20061576 Ver 1_COMPLETE FILE_20060929

ADAMS FARM HOMEOWNERS ASSOCIATION cam,,
C/O Paul M. Weaver "pro q'"°Y, Y? 9 '??/, tI//
5005 Birnarnwood Trail sr S
Greensboro, North Carolina 27407 0 14,q%FR°
Phone: [phone] Q-T IF ch
IDU - \S1 to
December 14, 2006
North Carolina Department of Environment and Natural Resources
Division of Water Quality
401/Wetlands Unit
1650 Mail Service Center
Raleigh, North Carolina 27699-1650
Reference: Modification to Filed Section 404, 10, and 401 Permit Application
Adams Farm Lake Bank Stabilization Project
Adams Farm Subdivision
Greensboro, North Carolina
Dear Sirs:
I am enclosing seven copies of the modified Page 11 of 12 of the permit application for the above referenced
project. The modification is to Section X and involves changing the answer to the question regarding if the
project will impact protected riparian and watershed buffers from "Yes" to "No". We met with Darryl
Lamb of the DWQ Winston-Salem regional office at the project site on December 12, 2006, and Mr. Lamb
informed us that this portion of the permit needed to be corrected because our project was not impacting
riparian and watershed buffers. During the December 12 meeting, Mr. Lamb reviewed the project and gave
his verbal approval for the work performed as part of the project (this was an after-the-fact permit
application). Should you have any questions or require further information, please do not hesitate to contact
me.
Very truly yours,
Paul M. Weaver, P.G.
Vice President
Adams Farm Homeowners's Association Board of
Directors
PMW/pmw
attachments
IX.
X.
Environmental Documentation (required by DWQ)
Does the project involve
(federal/state) land?
Yes E] No
f.y
?FT<q pc? l' J "9 7 O
NpS?NOSTORM?pgc/? ?6,
A?Re
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an expenditure of public (federal/state) funds or the use of public
M
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 ?
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 2B .0259 (Tar-Pamlico), 15A NCAC 213 .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify W4 )?
Yes ? No [] 'I yRl J)QVvered "ye)', SrRyide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 A/a 3
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state)
(federal/state) land?
Yes ? No E6
X.
?D
?Yq?RBP.?gq
funds or the use oftf ublic
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 ?
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 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Puffer Requirements), or other (please identify AL& )?
Yes ? No 'I yRu ]jQVvered "yep', SrRyide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Miti ation
1 NA" 3
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
IX.
X.
Environmental Documentation (required by DWQ)
Does the project involve
(federal/state) land?
Yes ? No
?yCh
an expenditure of public (federal/state) funds or the use of public
M
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 ?
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 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify WA )?
Yes ? No 'I yRu ??cvered "ye)', SrRyide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 Iva 3
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
IX. Environmental Documentation (required by DWQ)
X.
Does the project involve
(federal/state) land?
Yes ? No
A?
dos .. _ - a? p
Re?
?h
an expenditure of public (federal/state) funds or the use of public
0
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 ?
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 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Puffer Requirements), or other (please identify WA )?
Yes C] No 'I yRu MVvered "yep', SrRyide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 Iva 3
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
IX.
X.
Environmental Documentation (required by DWQ)
Does the project involve
(federal/state) land?
Yes ? No
i
O? < /yJ
C ??//
n
Alt.
gT<cRB
?'Gy
an expenditure of public (federal/state) funds or the use of public
Z
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 ?
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 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Puffer Requirements), or other (please identify WA )?
Yes ? No 'I yRu EIQVvered "yep', SrRyide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 Iva 3
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
IX. Environmental Documentation (required by DWQ)
X.
Does the project involve
(federal/state) land?
Yes ? No
an expenditure of public (federal/state) funds

o?
Oy+ray J?r ' ?1l'..? it?
or the use of publt?
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 ?
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 2B .0259 (Tar-Pamlico), 15A NCAC 213 .0250 (Randleman Rules and
Water Supply Puffer Requirements), or other (please identify W4 )?
Yes No [ 'I yRu I)QVvered "ye)', SrRyide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 IVA 3
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
IX.
X.
Environmental Documentation (required by DWQ)
r49 a. 19
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ? No F
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 ?
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 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Puffer Requirements), or other (please identify hi-A )?
Yes ? No [?] 'I yRu EQVvered "yep', SrRyide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 3
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
OF W ATF9
O? QG
Q <
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
-
P
DEC 1 E 2006
Mr. Paul Weaver UEt:K - YvATER QUALITY
Adams Farm Homeowners Association ' t1'WDSA AND STORM- MER SMICH
5005 Birnamwood Trail
Greensboro, NC 27407
APPROVAL of 401 Water Quality Certification with Additional Conditions
Dear Mr. Weaver:
Alan W. Klimek, P.E. Director
Division of Water Quality
December 14, 2006
DWQ# 06-1576
Guilford County
The Adams Farm Homeowners Association has our approval, in accordance with the attached conditions, to
place fill within, or otherwise impact by excavation, 0.12 acre of lake shoreline for the purpose of stabilizing
an eroding shoreline on Adams Farm Lake located in the Adams Farm residential subdivision on Adams Farm
Parkway in Greensboro, Guilford County, as described in your application received by the Division of Water
Quality on October 20, 2006. After reviewing your application, we have determined that this activity is
covered by General Water Quality Certification Number 3495, which. can be viewed on our web site at
http://www.ncwaterguality.org/wetlands.html. This Certification allows you to use Nationwide Permit
Number 13 when it is issued by the U.S. Army Corps of Engineers. In addition, you should secure any other
applicable federal, state or local permits before you proceed with your project, including (but not limited to)
those required by Sediment and Erosion Control, Non-Discharge, and Water Supply Watershed regulations.
Also, this approval will expire when the accompanying 404 permit (Regional General Permit) expires unless
otherwise specified in the General Certification.
This approval is valid only for the purpose and design that you have described in your application. If you
change your project, you must notify us in writing, and you may be required to send us a new application for a
new certification. If the property is sold, the new owner must be given a copy of the Certification and
approval letter and is thereby responsible for complying with all conditions. If total fill for this project (now
or in the future) exceeds one acre of wetland or 150 linear feet of stream, compensatory mitigation may be
required as described in 15A NCAC 2H .0506 (h). For this approval to be valid, you must follow the
conditions listed in the attached certification, as well as the additional conditions listed below:
1. The following impacts are hereby approved as long as all other specific and general conditions of the
Certification are met. No other impacts, including incidental impacts, are approved:
Amount Approved Plan Location or Reference
Waters 0.12 acre Adams Farm Lake located in the Adams Farm residential
subdivision on Adams Farm Parkway in Greensboro, Guilford
Count
None Carolina
Ntura!!y
North Carolina Division of Water Quality
Wetlands Certification Unit 1650 Mail Service Center Raleigh, NC 27699-1650 Phone [phone] FAX [phone]
2321 Crabtree Blvd. Raleigh, NC 27604-2260 Internet hfplhwww,ncwaterouality.oM
Customer Service Number: 1-877-623-6748
An Equal Opportunity/Affirmative Action Employer-50% Recycled/10% Post Consumer Paper

