20052038 Ver 1_Complete File_20050119

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Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
January 6, 2005
Kenneth L. and Audrey S. Uhlman
1035 Lake Royal
Louisburg, NC 27549
Subject Property: Uhlman Property
Lake Royale [030301, 28-31-(1), B, NSW]
Approval of 401 Water Quality Certification with Additional Conditions
Dear Sir or Madame:
Alan W. Klimek, P.E. Director
Division of Water Quality
DWQ Project # 05-2038
Franklin County
You have our approval, in accordance with the attached conditions and those listed below, to place fill
within or otherwise impact 0.00642 acres of waters (Lake Royale) for the purpose of constructing a
double boathouse/two slip dock and 71-foot (by 2-foot wide) bulkhead along the existing shoreline at
the subject property, as described within your application dated October 31, 2005 and received by the
N.C. Division of Water Quality (DWQ) on November 9, 2005. After reviewing your application, we
have decided that the impacts are covered by General Water Quality Certification Number(s) 3495
(GC3495). The Certification(s) allows you to use Nationwide Permit(s) NW80 when issued by the US
Army Corps of Engineers (USACE). In addition, you should obtain or otherwise comply with any other
required federal, state or local permits before you go ahead with your project including (but not limited
to) Erosion and Sediment Control, Non-discharge, and water supply regulations. Also, this approval to
proceed with your proposed impacts or to conduct impacts to waters as depicted in your
application shall expire upon expiration of the 404 or CAMA Permit.
This approval is for the purpose and design that you described in your application. 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 fills for this project (now or in the future) exceed one acre of
wetland or 150 linear feet of stream, compensatory mitigation may be required as described in 15A
NCAC 2H .0506 (h). This approval requires you to follow the conditions listed in the attached
certification and any additional conditions listed below.
The Additional Conditions of the Certification are:
1. Impacts Approved
The following impacts are hereby approved as long as all of the other specific and general
conditions of this Certification (or Isolated Wetland Permit) are met. No other impacts are
approved including incidental impacts:
Amount Approved nits Plan Location or Reference

Waters 0.00642 acres Lake (Full Pond) Plan Sheet
401 Oversight / Express Review Permitting Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: http://h2o.enr.state.nc.us/ncwctlands
N ` Caro '
ona
Aturally
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/ 10% Post Consumer Paper

