20072096 Ver 1_401 Application_20071212

Michael E. Gizinski
727 Gates Avenue
Winston Salem, NC 27103-3701
Phone/Fax [phone]
E-mail m.gizinski(~7prodigy.net
October 21, 2007
Ms. Sue White
NC DENR
Department of Water Quality
585 Waughtown Street.
Winston-Salem, NC 27107
Re: Fearringtan Forrest Subdivision, Forsyth County, NC
401 Water Quality Certification
Dear Ms. White:
RECEI•,rC::D
PLC, i)e,,". of .=Pvt..
~~ ~ _~ ~ 9,
~lYins2on-Se-;:r
~ Regional Office ~
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Please find enclosed two (2) copies of a application fora 401 Water Quality certification for the
above-referenced project. This project is located near Lewisville, NC and is anticipated to tie
under construction within the next 5 months, The proposed stream crossings are over an
intermittent stream and a perennial stream, both as designated on Vienna and Clemmons, North
Carolina USGS Quadrangle sheets and the total linear impact is expected to be 230 ft.
The US Army Corps of Engineers has already issued a NW 39 Permit. Please contact me if you
have any questions or require additional information. I may be contacted at 336-722-0554, or
[e-mail].
Thank you for your assistance in this matter.

Michael E. Gizinski
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U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT ~; __ ~ --~ r, ~
Action ID. 200703386234 County: Forsyth USGS Quad: Vienna
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property Owner /Authorized Agent: Piedmont Properties of NC, LLC / Fearrington Forrest Subdivision
Address: P.O. Box 4573 '
Greensboro, North Carolina 27404
Telephone No.: 336 854-1161
Size and location of property (water body, road name/number, town, etc.): Fearrington Forrest Subdivision located
off of the intersection of Robinhood Road and Lewisville-Vienna Road, north of Lewisville, in Forsyth County.
North Carolina. Property is adjacent to a tributary of Tomahawk Creek which is a tributary of the Yadkin
River.
Description of projects area and activity: Fill associated with construction of a subdivision roads (2) resulting in 230
linear feet of stream channel fill impacts to the jurisdictional waters of a tributary of Tomahawk Creek
Applicable Law: ® Section 404 (Clean Water Act, 33 USC 1344)
^ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Regional General Permit Number:
Nationwide Permit Number: NW 29
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the attached
conditions and your submitted plans. Any violation of the attached conditions or deviation from your submitted plans may subject the
permittee to a stop work order, a restoration order and/or appropriate legal action.
This verification will remain valid until the expiration date identified below unless the nationwide authorization is modified,
suspended or revoked. If, prior to the expiration date identified below, the nationwide permit authorization is reissued and/or
modified, this verification will remain valid until the expiration date identified below, provided it complies with all requirements of
the modified nationwide permit. If the nationwide permit authorization expires or is suspended, revoked, or is modified, such that the
activity would no longer comply with the terms and conditions of the nationwide permit, activities which have commenced (i.e., are
under construction) or are under contract to commence in reliance upon the nationwide permit, will remain authorized provided the
activity is completed within twelve months of the date of the nationwide permit's expiration, modification or revocation, unless
discretionary authority has been exercised on a case-by-case basis to modify, suspend or revoke the authorization.
Activities subject to Section 404 (as indicated above) may also require an individual Section 401 Water Quality Certification. You
should contact the NC Division of Water Quality (telephone [phone]) to determine Section 401 requirements.
For activities occurring within the twenty coastal counties subject to regulation under the Coastal Area Management Act (CAMA),
prior to beginning work you must contact the N.C. Division of Coastal Management .
This Department of the Army verification does not relieve the pernuttee of the responsibility to obtain any other required Federal,
State or local approvals/permits.
If there are any questions regarding thi rification, any of the conditions of the Permit, or the Corps of Engineers regulatory
program, please contact John Thomas (u7 1 876-8441 ext~25.
Corps Regulatory Official ~~,~ ~ ~~ ~~~~ Date: 10/19/2007
Expiration Date of Verification: X0/19/2009
The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we continue to do so,
please complete the attached customer Satisfaction Surveyor visit http://www.saw.usace.army.mil/WETLANDS/index.html to
complete the survey online.
Page 1 of 2