Mr. Paul Weaver
Page 2, DWQ# 06-1576
December 14, 2006
2. Appropriate sediment and erosion control measures which equal or exceed those outlined in the most
recent version of the North Carolina Erosion and Sediment Control Planning and Design Manual or the
North Carolina Surface Mining Manual (available from the Division of Land Resources at NCDENR
regional offices or the central office), whichever is more appropriate, shall be designed, installed and
maintained properly to assure compliance with the North Carolina water quality standards that are
applicable to lakes and reservoirs. These measures must be maintained on all construction sites, borrow
sites, and waste pile (spoil) sites, including contractor owned and leased borrow pits,. which are
associated with the project.
3. 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 measures in wetlands or waters is
unavoidable, they shall be removed and the natural grade restored within six months of the date that the
project is completed or, if applicable, within six months of the date that the project is released by the
North Carolina Division of Land Resources.
4. 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. Upon finishing the project, the Applicant shall fill out and return the enclosed "Certificate of
Completion" to notify NCDWQ when all work included in the §401 Certification has been completed.
This certificate should be returned to the 401/Wetlands Unit of the NC Division of Water Quality at the
address listed on the form.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You
must act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition
which conforms to Chapter 150B of the North Carolina General Statutes to the Office of Administrative
Hearings, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its conditions are final
and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act.
If you have any questions, please telephone Daryl Lamb in the DWQ Winston-Salem Regional Office at 336-
771-4959 or Ian McMillan in the Wetlands/401 Central Office in Raleigh at 919-715-4631.
Sincerely,
Alan W. Klimek, P.E.
AWK/cdl
Mr. Paul Weaver
r Page 3, DWQ# 06-1576
December 14, 2006
Attachments
cc: Mr. Monte Mathews, U. S. Army Corps of Engineers, Raleigh Regulatory Field Office
Winston-Salem DWQ Regional Office
Central Files
Wetlands/401 File Copy
RE: 06-1576 Adams Farm Lake Bank Stabilization
Subject: RE: 06-1576 Adams Farm Lake Bank Stabilization
From: Laurie Dennison <[e-mail]
Date: Mon, 18 Dec 2006 11:16:23 -0500
To: Daryl Lamb <[e-mail]
Daryl -
Received signed approval letter, thank you; but I have a question about the impacts approved.
the project was set up for open water (0.12 ac) AND the PCN showed 3192 sq ft of buffer.
Your approval reflected (0.12 ac) open water approval but nothing for the buffer.
Just want to double check before I "issue" in BIMS.
Thanks,
Laurie
S?os? 5 ?.d_ 1??? ?ea- Pc N isn p t,,?- wa.a c?. ??,?,o?},a?_
1 of 1 12/18/2006 11:16 AM
DWQ# 06-1576 Adams Farm Home Owners Association
Subject: DWQ# 06-1576 Adams Farm Home Owners Association
From: Daryl Lamb <[e-mail]>
Date: Fri, 15 Dec 2006 09:07:24 -0500
To: Ian McMillan <[e-mail]>
Ian,
DWQ# 06-1576 (due on 12/18/06) has been issued. Signed copy will follow.
Best regards,
Daryl
Daryl Lamb, P.G.
NC DENR Winston-Salem Regional Office
Division of Water Quality
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
Daryl Lamb <Daryl.Lamb(-,NCmail.net>
WSRO
NC DENR
061576.doc 1 Content-Type: application/msword
Content-Encoding: base64
1 of 1 12/15/2006 9:46 AM
Triage Check List
Date: 10/23/06 Project Name: Adams Farm Lake Bank Stabilization
DWQ#: 06-1576
County: Guilford
Daryl Lamb, Winston-Salem Regional Office
To:
60-day processing time: 10/20/06 - 12/18/06
From: Cyndi Karoly Telephone: [phone]
The file attached is being forwarded to you for your evaluation.
Please call if you need assistance.
? Stream length impacted
? Stream determination
Wetland 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
Comments: As per our discussion regarding revision of the triage and delegation processes,
please review the attached file. Note that you are the first reviewer, so this file will need to be
reviewed for administrative as well as technical details. If you elect to place this project on hold,
please ask the applicant to provide your requested information to both the Central Office in
Raleigh as well as the Asheville Regional Office. As we discussed, this is an experimental, interim
procedure as we slowly transition to electronic applications. Please apprise me of any
complications you encounter, whether related to workload, processing times, or lack of a "second
reviewer" as the triage process in Central had previously provided. Also, if you think of ways to
improve this process, especially so that we can plan for the electronic applications, let me know.
Thanks!
Adams Farm Homeowners' Association
c/o Paul M. Weaver
5005 Birnamwood Trail
Greensboro, North Carolina 27407
p-??eiA?r ?T
ECOVID
October 16, 2006
Ms. Cyndi Karoly
North Carolina Department of Environment and Natural Resources
Division of Water Quality
1650 Mail Service Center
Raleigh, North Carolina 27699-1650
Dear Ms. Karoly:
Attached is a check in the corrected amount of $200.00 for the permit application fee for the Adams Farm
Lake Bank Stabilization Project (DWQ Project No. 06-1576). We would appreciate your continuing the
review of our application.
Very truly yours,
TRIGON ENGINEERING CONSULTANTS, INC.
Paul M. Weaver
Vice President
Adams Farm Homeowners' Association
C?
0 C T G 0 2006
DENR - WATER QUALITY
WETLANDS AND STORMWATER BRANCH
a _3

