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 C4
IX. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 213 .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No M If you answered "yes", provide" the following information:
Page 11 of 13
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 3
2 1.5.
Total
Gone 1 extends out 30 teet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration./ Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B.0242 or.0260.
X. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
XI. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
A /h
Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes El No
Is this an after-the-fact permit application?
Yes ? No LaFV1
i
Page 12 of 13

MIL 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).
Appli nt/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

Page 13 of 13
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COUNTY 1 NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
1 0 m DIVISION OF HIGHWAYS-PLANNING AND RESEARCH BRANCH
IN COOPERATION WITH THE - -
U. S. DEPARTMENT OF TRANSPORTATION
FEDERAL HIGHWAY ADMINISTRATION