TO WMOM IT MAY CONCERN:
Michael E. Gizinski of Gizinski Surveying Co. has been designated as the Authorized Agent for
the purpose of submitting and obtaining any and all applications, permits, certifications, etc. for
the proposed subdivision entitled FEARRINGTON FORREST, located near Lewisville, NC.
OWNER
~. 8-~i ~
Gilbert L. Rockson
Member-Manager
Piedmont Properties of NC No. 2, LLC
P O Box 4573
Greensboro, NC 27404

07-2096
Office Use Only: Foam version March fly
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or'N/A".)
I. Processing
i. Check all of the approval(s) requested for this project:
^ Section 404 Permit ^ Riparian or Watershed Buffer Rules
^ Section i0 Permit ^ isolated Wetland Permit from DWQ
~] 40I Water Quality Certification ^ Express 401 Water Quality~~pC~~ertifi°c~ation
~. Nationwide, Regional or General Permit Number(sj Requested: ~Y~ ,~
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 Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, 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 1Vlanagement Area of
Environmental Concern (see the top of page 2 for further detaiisj, check here: ^
IL Applicant Information ~.oC~FS~'
~'~
1. Dwner/Applicant Information
Name: I~1 ~nl >~f '~~G?~r-w ~ ~s c~~ ?~1C ~G= `~ ~ t--~.~-
Mailing Address: ~Ci} ~'-~~~~ /- ~-~ ~-~ ~ ~-
~ ~~--a~~ ~~ (<~ ~: rte:: , h- ~-- ~ ~'I car;~..~ t'
Telephone Number:~~:~~- ~ ~~`-~Jr~ t`.'~ Fax Number: f~. '~
E-mail Address: ~, ! ~-
2. Agent/Consuitant 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: ~~~~ ~- ~ ~ , ~~ ~ ~- i %~V. ~~ ~
Company Affiliation: ~~ ~ ~ o ~ -~ ~ i ~~ ~-~~ ~„~ ~ vC< ~°
Mailing Address: '?`?~ ~`~'~ ~ " ~ ~~ ``~="_ --°~
•il i 1 ~~ ~! G ;+.:. ~ '"-~-t.,~7r~°~ ! f~ ~ r~ / `Ei
r
Telephone Number_ ~ ~ ;~ ~ ~ ~~ ~ S ~-- Fax Number ~ 1. `~ ~ ~ ~ °`c - ~`
E-mail Address: ., ~ ~ ~ P:~~ ~ t ~ j?- ~ i~~, ~ ~i,-~"T•
~ , ~ ~d ~ k's
Page S of 1~ ; ~;

III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
Iandmarks 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 ii by i7-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: ~~ ~.~ I -`G~rT o ~ ~ ~~ S I
2. T.I.P. Project Number or-State Project Number (NCDOT Oniy):
3. Property Identification Number (Tax PIN): S B~JS -(~7 ~(~ ~~ ~~ ~cg~,° b7• So i ~
4. Location
County: ~ ~S~'r F~ Nearest Town: L.i/`~ ISV r c..c..~ n(; L
Subdivision name (include phase/lot number): ~,~~` ~~~`~o ~- ~~=~
Directions to site (include road numbers/names,. landmarks, etc.):
'~ !v 5 - G nI ~d.~ r+~ t~ ~ D ~c~l~ - 5 ~- l 314 ~2a Nt w , ~, sTd ~ ~-~
7v I n[ ~ ~~S-fir co/~, ~F r`~~c,l IS~lll.~-,E ~IY.~~. 'j?Gr9~ "S~ t~d~
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbod .j
Decimal Degrees. (6 digits. minimum)` 3C9- t 2 S ~~7 I °IV ~~ ~~6 ~ °W ~'
ab, I25 00 S ~6. ~`~' 2
6. Property size (acres): S~~ ~`
7. Name of nearest receiving body of water: T~'/~I ~ }~..~tl ~ CP.~~ ~-
S. Raver Basin: YAD~ /~.
(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!adminimay~/
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: TI ~ 3 ~E.~ ~ ~ o D-S ~
C 20 ~ - ~ t~ (~ F 11/(~S
Page 6 of i2