W a rF9
QG
r
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
October 2, 2006
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
Alan W. Klimek, P.E. Director
Division of Water Quality
DWQ Project # 06-1576
Guilford County
Adams Farm Homeowners Association
Attn: Paul Weaver
5005 Birnamwood Trail
Greensboro, North Carolina 27407
co
Subject Property: Adams Farm Lake Bank Stabilization
Permitting Fee
? REQUEST FOR MORE INFORMATION
® PERMITTING FEE MISSING/INCORRECT
? RETURN OF APPLICATION PACKAGE
Dear Mr. Weaver:
On September 29, 2006, the Division of Water Quality (DWQ) received your application dated
September 27, 2006 for the above referenced project. The DWQ has determined that your application
was incomplete and/or provided inaccurate information as discussed below. The DWQ will require
additional information in order to process your application to impact protected wetlands and/or streams on
the subject property. Therefore, unless we receive five copies of the additional information requested
below, we will have to move toward denial of your application as required by 15A NCAC 2H.0506 and
will place this project on hold as incomplete until we receive this additional information. Please provide
the following information so that we may continue to review your project.
Additional Information Requested:
? Water Quality Certification, See I. Processing, Item 2.. Please state which Permit
(Nationwide, Regional or General) number you intend to use. You may want to contact the
U.S. Army Corps of Engineers (USACE) to determine which permit they will allow you to
use.
? DWQ requires the name of an individual shown as "Owner/Applicant" to set up the project.
? The PCN Application failed to contain the Applicant/Agent's Signature and Date. See last
page of application. (Agent's signature is valid only if an authorization letter from applicant is
provided).
? Water Body information not stated. See III Project Information, Item 7.
? Incorrect and/or missing wetland, intermittent-perennial stream and/or buffer impacts.
DWQ is unable to review this project without noted or corrected impacts reflected.
One
N Carolina
401 Oversight/Express Review Permitting Unit Naturally
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: htto://h2o.enr.state.nc.us/ncwetlands
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper

? Lack of permitting fee. 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.
® Incorrect permitting fee amount. Please see above item. Your check # 2642 for $475 is herein
enclosed for fee correction. DWQ does not retain any payment unless it is in the correct
amount. See `Other' section below.
? A request for a modification of an issued permit requires re-submission of five (5) application
sets and appropriate fee. We have herein returned your modification request.
? Application was missing pages or sections of information. See Other section below.
® OTHER: A review of the application reflects open water impacts of 0.12 acres; based on the
impacts, the correct fee to remit is $200.
Please contact the DWQ within three weeks of the date of this letter to verify that you have received this
letter and that you remain interested in continuing to pursue permitting of your project and will be
providing the DWQ the requested information at a later date. Please contact this office in writing and
Daryl Lamb of the DWQ Winston Salem Regional Office. If we do not hear from you within three
weeks, we will assume that you no longer want to pursue this project and we will consider the project as
withdrawn.
This letter only addresses the application review and does not authorize any impacts to wetlands, waters
or protected buffers. Please be aware that any impacts requested within your application are not
authorized (at this time) by the DWQ. Please call Mr. Ian McMillan or Ms. Cyndi Karoly at 919-733-
1786 if you have any questions regarding or would like to set up a meeting to discuss this matter.
Sincerely,
Cyndi Karoly, Supervisor
401 Oversight/Express Review Permitting Unit
CBK/ljd
Enclosures: Check # 2624 for $475
cc: Daryl Lamb, DWQ Winston Salem Regional Office
USACE Raleigh Regulatory Field Office
File Copy + Check Copy
Central Files + Check Copy
Filename: 061576AdamsFarmLk(Guilford)_Hold_Fee
DAMS FARM COMMUNITYASSOCIATION
1 1 _,
NC Division of Water Quality
Date Type Reference
08/31/2006 Bill
9/26/2006
Original Amt. Balance Due Discount
475.00 475.00
Check Amount
Q19 Qf??5 12 oeiri.' I
SEP 2 9 2006
WETLANDS AND STTORRMw?UTFFRR' RANCH
Wachovia - Comm. Checki Adams Farm Lake Retaining Wall Project
ADAMS FARM COMMUNITY ASSOCIATION
P.O. BOX 77726
GREENSBORO, NC 27417
20061576
9/26/2006
475.00
2642
u PAY TO THE NC Division of Water Quality $ **475.00
ORDER OF
o-
Four Hundred Seventy-Five and 00/100********************************:********************************************
DOLLARS e
NC Division of Water Quality
<5
i o
;s MEMO sP
Adams Farm Lake Retaining Wall Project
WACHOVIA BANK, NA
GREENSBORO, NC 27405
66-49/531
2642
Payment
475.00
475.00
11100264211' 1:0S31004941: 356? 0482VS118
i ;
2 0 0 6 1 5 7 6
LETTER OF TRANSMITTAL
TO:
N.C. Division of Water Quality
401/Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Date: 9/27/06
Regular Mail: XXX
Express Mail:
Federal Express:
Hand Carried:
Other:
COPIES DESCRIPTION COMMENTS
7 Permit Application 1 copy of permit has
been send to USACE
1 Check in the amount of $475.00