Kenneth L. and Audrey S. Uhlman
Page 2 of 3
January 6, 2005
2. Diffuse Flow
An additional condition is that all stormwater shall be directed as diffuse flow at non-erosive
velocities through the protected stream buffers and will not re-concentrate before discharging into the
stream as identified within 15A NCAC 2B .0259(5).
3. Erosion & Sediment Control Practices
Erosion and sediment control practices must be in full compliance with all specifications
governing the proper design, installation and operation and maintenance of such Best
Management Practices in order to protect surface waters standards:
a. The erosion and sediment control measures for the project must be designed, installed,
operated, and maintained in accordance with the most recent version of the North Carolina
Sediment and Erosion Control Planning and Design Manual.
b. The design, installation, operation, and maintenance of the sediment and erosion control
measures must be such that they equal, or exceed, the requirements specified in the most
recent version of the North Carolina Sediment and Erosion Control Manual. The devices
shall be maintained on all construction sites, borrow sites, and waste pile (spoil) projects,
including contractor-owned or leased borrow pits associated with the project.
c. For borrow pit sites, the erosion and sediment control measures must be designed, installed,
operated, and maintained in accordance with the most recent version of the North Carolina
Surface Mining Manual.
d. The reclamation measures and implementation must comply with the reclamation in
accordance with the requirements of the Sedimentation Pollution Control Act.
4. No Waste, Spoil, Solids, or Fill of Any Kind
No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or riparian areas beyond
the footprint of the impacts depicted in the Pre-Construction Notification. All construction
activities, including the design, installation, operation, and maintenance of sediment and erosion
control Best Management Practices, shall be performed so that no violations of state water quality
standards, statutes, or rules occur.
5. No Sediment & Erosion Control Measures w/n Wetlands or Waters
Sediment and erosion control measures shall not be placed in wetlands or waters to the maximum
extent practicable. If placement of sediment and erosion control devices in wetlands and waters
is unavoidable, they shall be removed and the natural grade restored within six months of the date
that the Division of Land Resources has released the project.
6. Bulkhead Construction
The bulkhead may be no longer than 71 feet in length (along the existing shoreline) and may be
no wider than two feet in width and must follow the existing shoreline geomorphology.
7. Boathouse/Slip and Pier Construction
Boathouse/slip and pier may extend a maximum of 10 feet from the existing shoreline.
r
Kenneth L. and Audrey S. Uhlman
Page 3 of 3
January 6, 2005
8. Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable
Buffer Rules, and any subsequent modifications, the applicant is required to return the attached
certificate of completion to the 401 Oversight/Express Review Permitting Unit, North Carolina
Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650.
Violations of any condition herein set forth may result in revocation of this Certification and may result in
criminal and/or civil penalties. The authorization to proceed with your proposed impacts or to conduct
impacts to waters as depicted in your application and as authorized by this Certification, shall expire upon
expiration of the 404 or CAMA Permit.
If you do not accept any of the conditions of this Certification (associated with the approved wetland or
stream impacts), 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, 6714 Mail Service Center,
Raleigh, N.C. 27699-6714. This certification and its conditions are final and binding unless you ask for a
hearing.
Any disputes over determinations regarding this Authorization Certificate (associated with the approved
buffer impacts) shall be referred in writing to the Director for a decision. The Director's decision is
subject to review as provided in Articles 3 and 4 of G.S. 150B.
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 Cyndi Karoly or Ian McMillan in the Central Office in
Raleigh at 919-733-1786 or Mike Horan at 919-7914200.
Sincerely,
A?4
AWK/jfm
Enclosures: GC3495
Certificate of Completion
cc: USACE Raleigh Regulatory Field Office
Mike Horan, DWQ Raleigh Regional Office
DLR Raleigh Regional Office
File Copy
Central Files
Alan W. Klimek, P.E.
Filename: 052038KennethUhlman(Frunklin)301
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
November 3, 2005
Franklin County
CERTIFIED MAIL
Kenneth & Audrey Uhlman
1035 Lake Royale
Louisburg, NC 27549
Subject: Kuhlman @ Lake Royale
Application and Fee Payment
Dear Mr. & Mrs. Uhlman:
On November 2, 2005 the Wetlands/401 Unit of the Division of Water Quality received your paperwork
pertaining to the property at 1035 Lake Royale. We are returning your paperwork for the following reasons:
1. Please,complete the enclosed FERC/GP30 Permit application and submit five (5) copies
2. Include the appropriate fee
3. Contact the US Army Corps of Engineers
Please note that beginning January 1, 1999, the N.C. General Assembly passed legislation requiring payment of a
fee for all 401 applications. The fee for applications is $200 for projects impacting less than an acre of wetland
and less than 150 linear feet of streams. For projects impacting one or more acres of wetland or 150 or more feet
of streams, the fee is $475. In order for DWQ to begin review and process your request, you must send the
application sets and a check in the appropriate amount made payable to the N.C. Division of Water Quality.
If you have any questions regarding this letter please do not hesitate to call me at [phone].
Sincerely,
Cyndi Karoly
Wetlands/401 Unit
Enclosure: PCN Application, FERC/GP30 Application, Check #9033 for $200.00
CBK/ jd
cc: File copy
Uhlman (Fmnklin)_GP30 appl_fee
XIM.
N. C. Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (http://h2o.enr.state.ne.us./newetlands)
Customer Service #: 1-877-623-6748
Triage Check List .
e:
Pr/o'ett Nam
Date:
J
DWQ#:
County:

To: ? ARO Kevin Barnett. ? WaRO. Tom Steffens and Kyle Barnes
? FRO Ken Averitte ? WiRO Noelle Lutheran
? MRO Alan Johnson ? WSRO Daryl Lamb
021"'RRO ACke Horan -
?-
-631
?i Tele hone . (919
From. P )
The file attached. Is being forwarded ??o . our for your evaluation.
Please call if you need\,Aa ' Lance.-
F] Stream length impacted ??
Stream-determination
? Wetiand determination and distance to blue-line surface'.waters on USFW topo maps
? Minimization/avoidance issues
? Buffer Rules (Meuse, Tar-Pamlico, Catawba, Randleman)
? Pond fill
? Mitigation Ratios
? Ditching
? Are the stream and or wetland mitigation sites available and viable?
? Check drawings for accuracy
? Is the application consistent with pre-application meetings?
Cumulative impact concern
U?IR'Pu
Comments:

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NOV
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Office Use Only: th'cTLAt:'DSt;t;JSiC;cio f?''tR6r?""iCti Form version March 05
? ?' ? 520 38
USACE Action iD No. DWQ No.
(Ifany particular item is nol applicable to this project, please enter "Not Applicable" or "N-A".)
1. Processing
Lg k?? IN 9 W R B
1. Check all of the approval(s) requested for this project: I OV 2 - 2005
? Section 404 Permit ? Riparian or Watershed I3ufier Ru cs
Section 10 Permit ? Isolated Wctland Permit Irom'MW-WATER QUAL11Y
401 Water Quality Certification ? Express 401 Water Quality WE M:ElVt1t ik&30RMWATERBRAI "N
2. Nationwide, Regional or General Pen-nit 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 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 Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
11. Applicant Information
1. Owner/Applicant 1nf nnation
Name: n evt vt t ?-yl ?. Gt fit eQ a ?? y S (.C Lt, (w?
Mailing Address:__ _ 1 d 3.5- Z-Alc- TLO NA l
c4 i's u -g& Nr a7Y-' O'
Telephone Number: 2C1'-Y78-763 Fax Number:
E-mail Address: _ util VIA 0, v, L<-e a 1, Cows
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:
Mailing Address: r
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 12
III. 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: vn6t V) ?C vo 00 e
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN):

0 /ipt
4. Location
County: Nearest Town: Y) r)
Subdivision name (include'phase/lot number): L=a c-c- Z
Directions to (include road numbers/names, landmarks, etc.):- e- H-wa n, Ce
l n. KL ` d,',A O, 6 n Sate. C. VV\ e V-P. - 1 n fi w S t
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 waterbody.)
Decimal Degrees (6 digits minimum): ON °W
Property size (acres):
¦ a. cre.S
'---C?
7. Name of nearest receiving body of water: L-C, Lcp- 'P-C, VwL le'
8. River Basin:
(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/maps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: 1`1© r) e.
Page 6 of 12
10. Describe the overall project in detail, including the type of quipment to b ;,used:
?p?Co t? WA-?LASc i 2.-hJ c -acLf
11. Explain the purpose of the proposed work:
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 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.
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. 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 clearly 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:
Page 7 of 12
I . Provide a wrist ert description of e proposed imZacts: ? c C? Utz 1 ?
C-,- ' G L ';
2. Individually list wetland impacts below:
\Vetland Impact Area of Located within Distance to
Site Number Type of Impact* Impact 100-year Floodplain** Nearest Stream
indicate on ma acres es/no (linear feet)
Type of %Vetland***
' 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
(FIRIA), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://ativw.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: N
Total area of wetland impact proposed: rt
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact Length of Average Width Perennial or
Site Number Type of Impact* Impact Stream Name** of Stream Intermittent?
indicate on ma linear feet Before Impact (please specifvl
* 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
\v%+1v.usgs eov. Several intemet sites also allow direct download and printing of USGS maps (e.g., vyww.topozone cum,
w-\v\v.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: VN ('D
Page 8 of 12
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
Type of Impact* Area of
Impact

acres
(if Name p Waterbody
applicable) Type of Waterbody

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

List each impact separately and identity 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 ? stream ? wetlands
Describe the method of.construction (e.g., damfembankment, 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.
VIII. Mitigation A
DW - In accordance w'
Q rth l5 NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12

USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed. impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/strmgide.htmI.-
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 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 httl2://h2o.enr.state.nc.us/w!p/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure 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 E] ? \
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.. 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), 15A NCAC 213 .0259 ar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Require ts), 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.
Z Impact Multiplier Required
s uare feet Miti ation

3
1.5

- Nw}+cuuluular,rum near nanx of channel; Gone 2 extends an -
additional 20 feet from the edge of Zone 1.
Page I I 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.
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.
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 214.0500) 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 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
http://112o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description:
XV. 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).
x00A,, ,