10. Describe the overall project in detail, including the type of equ~ment to be used:
lnis-r,~c1.~~~ q(~` d~ 4f~'}~~ ~.~~ ~ o CAF ~L-~C~''RL~ ; 1~o-r~
~6 -BAST CG t -~' ~~.! Ill, F~I~1 ~.L1~S ~ ! ~f, S-7'~L.C~PsT 1 G V.l ICI..
~~ V i R USE ~ F ~A T2AG~C-= TY(~~. ~~G~ G
11. Explain the purpose of the proposed work: T~ <a-L-t--c ~ ~4- c.G1~.5 S i i-} 2D l~ G u
rv.
V.
VL
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 NCDQT project,
list and describe permits issued for prior segments of the same T.LP. project, along with
construction schedules. /~
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.
/~lU C~Ti-f ~R- 'P~Q.~ t ~ S AFB Q ~ ~ 1 ~~ P ~ ~ r=-1~
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 ail impacts to
wetlands, open water, and stream channels associated with the project. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and. temporary, must be listed, and must be .labeled and cieaziy identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should 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: T ~ ~ ~ M ~~G i W ( I
T 41 CLu~D~ ~!~ S~'4(...LATI v/~I of "T-vJo t-tfi.~~tJ/~t..C.~S ~~~..
9 ~o' T ~ ~ y2-G ~ ~ D 9d 2 ^G~~ `' r~-C- t~ T 1-~-~ ~ ~IJ~/~E-~-5 ~c.J 1 c~L,
n
~~ O F ~l/ -GAS ; CG I ~C~i?~~ ~ i ~. r TF-11 G~ '~-~ _ ~' ~_ -~ p -fZI~P
`( U T~ (_ f M. 7~ G r \c.4 1 l~l.. 13 C. `~I SS I ~P~v~-S
13age 7 of I2

2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditchingldrainage, etc. For dams,
separately List impacts due to both structure and flooding. i~L ~~
Wetland Impact
Site Number

(indicate on map)
Type of Irnpaet Type of Wetland
(e.g., forested, marsh,

herbaceous, bog, etc.} Located within
100 year
Floodplain
(yes/no) Distance to
Nearest
Stream
(linear feet) Area of
Impact
(acxes)

Total Wetland Impact (acres)
3. List the total acreage (estimated) of all existing wetlands on the property: ~`1' / ~
4. individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of f it or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, 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. To calculate acreage, multiply length X width, then divide by 4,560.
Stream Impact
Number
indicate on ma
Stream Name
Type of Impact
Perennial or
Wermtttent? Average
Stream Width
Before act Impact
Length
(linear feet Area of
Impact
acres
2 uN~~nti~D 1-l~tiAl.[.g ~ ~ r~ C~ 6.~~~
4 Cv~C~1P

~ V..IntActit ~ ~ D"~ ~~. ~- ~ 2 ~ ~ ~ ~ ,~3 Z
~ ca~.c P ~ PAS
~~P-QAP
Total Stream Impact (by length and acreage) 'L3 O (,,,Q~

~~
~~
5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts in~ de~~but are not limited to
fill; excavation, dredgin , floodin draina e, bulkheads, etc. //
Open Water Impact

Site Number
(indicate on ma)
Name of Waterbody
(if applicable)

Type of Impact Type of Waterbody

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

Fact
(acres)

Total Open Water Impact (acres)
Page 8 of 12

6. List the cumulative impact to all Waters of the U.S. resulting from the project:
Stream Impact (acres): b, 6 Q$
Wetland Impact (acres):
n Water Impact (acres):
Total Impact to Waters of the U.S. (acres)
Total Stream Im act (linear feet): 23rj

7. Isolated Waters
Do any isolated waters exist on the property? ^ Yes '~ No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.
Pond Creation PSI ~~
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.):
Current land use in the vicinity of the pond:
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
fmancial 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.
t-~L~Qt~ t~ I P•1, Gi l~'`aG~r~l~ 'iZ I~-C~U I P--~~ STEM CT~-~ SS i mil,

VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Qualify for projects involving greater than or equal fo 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 January i S, 2002, 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 IIWQ to consider the application complete for processing. Any application
lacking. a required mitigation plan or NCEEP 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
I ~_! ~;; I'_.2. ~. ~nr_state. rrc. us%t~c~~ e:t a~~ ds/strm~ide.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.
~ ~~
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Flease note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at htt~/,rh2.~.ez~r.state.nc.us/v,~rp/:ndex.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:
Amount of stream mitigation requested (linear feet): N / /~
Amount of buffer mitigation requested (square feetj:
Amount of Riparian wetland mitigation, requested (acres):
Amount of l~ton-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acresj: .
Rage i b of 12