PROJECT INFORMATION:
Adams Farm Homeowners' Association
Adams Farm Lake Retaining Wall Project
Greensboro, North Carolina
SIGNATURE: (ZAbz X"
Paul M. Weaver
i
Office Use Only: Form Version May 2002
USACE Action ID No. DWQ No. 2 0 6 6 1 5 7 6
(If any particular item is not applicable to this project, please enter "Not Appucame or 1WA .)
I. Processing
1. Check all of the approval(s) requested for this project:
Q Section 404 Permit 0 Riparian or Watershed Buffer Rules
0 Section 10 Permit ? Isolated Wetland Permit from DWQ
0 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: 13
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), chec
II. Applicant Information EROWRM
SEP 2 9 2006
1. Owner/Applicant Information
Name: A Jam i FG r M Plo M e e a we rs /Is.ro c: y ;: o? a ?ENR WATER QUAt irv
'E7d -
Mailing Address: c/o P4o t?ewver ATER BRANCH
So or R. r,?a Mwaa 1 Tea'
6 re twA,r ? ,Je- l0407
Telephone Number: (331) d It-1633 Fax Number:
E-mail Address: pin idsuer be//roy?/. Wef
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:
E-mail Address:
Fax Number:
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: A d 4m-s Ly ke Q 4-rk lfh 6: 1. z 4 f%ow
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): S4 ' I SAS 7 91
4. Location
County: Gtiilf.rd Nearest Town: Gre ..,.slcro
Subdivision name (include phase/lot number): 4d,, -j Pc rM
Direct//ions /torr site (include road numbers, landmarks, etc.): //:L ?. &. /+ Rd 4. M44
4Y-
AI.JL R ! k P? ?[ Lt _J FI r_LVI XGiM / c,k,.,,- . #A MJ / G PIM PLf k..? L. 1p `(1? C/T,• «?
C44 Koti+e r jr.N« d4M , 1; k.e Se ?',rd C[.A?(f 1,Je
Site coordinates, if available (UTM or Lat/Long): 7tc? ?? -'T? a?0 ??
Q RW-' I SUIdFV4 OgEU suli? I3 DU UPpLN)W1ty line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): L 4 ke 'J r •W l 17 4 cr s : w J'z t
1. 1
7. Nearest body of water (stream/river/sound/ocean/lake): 4d4M r 44rM ??/u fQw// kh? creek
River Basin: r a oz
0 RW- V'Is p usVEe pq RI North C olina's seventeen designated major river basins
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
The
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: T ke 5 e yY -i: r?rs. ? ? of -Mt Im ke S.,Jk r V J -dx we r#
?l'n/S1? TriMt?Y
eMd J tke /,Ice. 74e AN?t?Y Jhr_ rV%W? -,7 -r4e /&1(f ?PIJP/G?(Y (0AIXIV of
{?v?.,pJ 4 c.IMd1,,,N,re w'?1. ,o,?l u,rJ ?'e?.Ji cok?f.r? cJa a rPs/es/-•?e e?'oe
Page 6of12
N r, rte
10. Describe the overall project in detail, including the type of equipment to be used: Tk e p?ae? c.
AT L., n/e LO_ .-/J . F r. ROL.t?OJ/. .re-C-O?4.1 Sla&,f rP ?olN rNt N/4II OIOCS_S•2e IpO•,J(6~ J V/ONR f'4e
.t
11.
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.
A pe.rM k A A e- rat Ae daM Al 7,4e t 1? 4Crl? PA
OT -KC 1AKC ./41 IIJHPJ 300). We tLN?nf ?i,id f4n_NcAUU/cr/c I•.r}I?C P (?J.4CE aNJ
?7
aWLL AA-A-SW •r c'al-PJ
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 Iapplication.
We wrh?c? CVPMFN?IIy IIfC? 70 ;".r l J M l4 rP ?LI'V "./C "/I, C. re4N6
11 i
14'1 Wrr/C if NOT C "-S 'Nchjed ?J 71'j yPfi[a?Cuw/ lecst.1e WC 4n, f k,,tl-? exit-' & -Acre
I
V?C I.Joh 1 II ?Ce 4v Aier f rA(C ocl J- *4-',,,,, I re c W1 //
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
we, li
srPtr?cuf?ir
it
Page 7 of 12
rC P/c[? C Diu u.?cIP?MI / /a 1C[
I k01 C/P rej t/Pr41 (-AI er r1 u.v -.%114 /O,.c 1'4t a/u &-2
fao?;.,y a?"v: de .r! ?oIB"deep Cselor?le Pxpo-zeJ MgJ 1'.4e) w'1I4e ex cw,fej --A? ,Nisi FX«vofor'
1. / Provide a written description of the proposed impacts: T?_pre.te.?ce J Ar- 6,M don.4tr ee,ot
of -kk{e. trodey' rwl all wyr.G r rLtneJ Wkile wa ,,4c. J 4a-%js oyu- 74C weir MenN'r NO
we $p.11 v qk or Q.11 R1?? C/P ?? a /?a Z 1 n -41(r &C
C LO,.C('rCC.ti7<'y,j o?r .14l /.r A oin (d AavC 4 Po fl lk Ve I M pit 1 W Ae 1A kC &4 r -11 e,._ Uea, .
2. Individually list wetland impacts below:
Wetland Impact
Site Number
(ind' ate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
(es/no Distance to
Nearest Stream
(linear feet)
Type of Wetland***