Applicant/Agent's Signature Date
(Agent's signature. is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12

Lake (Full Pond)
f=ull Pond
Shoreline

Please approximately sketch the following information on this plan
(picase provide dimensions for each item, such as 10 ft. x 100 ft):
1) All proposed vegetation clearing (provide dimensions)
7) Location of rip rap or fill to be placed above the Full Pond elevation
3) Location of rip rap or fill to be placed below the Full Pond elevation
.i) The location of any proposed structures such as buildings, retaining
walls, clocks; etc.
The location of any excavation or dredging below the Full Pond
elevation.
6) Location of construction access corridors.

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''V3
Office Use Only: M.R V ',TERCJ LI1Y 2 ,-, J ntti ?}isi i ?1 irch n5
61?TtA S?SFd D STCR,'„'.,,1 ER BEt'TCH ?.
USACE Action 11) No. DWQ No.
'2
BI -
NOV
(Ifany particular item is not applicable to this project, please enter "Not Applicable" or "NIA".)
I. Processing
Lp= k.;&F E 0 W [I no
1. Check all of the approval(s) requested for this project: ??V 2 - 2005
? Section 404 Permit ? Riparian or Watershed t3uffcr Ru es
Section 10 Permit ? Isolated Wetland Permit from tagP-WATERQUALITY
[ 401 Water Quality Certification ? Express 401 Water Quality WUWC,%MikgrAMWATERBRAt •-H
2. Nationwide, Regional or General Permit Number(s) Requested: /11-
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 Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
11. Applicant Information
1. Owner/Applicant Inf nnation , n r_
Name: enn-e b-k 'L, a" Au Dr° S utM4 ?
Mailing Address: 10 3 S' LAIC- E P=0 yA( -t
Loui`s!•ary, ,wc A7,-"7
Telephone Number: Z,r'L'-Y?g-763 / Fax Number:
E-mail Address: I t ti l vt.? a f t .<<e L-t-(p Q 0 I, C aVL".
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:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 12
III. Project Information
5.
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 are provided.
1. Name of project: )(N lA Y ) 1 rma ?Ss (-a kc U
2. T.I.P. Project Number or State Project Number (NCDOT Only): ?_3
3. Property Identification Number (Tax PIN):
4. Location / ,.-
County: '""C" ?? Nearest Town:Y
Subdivision name (include'phase/lot number): ICS
Directions to
g (include road numbers/names, rs?names, landmarks, ?etc.):_
ISI
r1-C V\+ Site coordinates -(For linear projects, such as a road or utility line,
separately lists the coordinates for each crossing of a' distinct waterbody.)
Decimal Degrees (6 digits minimum): ON

7. Name of nearest receiving body of water: Le, Ke ?"c sy0..Ie
6. Property size (acres):
(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/maps/.)
8. River Basin:
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: r\ O r) e
T
attach a sheet that
ow
Page 6 of 12
10. Describe the overall project in detail, including the type
JD O ? CO le h ors., 4UQ V '5 M kj_D
N, C-- I-- n L r'Ya__. rnve? % nc.
11. Explain the purpose of the proposed work:
C-CM a
to b used
?- 6Z6?
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 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.
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. 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 clearly 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:
Page 7 of 12
I . Provide a writte description of e proposed im acts
e C11 r1 f tuna
x c cl? vc--? t

2. Individually list wetland impacts below:
Welland Impact Area of Located within Finear istance to
Site Number Type of lmpact* Impact 100` yearFloodplain** arest Stream
indicate on ma acres es/no feet)