IX. Environmental Documentation (required by DWQ)
Roes the project involve an expenditure of public (federaUs to/iocaij funds or the use of
public (federal/state} land? Yes ^ No {
2. 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/SEPAj?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at (919) 7 3-5083 to review current thresholds for enviranrnental documentation.
Yes [] No
3. 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 ^ ~ /~
X. Proposed Impacts on 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. Aii 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 OfEce may be included as appropriate. Photographs may also be included at the
applicant's discretion.
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), I SA NCAC 2B .4259 (Tar-Pamlico}, I ~A NCAC OZ$ .0243 (Catawba) I SA NCAC
2B .0250 (Randleman Rules and Water Supply Buff Requirements), or other (please
identify 3? ~'es ^ No
2. If "yes", identify the square feet and acreage of impact to each zone of the riparian buffers.
If buffer mitigation is required cal~ula~he required amount of mitigation by applying the
buffer muitinliers. ~d.•,,(( ~
Zone* I Fact ' Multiplier I Required
1 3 (2 for Catawba)
2 1.5
Total
• Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additiona120 feet from the edge of Zone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration I Enhancement, or Payment into the
Riparian Buffer Restoration Fund}. Please attach all ap ropriate information as identified
within 13A NCAC 2B .0242 ar .0244, or .0250. /.1 ~~-
Page 11 of 12

XI. Stormwater (required by DWQ)
Describe impervious acreage (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. If percent impervious surface exceeds 20% please provide calculations
demonstrating total proposed impervious level. V h, c~:~£ U FzS - IvS ~ugLKS
2,~0o F7 Z x `~~ i~--rt = ~.Z~~G ; ~S-r2~~-, ~ = io.:27 ~' ~- .
To-r~ L ~ n,ci~N~ ~uS ~~=--~- = l 1,S? ~ ~ ~ r ~.r~p~-y/o ct S - t 1..53,,~57~
STS Q-M~v,~~ ~~.~. C~ uT~S 1~1 ~~" Q~C~u1 ~E-L7 (,°} `~y
XII. Sewage Disposal (required by DWQ)
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.
1=.,4ci~ (_....b-~r' ~ - c..~ 1~~(~ A~ 1 ~'~nL 1 °bu A 1,
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 21i .0500) or any Buffer Mules?
Yes [] No
Is this an after-the-fact permit application? Yes ^ No
XTV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts] result in add' ionai
development, which could impact nearby downstream water quality? Yes ^ No
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
httl~:/,~li2o.er~-.state.nc.~~s/ncwetl~.nds_ If no, please provide a short narrative description
XV. Other Circumstances (Optional): /~ /,,8
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).
ApplicantlAgent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Tsage 12 of 12

XL Stormwater (required by DWQ)
XII.
Describe impervious acreage (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. If percent impervious surface exceeds 20% please provide calculations
demonstrating total proposed impervious level.'~~ l~-a o~~~'bR~y~S sp~T/yS ~~uQC~KS
2~` JO4 F7 Z X ~ol /~,-YS = S.ZCo~G'~ .~'-r0~~ c = f~.:27 ~' "y
STd P-M~wl~ ~~. C~ N
Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity ofthe subject facility.
1` Ac }-1 t~-r tc.t - t. V ~~C ~ 1 ~1,'D /~f 1 ~u /-~ L
5 ~ f T~ C. ~~-r~L~L 5~{S`.~
XIIL Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (I SA NCAC ZIi .0500) or any Buffer Rules?
Yes^ No~
Is this an after-the-fact permit application? Yes ^ No
XIV. Cumulative impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water qualify? Yes ^ No ~,
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
httra://h2o.err.state.nc.~is/ncwetlauuds_ If no, please provide a short narrative description
XV. Other Circumstances (Optional): ~ /,4
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).
ApplicantlAgent's Signatur Date
(Agent's signature is valid only if uthorization letter from the applicant is provided.)
Page I2 of 12

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~rp euMm"v~u3% / / r / / ~ S PIN I SB85 67-6766 and 5866-67019
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