* List each impact separately and identity temporary impacts. impacts mcitiae, out are not irrnrteu to: mccnacuLcu c.ca.u.g, r'.auu.g, iii.,
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 0 anagement Agenly's (FEO A) Flood Insurance Rate Maps
ffIItMF, or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http:/hvww.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.F Indicate if wetland is isolated Fdetermination of isolation to be made by USACE onlyF.
List the total acreage (estimated) of all existing wetlands on the property: do
Total area of wetland impact proposed: 0
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
(linear feet
Stream Name* * Average Width
of Stream
Before Impact Perennial or
Intermittent?
(please seci

* List each impact separately and identify temporary impacts. impacts mciuae, out are not imnneu to: curvrm auu a buc.aLcu ..y-.ap,
dams Fseparately list impacts due to both structure and floodingF, relocation Enclude linear feet before and after, and net loss/gainF,
stabilization activities Rement wall, rip-rap, crib wall, gabions, etc.F, 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 Emnamed tributaryFto the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.gov. Several internet sites also allow direct download and printing of USGS maps Fe.g., wwwjopozone.com,
www.mapouest.com, ete.F.
Cumulative impacts (linear distance in feet) to all streams on site:
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) e) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.
w..Il F-if 0. oS A&_. .c Fti. L41ce L
F:I! a wC-11 0.07 e F Le e Luk

" List each impact separately and identify temporary impacts. Impacts include, but are not tanned. to: tut, excavation, urcuging,
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., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
UQ lake lev ( w'11 If le Jew flc •g A of 11c C'AM evyFlo? wer•/
aNy d, c}tirled Jea,ra-f fe.M r-dtn'., Rkt/ 2c., Creek. Ike walk w,11 de 01-ced sltsk% ." At h4kc
S 2e of ero-Vey b,/4111 w1krrt er Autt'?Ic -/a /'M4 J /-/cc 44N/C
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the c ederal o egister on March 9I 20001 mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. c actors
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 wetlanj
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 r SACE or a t n to consider the application complete for processing. Any application
lacking a required mitigation plan or NCt o P concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in D: Q's Draft Technical Guide Ior Streap t ork in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/strmgide.html.
N 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 Fattach directions
and/or map, if offsiteFl affected stream and river basin, type and amount Facreage/linear feetF
of mitigation proposed restoration, enhancement, creation, or preservationF, a plan view,
preservation mechanism Fe.g., deed restrictions, conservation easement, etc.F, and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
Aropo.t e I
2. Mitigation may also be made by payment into the North Carolina t etlands o estoration
Program INCt o PF. Please note it is the applicant's resSonsiEility to contact the NO RP at
I9NFTPP-R20Uto determine availability and to request written approval of mitigation prior
to submittal of a PCN. c or additional information regarding the application process for the
NCt o PI check the NCt o P website at http://h2o.enr.state.ne.us/wrp/index.htm. If use of
the NCt o P is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested Hinear feetF.
Amount of buffer mitigation requested Fsquare feetF
Amount of o iparian wetland mitigation requested FacresF
Amount of Non-riparian wetland mitigation requested FacresF.
Amount of Coastal wetland mitigation requested FacresF
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 ?
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 2B .0259 (Tar-Pamlico), 15A NCAC 213 .0250 (Randleman Rules and
Water Supply uffer Requirements), or other (please identify /,fg "/C oc J-3 . ob ro )?
Yes 9 No ? 'I yRu DQVvered "ye)', SrIC&e the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 315 3 956
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Gone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
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If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCA C 2B .0242 or .02860. I /? y,
1 ?•?Sflt ?./ ?NTT? re-14-arc. Ru j ' AN d,Whr4ed ire,_r w:1 3e ?tµTCE 41 7 4 wrerf: d? tc.rfveP r
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
/?t uidlFlCAC lord ICYt.
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 2H.0500) or any Buffer Rules?
Yes ? No FA
Is this an after-the-fact permit application?
Yes 0 No ?
XIV. 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).
W M W 9? Z -7 106
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
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Office Use Only: Form Version May 2002
2o061576
USACE Action ID No. DWQ No.
1.
II.
(If any particular item is not applicable to this project, please enter " Not Appiicame or iN/A .?
Processing
1. Check all of the approval(s) requested for this project: Ilr[:-l?Ei?`D
Section 404 Permit 0 Riparian or Watershed Buffer Rules
Q Section 10 Permit ? Isolated Wetland Permit from DWQ
Q 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: 13
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
Applicant Information
F@EWR P
1. Owner/ApplicantInformation ? SEP 2 9 ZUUb
Name: A b et s r f a r m Plo M e n a we r s ' As.ro c: q 'r.'ow
Mailin Address: G/o A%) Veaver DENR-WATER QUALITY
SO O.r R? ?,?A M W ns d Trn ?
Gree,,A,,. ide_ )11W
Telephone Number: (331) a 9't- /633 Fax Number:
E-mail Address: Pin weaver 0 6e//.rawhk wet
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
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: 14 d angs Farf. L4 ke Qyw/c Jfa S:1. z4 %a?
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): S6- IS'3S7 91
4. Location
County: GtJIT-rd Nearest Town: Gree.Aaro
Subdivision name (include phase/lot number): A s ,,,,1 Farm
Directions to site (include road numbers, landmarks, etc.): /1:;1, P..-,j+ Rd 4. A4ack4., /el
dhI W.We a e&MLe C<<^M ? /ckc ?t? ?a G1"kQ1A1e
a
5. Site coordinates, if available (UTM or Lat/Long): Yc,bM o? -1C),9Cq0
(1 RW-' I SIRMFV4 suFh U DU?EPIU)Vity line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): L 4 ke :c ,Ppro -t1 l7 a cr s ;A1 f'z t
7. Nearest body of water (stream/river/sound/ocean/lake): ffd?MJ Firm LJU.1801 kh,? creek
River Basin: r aoa ?'` ,,F
(1 RW- *Is p usV1Fe gQe RI North C olina's seventeen designated major river basins.
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
The
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Tl,e p rj?e c* -r:4 rugs r ? f JU /« ke 4.,4k r •,d -dx ward
-
eNd J f4c ISke T^e 4,yperf?v shrrutiN? Nc 'V4e l&ke E1eW?1,.1t7 [PXWrf of.r"451t,
E?v?,Pr 4 G&14aNJe w' k ,2o.1 u,/j +ecourf,t cwd a rPs/esf?fe of 'oe
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used: At p?det? L..,a, f,
--F 4-1 _ -1., . _ d F . /re._tl.. -r., -.14-1 51-1f- rlI../n11 s.2e /B?XR~) 4/o•?i f/ Q.
w4 //