Type of Wetland***
' 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
(I IRNI), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://%vutiv.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: N
Total area of wetland impact proposed: /
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact Length of Average Width Perennial or
Site Number Type of Impact* Impact Stream Name** of Stream Intermittent?
indicate on ma linear feet Before lm act (please 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
wxvu•.us s ov. Several internet sites also allow direct download and printing of USGS maps (e.g., vvww.tooozone corn,
vvww.maoquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: V l 'D
Page 8 of 12
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
Type of Impact„ Area of
Impact
acres Name of Waterbody
(if applicable) Type of Waterbody
(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 I '
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., darn/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.
VIII. Mitigation A
DWQ - In accordance wtth l5 NCAC 2H .0
Division of Water Quality for projects involving
freshwater wetlands or greater than or equal to
streams.
Page 9 of 12
500, mitigation may be required by the NC
greater than or equal to one acre of impacts to
150 linear feet of total impacts to perennial
I
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 advefse 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
http://h2o.enr.state.nc.us/ncwetiands/strm.izide.htm1.-
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 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 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): I\J
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure 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 ? N /
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. 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 ar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Require ts), 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.
one* Impact Multiplier Required
s uare feet Miti ation
1
h 3
2 1.5
otal
*7nn?
1 n vfo ie ..? ?n a _.
--- r-.r_••-•--•W ••?••.....- vuun w wauum.- Gone L exienos an -
additional 20 feet from the edge of Zone 1.
Page 1 I of 12
XI. Stormwater (required by DWQ)
Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss
stornnvater 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.
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.
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 21-1 .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 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 wcbsite at
littn://li2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description:
XV. 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).

Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12

Lake (Full Pond)
l=ull Pond
Shoreline

Please approximately sketch the following information on this plan
(please provide dimensions for each item, such as 10 ft. x 100 ft):
1 i All proposed vegetation clearing (provide dimensions)
Z) Location of rip rap or fill to be placed above the Full Pond elevation
3) Location of rip rap or fill to be placed below the Full Pond elevation
-ti The location of any proposed structures such as buildings, retaining
walls, clocks, etc.
-i The location of any excavation or dredging below the Full Pond
elevation.
6) Location of construction access corridors.

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Plan Detail Incomplete
Q?
Date ? Ib ? S Who Reviewed:
? Please provide a location map for the.project.
? Please show all stream impacts including all fill slopes, dissipaters, and bank stabilization on the site plan.
? Please show all wetland impacts including fill slopes on the site plan. 1?
-'(toli62 1 ?u- flf , 6.2 ???•? Sea Gt/a (( ,?
Please indicate all buffer impacts on the site plan.
? Please indicate proposed lot layout as overlays on the site plan.
? Please indicate the location of the protected buffers as overlays on the site plan.
? Please locate all isolated or non-isolated wetlands, streams and other waters of the State as overlays on the site plan.
? Please provide cross section details showing the provisions for aquatic life passage.
? Please locate any planned sewer lines on the site plan.
? • Please provide the location of any proposed stormwater management practices as required by GC
? Please provide detail for the stormwater management practices as required by GC
? ' Please specify the percent of project imperviousness area based on the estimated built-out conditions.
? Please indicate all stormwater outfalls on the site plan.
? Please indicate the diffuse flow provision measures on the site plan.
?, Please indicate whether or not the proposed impacts already been conducted.
Avoidance and/or Minimization Not Provided
? The labeled as on the plans does not appear to be necessary. Please eliminate the or provide additional
information as to why it is necessary for this project.
? This Office believes that the labeled on the plans as can be moved or reconfigured to avoid the impacts to the
Please revise the plans to avoid the impacts.
? This Office believes that the labeled on the plans as can be moved or reconfigured to minimize the impacts to the
Please revise the plans to minimize the impacts,
? The stormwater discharges at the location on the plans labeled will not provide diffuse flow through the buffer because
Please revise the plans and provide calculations to show that diffuse flow will be achieved through.the entire buffer. If it
is not possible to achieve diffuse flow through the entire buffer-then it may be necessary.to provide stormwater management
practices that remove nutrients before the stormwater can be discharged through the buffer.
Other
? The application fee was insufficient because over 150 feet of stream and/or over 1 acre of wetland impacts were requested. Please
provide $ This additional fee must be received before your application can be reviewed.
Please complete Section(s) on the application. CC. 4._ao. ? i
? Please provide a signed copy of the application.
? - Please provide copies of the application,
Mitigation
copies of the site plans and other supporting information.
? of compensatory mitigation is required for this project. Please provide a compensatory mitigation plan. The
plan must conform to the requirements in 15 A NCAC 2H.0500 and must be appropriate to the type of impacts proposed.
? Please indicate which 404 Permit the USACE would use to authorize this project.