20080086 Ver 1_Application_20080111

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Olflce USe Only: Form Vcrsian March OS
USACE Action ID No.
(It any particular item is not applicable to
I. Processing
_ DWQ No.
project, please enter "Not
or "N/~1". )
I. Check all of the approvals} requested fur this project:
^ Section 4(>4 Permit ^ Riparian or Watershed Buffer Rules
Section 10 Permit ^ Isolated Wetland Permit from DWQ
401 Water Quality Certification ^ Express 40l Water Quality Certification
2. Natiomvide, Regional or General Permit Numbers} Requested: G P 3D
3. If this notification is solel}~ a courtesy copy because written approval for the 40I Certification
is not required, check here: ^
4. If payment into the 1V'orth Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacas, attach the acceptance letter from NCEEP, complete section ti III,
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 to of a e 2 for further details ,check here: ~ ~° fJ ~ ~1~~,';.
=~ ~jc
II. Applicant [nformation ~..
J~,N 1 1 2008
1. O~amer/Ap licant Information ,
p`, r ()ENR-1hATF.FUI,A~I't
Name: ~I~h 7 ~i i e~T ~VC N S ~~IFTIANDS AND STORMN.~:4TER E?i:~'~~ri
Mailing Address:
"Telephone Number:
E-mail Address: ~?'
2. Agent!'Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if jh~ Agent has si~atory authority for the owner/applicant.)
Name: /y/
Company Affilifition:
Mailinb Address:
Telephone Ntmiber:
E-mail Address:
Fax Nttmber:
Page ~ of 12

IIL Project info~wation
Attach a vicinity ~ clearly showing the location of the property with respect to local
landrnarics such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Bode the vicinity map
and site plan must include a scale oral north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. ff 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 administrgtive 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 cor~stnxstion
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 infomled that
the project has been placed on hold until deciphorabie maps are provided.
1. Name of pr3aj~,ZE~I/S ~~ e=~~D/c~.~iC~/1/~ e`~7~/Ll~s¢~T-/1)/~
2. T.I.P. Project Number or State Project Number (NCDOT ):
3. Properly Identification Number (Tax PIN): Z7~
4. Location
County: ~D/t SS~T~' Nearest Town:;
Subdivision Warne (include phaseJlot number): U`~l1/E`/ ~
Dirediori~ bo site (inclujle road numbers/names, landmarks, etc.
S. Site coordinatES (For linear projects, such as a road or utility line, attach a sheet that
separatel5° lists the Coordinates for each exossin of a disq~~
Decimal Degrees (6 digits minimum): 3 ° ! !, °NI~~~ ~~'1 ~~ "ql
6. Property size (acres>: . 93
7. Name of nearest receiving b~od/y of water: ~5'El.~i/~,5' ~.f~i~.~~
8. River Basin: _ !~~ >'~Y ~~~
(Note -this must be one of North Carolina's seventeen designated major river basim. The
River Basin map is available at http:i,`1120.enr.state.nc.us/adminimaps; .)
9. Describe the existing conditions on the site and
at the time of this apalicat~ion: ,~X /STfit/G
land use in the vicinity of

Page 6 df 12

10. Describe the overall project in detail, includinb the type of equipment lu be used:
11. Explain the purpose of the proposed ~vurk: ~J rG(/~i1h- ~(f~/j/~ .~i _ ~D/I/
IV. Prior Project History
If jurisdictional determinations and,~or permits have been requested and/or obtained for this
project (including all prier phases of the same subdivision) in the past, please explain. Include
the USAC'E Action ID Number, DVVQ Project Number, application date, and date permits and
certifications ~,~ere issued ur withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved ~a~etland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCD4T project,
list and describe pemuts issued for prior segments of the same T.LP. project, along with
construction schedules.
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated w-ork,
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 abent's) responsibility to determine, delineate and map alt impacts to
wetlands, open water, and stream channels associated with the project. Each impact must be
listed separatel}~ 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 tempora.n~, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shod-n 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.
Photobraphs 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. It' additional
space is needed for listing or description, please attach a separate sheet.
Provide a written description of the proposed impacts: /ll~/7/~
Page 7 cif 1 Z

[ndi~idtrally list ~~elland impacts. Types of impacts include, but are rivl limited Eu
mechanized clearing, grading, till, exca~ alion, ilvvdinb, ditcliingidrainabe, etc. Fvr dams,
separately list impacts due to both structure and flooding.
' Wti to Numberct

(indicate on map) ~ "1'vpe ~~f Impact ~ __ __(~ g),~roa aetm~ rh' -

herbaceous, bog, etc.) Lo 100 earthtn

1 le cxiplam
~t~es/no) ~ ~Nearncc;tto
I
Stream
(linear feet) ` Ar fact
I
(ac.r~s)

Total Wetland Impact (acresl
3. List the total acreage (estimated) of all existing Wetlands on the property:
~. Individually lis! all intermittent and perennial stream impacts. Be sure !o identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
constntction, 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 shoving the linear footprint for both the original and relocated streams
must be included. To calculate acreage, multiply length X width_ then divide by 43.560_
Sh~eam Impact
Ntunber
indicate on ma)
Stream Name
T)pe of Impact Perennial or
Intermittent^ Average
Stream Width
Before Im act Irupact
Length
(linear feet) Area of
Impact
nacres)
~i

Total Stream Impact (Uy length and acreage)
5. Individualh~ list all open water impacts {including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, dredg7ng, hooding, drainage, bulkheads, etc.
Open Water Impact
Site Number

(indicate nn ma)
Name of VVaterbody
(it appliuible)
~ T of Im act
ti'Pc P Type of W aterbody