M..0 bwt .4;11 6e r.4 . I tit w..u w:11 vary iN herd nr `Kt 70 V..rranrcr+ .r ".•Jar or VJ.6CO .a..a -
11. Explain the purpose of the proposed work: I f
6r 7 1.01 Crt f eJ ?P 4I t.ul Pr -11.r JOo s f,/C /a/cc C-NJ .I foh(C4 414 un1c/6iM1„1e e A c
?r
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. rr J I
A pLr,, 4- A, e- rek,l 11 e C-wcrer/te J?/lu/4V o? fl,? dtro. 41 714 1.?PJr(!r-, PA
0f At. La KC .i4.1 iJJ. eJ rr 300.? k/f Ccnr .nf• fVd 4'4t_ P? rw b?U /c 1.4+Z..rc t4e 141AC6 vNJ
.? claftJ
Ow(L •?4Mb14
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 1ap?pflication.
'V t. W)IJA eVPwr?h4 ///t't 7l0 INK'S I .r'A-/4 "//r Gre4N6 •10 MOtO If -?We /4/Ce.
6 ei<. it Nol 6t t irClti.lPel -J 771id q?plital?ruN le-t.1-1e W( e,-W;4 C.?,j QX4td/y 1AACr7
use w?,, 1 Li /;lce 'fo Ne)at e/A(t . 94'f I .re a {iV ? 1 .,F w4 ff
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
To041.1$ d'!W#019,d(g.le (del..rAe Pxposea Mal P'le) ,,:// 4t XI-,.fei .?.41. o Min/; f-"VOfo .,
1. Provide a written description of the proposed impacts: LL prelwce J jv e <<M 4"'-dtr eu^A
of4lo. t%eof &?4 -.// work Lw 'forrled wl„It r/u .4r,- 'a ?c?J-?? over r weir me,,-4 No
04e af' ,, ( r ak 0r Q.11 R.oj Cie . Trl ? ? L .l -n/'h -46, &C
C Go..c.(trcw [yy.J oT W4//.r ApLjd knvc 4 &Lf?iv0 imp.,, A ? -tAC AkC art ?•?l/ ?r,r/ ?let?c.
2. Individually list wetland impacts below:
Wetland Impact
Site Number
(ind' ate on ma
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
(linear feet
Type of Wetland***
?i

* List each impact separately and identify temporary impacts. Impacts include, but are not imutea to: mechanized clearing, grdatng, 1111,
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 0 anagement AgenLy's (FEO A) Flood Insurance Rate Maps
1TIRMF, or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://wtivw.fema.gov.
*** List a wetland type that best describes wetland to be impacted Fe.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.F Indicate if wetland is isolated Fdetermination of isolation to be made by USACE onlyF.
List the total acreage (estimated) of all existing wetlands on the property: 40
Total area of wetland impact proposed: 0
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
(linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
(please seci

* List each impact separately and identify temporary impacts. Impacts include, but are not limttea to: culverts ana assoctateu np-rap,
dams Fseparately list impacts due to both structure and floodingF,, relocation Enclude linear feet before and after, and net loss/gainF,
stabilization activities Rement wall, rip-rap, crib wall, gabions, etc.F, 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 tributaryFto the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.eov. Several intemet sites also allow direct download and printing of USGS maps R.g., wwwtonozonexom,
wwryv.mapouest.com, ete.F.
Cumulative impacts (linear distance in feet) to all streams on site: 0
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.
IA&i(F +t Exc? •f; 0. oS A2r,M r F9r L4 ke L /c
(.I( a I.' 4 Wr U 0.07 e V r l.ce C L ak

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
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., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
TAe 14ke. level w'/i At lc/n./ ?(c 14- of 'nc d,M e?V'FI.,.? WPer dtc:,%c w.It u,.J?rtiG1??y? ?yyo/I NI;?I,;?q?Le
l.e w,lk W.7/ ?e ??(td si%Sl?fl? er /Al /•+?t
ANY d.J 4r3Pd Jtd:,,P./f f,M P ?ftl: .•3 R.,il 2t., (reek_
,s 2e of erud:*r w4!lf 6Aert?t'- 4,44'11 4e /'n C •Ut4rl?,?cc of /-/ct d4N/c.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the c ederal o egister on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. c actors
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 wetlani
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 r SACE or a t n to consider the application complete for processing. Any application
lacking a required mitigation plan or NCt o P concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in D: Q's Draft Technical Guide Ior Streap t ork in North Carolina, available at
hLtp://h2o.enr.state.nc.us/ncwetlands/stnngide.htmi.
N 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 Fattach directions
and/or map, if offsiteF, affected stream and river basin, type and amount Facreage/linear feetF
Of mitigation proposed Festoration, enhancement, creation, or preservationF, a plan view,
preservation mechanism Fe.g., deed restrictions, conservation easement, etc.F, and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
Ala ,?,f;«TiOJ A^vAdJe
2. Mitigation may also be made by payment into the North Carolina t etlands o estoration
Program INCt o PF. Please note it is the applicant's resSonsiFility to contact the NO RP at
I9NFTPP-1COUto determine availability and to request written approval of mitigation prior
to submittal of a PCN. c or additional information regarding the application process for the
NCt o PI check the NCt o P website at http://h2o.enr.state.nc.us/wEp/index.htm. If use of
the NCt o P is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested Hinear feetE
Amount of buffer mitigation requested Fsquare feetF.
Amount of o iparian wetland mitigation requested FacresF.
Amount of Non-riparian wetland mitigation requested FacresE
Amount of Coastal wetland mitigation requested FacresE
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 ?
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 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify lS g n/coc 3R •obJ"? )?
Yes [ No ? 'I yRu WVvered "yep', SrRyide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Miti ation
1 13 15 a- 3 919,74
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NC AC 2B.0242 or .0260. q y,
{`•Pcrlc ?/ ?N ? ?tJ?pfaTitlrJ Aid d,W,,,SPC Frp,_J W.11 ?C ?I?TCC W i•l G o?nrl:y Src.lJP.r_
J
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
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.
r-.
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No FA
Is this an after-the-fact permit application?
Yes F? No ?
XIV. 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
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DryJ:ar N° . 2
i
Office Use Only: Form Version May 2002
USACE Action ID No. DWQ No. 2 0 6 6 1 5 7 6
(If any particular item is not applicable to this project, please enter "Not Appucame or 1WA .)
I. Processing
1. Check all of the approval(s) requested for this project:
Q Section 404 Permit 0 Riparian or Watershed Buffer Rules
0 Section 10 Permit ? Isolated Wetland Permit from DWQ
0 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: 13
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), chec
II. Applicant Information EROWRM
SEP 2 9 2006
1. Owner/Applicant Information
Name: A Jam i FG r M Plo M e e a we rs /Is.ro c: y ;: o? a ?ENR WATER QUAt irv
'E7d -
Mailing Address: c/o P4o t?ewver ATER BRANCH
So or R. r,?a Mwaa 1 Tea'
6 re twA,r ? ,Je- l0407
Telephone Number: (331) d It-1633 Fax Number:
E-mail Address: pin idsuer be//roy?/. Wef
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:
E-mail Address:
Fax Number:
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: A d 4m-s Ly ke Q 4-rk lfh 6: 1. z 4 f%ow
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): S4 ' I SAS 7 91
4. Location
County: Gtiilf.rd Nearest Town: Gre ..,.slcro
Subdivision name (include phase/lot number): 4d,, -j Pc rM
Direct//ions /torr site (include road numbers, landmarks, etc.): //:L ?. &. /+ Rd 4. M44
4Y-
AI.JL R ! k P? ?[ Lt _J FI r_LVI XGiM / c,k,.,,- . #A MJ / G PIM PLf k..? L. 1p `(1? C/T,• «?
C44 Koti+e r jr.N« d4M , 1; k.e Se ?',rd C[.A?(f 1,Je
Site coordinates, if available (UTM or Lat/Long): 7tc? ?? -'T? a?0 ??
Q RW-' I SUIdFV4 OgEU suli? I3 DU UPpLN)W1ty line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): L 4 ke 'J r •W l 17 4 cr s : w J'z t
1. 1
7. Nearest body of water (stream/river/sound/ocean/lake): 4d4M r 44rM ??/u fQw// kh? creek
River Basin: r a oz
0 RW- V'Is p usVEe pq RI North C olina's seventeen designated major river basins
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
The
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: T ke 5 e yY -i: r?rs. ? ? of -Mt Im ke S.,Jk r V J -dx we r#
?l'n/S1? TriMt?Y
eMd J tke /,Ice. 74e AN?t?Y Jhr_ rV%W? -,7 -r4e /&1(f ?PIJP/G?(Y (0AIXIV of
{?v?.,pJ 4 c.IMd1,,,N,re w'?1. ,o,?l u,rJ ?'e?.Ji cok?f.r? cJa a rPs/es/-•?e e?'oe
Page 6of12
N r, rte
10. Describe the overall project in detail, including the type of equipment to be used: Tk e p?ae? c.
AT L., n/e LO_ .-/J . F r. ROL.t?OJ/. .re-C-O?4.1 Sla&,f rP ?olN rNt N/4II OIOCS_S•2e IpO•,J(6~ J V/ONR f'4e
.t
11.
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.
A pe.rM k A A e- rat Ae daM Al 7,4e t 1? 4Crl? PA
OT -KC 1AKC ./41 IIJHPJ 300). We tLN?nf ?i,id f4n_NcAUU/cr/c I•.r}I?C P (?J.4CE aNJ
?7
aWLL AA-A-SW •r c'al-PJ
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 Iapplication.
We wrh?c? CVPMFN?IIy IIfC? 70 ;".r l J M l4 rP ?LI'V "./C "/I, C. re4N6
11 i
14'1 Wrr/C if NOT C "-S 'Nchjed ?J 71'j yPfi[a?Cuw/ lecst.1e WC 4n, f k,,tl-? exit-' & -Acre
I
V?C I.Joh 1 II ?Ce 4v Aier f rA(C ocl J- *4-',,,,, I re c W1 //
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
we, li
srPtr?cuf?ir
it
Page 7 of 12
rC P/c[? C Diu u.?cIP?MI / /a 1C[
I k01 C/P rej t/Pr41 (-AI er r1 u.v -.%114 /O,.c 1'4t a/u &-2
fao?;.,y a?"v: de .r! ?oIB"deep Cselor?le Pxpo-zeJ MgJ 1'.4e) w'1I4e ex cw,fej --A? ,Nisi FX«vofor'
1. / Provide a written description of the proposed impacts: T?_pre.te.?ce J Ar- 6,M don.4tr ee,ot
of -kk{e. trodey' rwl all wyr.G r rLtneJ Wkile wa ,,4c. J 4a-%js oyu- 74C weir MenN'r NO
we $p.11 v qk or Q.11 R1?? C/P ?? a /?a Z 1 n -41(r &C
C LO,.C('rCC.ti7<'y,j o?r .14l /.r A oin (d AavC 4 Po fl lk Ve I M pit 1 W Ae 1A kC &4 r -11 e,._ Uea, .
2. Individually list wetland impacts below:
Wetland Impact
Site Number
(ind' ate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
(es/no Distance to
Nearest Stream
(linear feet)
Type of Wetland***