(lake, }x>nd, estuar}, sotuid, bay,
<xean, etc.) Area of

Impact
(a
res)
c
~ ~ie~ ' ~ At~l~l ~ ~-'~}'~~ /
~
~ not

' Total <)pen Water Impact (acres)
{'aga K ~,f 12

6. List the cumulative impact to all Waters of ttie V.S. resulting from the project:
Stream Im act (acres):
__
«'etland Impact (acres):_ ____
4--_.---- - -- __ _
--
Open Water Im act (acres):
Total [mpact to Waters of the LJ.S. (acres)

Total Stream Impact (linear feet): I
?. Isolated Waters
Do any isolated waters exist on the property? ^ ~'es No
Describe all impacts to isolated «-titers, and include the type o water (wetland or stream) and
the sire of the proposed impact (acres or linear feet). Please note that this section only
applies to wafers shat have specifically been determined to be isolated by the USACE.
K. Pond Creation
If construction of a pond is proposed, associated ~~-etland and stream impacts should be
included above in the ~~elland and stream impact sections. :Also, the proposed pond should
be described here and illustrated on anv 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-do~~m valve or spillway, etc.):
Proposed use or purpose of pond (e.g., Livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Ctu~rent land use in the vicinity of the pond:
Sipe of watershed draining to pond: Expected pond s~uface area:
~'II. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. Il 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 desi« options were not feasible. Also discuss how impacts
.,-ere minimised once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, milialion may be required by the NC
Division oC Water Quality for projects involvin b~reater than or equal to one acre of impacts to
freshwater ~~etlands or f;reater than or equal to I50 linear feet of total impacts to perennial
streams.
Yaffe cy oY t 2

USACE - [n accordance Huth the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal RegisUer on January 15, 2W2, 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 de4ermir-ing 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 replaang losses of
aquatic resowce 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 ntigation 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 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
Daft Technical Gtdde for Stream Work in North Carolina, available at
http:/~'1~2o.enr. siate.nc.us; nc~tietlands/strmgide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited tn: sitee location (attach directions
and/or map, if offsite), a~'ected stream and river basin, type and amount (acreagea(inear feet)
of mitigation Proposed (restoration, enhancernerrt, creation, or presen~ation), a plan view,
preservation mechanism (e.g., deed restrictions, oorrservation esserrrerrt, etc-), and a
description of the current site conditions and proposed method of construction. Please attach
a separateN if more space is needed_
2. Mitigation may also be made by pa}Tn~rt into the North Carolina Ecosystem EnhancerneRt
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
(919) ?15-(1#76 to determine availability, and written approvrd 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 http:%~'h2o.enr.state.nc.us/~~ rplinde~.}Itm_ If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the follower information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acxs):
Amount ofNan-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 ciF 12

Il. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/stateilocal) funds or the use of
public (federal/state) land'' Yes ^ No
2. If yes, does the project require preparation of an environmental doc:urnent 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 dtx;ument is required, call the SEPA
coordinator at (9l~)) 733-50x3 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 ^
R. Proposed Impacts on Riparian .u~d 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 bolters 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 sho~~m on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional OlTice may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified v,~ithin 15A NCAC ZB .0233
(Neese), 15A NCAC 2B .0259 (Tar-Pamlico}, 15A NCAC 02B .0243 (Catawba) ISA NCAC
2B .0250 (Randleman Rules and Water Supply B er Requirements), or other (please
identify )? Yes ^ No
2. If "yes", identify the sgttare feet and ae;reage of impact to each zone of the riparian bolters.
If buffer mitigation is required calculate the required amour! of mitigation by applying the
buffer multipliers.
7,one" Itupact I Multiplier l Requirc:il
(sattare feef) Miti¢ation
3 (2 for Catawba)
1.5
j Total ~ ~
' Lone ]extends out 30 feet perpendicular from the top of the near bank of channel: Gone 2 extends an
additional 20 feet from the edge of Lane 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i. e..
Donation of Property, Riparian Buffer Restoration /Enhancement, or Payment into the
Riparian Buffer Restoration Fund}. Please attach al~i~ priate infornlation as identified
within 15A NCAC 2B .0242 or .0234, or .0260. _~_
Page 11 of 12

xI. Stormn.aler (,tgwrea by Dwty
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 impen~ous surface ex 2C)sr6, please pro~ride calculations
demonstrating tote! proposed imperious level.
XII. SavaSe Disposal (required by DWQ)
Greedy detail the ultimate treaRrrrent methods and disposition {non-discharge or discharge) of
wastewater g N ~ Gom the proposed project, or available capa~aiy of the subject facility.
XIII. Violations (r+r;gaired by DWQ)
Is this site in vioiati~ of QWQ Wetland Rules (ISA NCAC 2H .t)SClO) or arty Buffer Rules?
Yes ^ No (~~'~(
Is this an after-the-fact permit applicamon? Yes ^ No
XIV. Cutnulativ~e Impacts (regl~red by DWQ)
Will this project {based on past and reasonably anticipated future impacts) result in 'tional
development, which could irr~aCt nearby downstream water' qualiiy? Yes ^ No
If yes, please submit a qualitative or quantitative cumulative irr~ad analysis in with
the most recent North Carolina Division of Water Quality policy posted ~ our website at
http:Uh2o.enr.state.nc.us/nc« etlands. If no, please provide a short narrative description.
XV. Otber Circunutaioes (Optional)=
it is the applicant's responsibility to submit the application sufftciently in advance of desired
construction dates to allow processing time for these permits. However, as applicant may
choose to list constraints associated with comtrudion or sequencing that may impose limits on
wort schedules (e.g., draw-down schedules for lakes, dates assocaated with Endangered and
7t~reaterx~i,Specres, accessibility problerr~, or other issues outside of the applicants control).
t1~nt's Sig~attare Dx>e
is valid only if an authorization letter from the applicant is provided.)

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