* List each impact separately and identity temporary impacts. impacts mcitiae, out are not irrnrteu to: mccnacuLcu c.ca.u.g, r'.auu.g, iii.,
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 0 anagement Agenly's (FEO A) Flood Insurance Rate Maps
ffIItMF, or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http:/hvww.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.F Indicate if wetland is isolated Fdetermination of isolation to be made by USACE onlyF.
List the total acreage (estimated) of all existing wetlands on the property: do
Total area of wetland impact proposed: 0
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
(linear feet
Stream Name* * Average Width
of Stream
Before Impact Perennial or
Intermittent?
(please seci

* List each impact separately and identify temporary impacts. impacts mciuae, out are not imnneu to: curvrm auu a buc.aLcu ..y-.ap,
dams Fseparately list impacts due to both structure and floodingF, relocation Enclude linear feet before and after, and net loss/gainF,
stabilization activities Rement wall, rip-rap, crib wall, gabions, etc.F, 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 Emnamed tributaryFto the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.gov. Several internet sites also allow direct download and printing of USGS maps Fe.g., wwwjopozone.com,
www.mapouest.com, ete.F.
Cumulative impacts (linear distance in feet) to all streams on site:
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) e) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.
w..Il F-if 0. oS A&_. .c Fti. L41ce L
F:I! a wC-11 0.07 e F Le e Luk

" List each impact separately and identify temporary impacts. Impacts include, but are not tanned. to: tut, excavation, urcuging,
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., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
UQ lake lev ( w'11 If le Jew flc •g A of 11c C'AM evyFlo? wer•/
aNy d, c}tirled Jea,ra-f fe.M r-dtn'., Rkt/ 2c., Creek. Ike walk w,11 de 01-ced sltsk% ." At h4kc
S 2e of ero-Vey b,/4111 w1krrt er Autt'?Ic -/a /'M4 J /-/cc 44N/C
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the c ederal o egister on March 9I 20001 mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. c actors
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 wetlanj
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 r SACE or a t n to consider the application complete for processing. Any application
lacking a required mitigation plan or NCt o P concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in D: Q's Draft Technical Guide Ior Streap t ork in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/strmgide.html.
N 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 Fattach directions
and/or map, if offsiteFl affected stream and river basin, type and amount Facreage/linear feetF
of mitigation proposed restoration, enhancement, creation, or preservationF, a plan view,
preservation mechanism Fe.g., deed restrictions, conservation easement, etc.F, and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
Aropo.t e I
2. Mitigation may also be made by payment into the North Carolina t etlands o estoration
Program INCt o PF. Please note it is the applicant's resSonsiEility to contact the NO RP at
I9NFTPP-R20Uto determine availability and to request written approval of mitigation prior
to submittal of a PCN. c or additional information regarding the application process for the
NCt o PI check the NCt o P website at http://h2o.enr.state.ne.us/wrp/index.htm. If use of
the NCt o P is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested Hinear feetF.
Amount of buffer mitigation requested Fsquare feetF
Amount of o iparian wetland mitigation requested FacresF
Amount of Non-riparian wetland mitigation requested FacresF.
Amount of Coastal wetland mitigation requested FacresF
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 ?
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 2B .0259 (Tar-Pamlico), 15A NCAC 213 .0250 (Randleman Rules and
Water Supply uffer Requirements), or other (please identify /,fg "/C oc J-3 . ob ro )?
Yes 9 No ? 'I yRu DQVvered "ye)', SrIC&e the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 315 3 956
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Gone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
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If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCA C 2B .0242 or .02860. I /? y,
1 ?•?Sflt ?./ ?NTT? re-14-arc. Ru j ' AN d,Whr4ed ire,_r w:1 3e ?tµTCE 41 7 4 wrerf: d? tc.rfveP r
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
/?t uidlFlCAC lord ICYt.
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 2H.0500) or any Buffer Rules?
Yes ? No FA
Is this an after-the-fact permit application?
Yes 0 No ?
XIV. 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).
W M W 9? Z -7 106
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
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Office Use Only: Form Version May 2002
2o061576
USACE Action ID No. DWQ No.
1.
II.
(If any particular item is not applicable to this project, please enter " Not Appiicame or iN/A .?
Processing
1. Check all of the approval(s) requested for this project: Ilr[:-l?Ei?`D
Section 404 Permit 0 Riparian or Watershed Buffer Rules
Q Section 10 Permit ? Isolated Wetland Permit from DWQ
Q 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: 13
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
Applicant Information
F@EWR P
1. Owner/ApplicantInformation ? SEP 2 9 ZUUb
Name: A b et s r f a r m Plo M e n a we r s ' As.ro c: q 'r.'ow
Mailin Address: G/o A%) Veaver DENR-WATER QUALITY
SO O.r R? ?,?A M W ns d Trn ?
Gree,,A,,. ide_ )11W
Telephone Number: (331) a 9't- /633 Fax Number:
E-mail Address: Pin weaver 0 6e//.rawhk wet
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
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: 14 d angs Farf. L4 ke Qyw/c Jfa S:1. z4 %a?
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): S6- IS'3S7 91
4. Location
County: GtJIT-rd Nearest Town: Gree.Aaro
Subdivision name (include phase/lot number): A s ,,,,1 Farm
Directions to site (include road numbers, landmarks, etc.): /1:;1, P..-,j+ Rd 4. A4ack4., /el
dhI W.We a e&MLe C<<^M ? /ckc ?t? ?a G1"kQ1A1e
a
5. Site coordinates, if available (UTM or Lat/Long): Yc,bM o? -1C),9Cq0
(1 RW-' I SIRMFV4 suFh U DU?EPIU)Vity line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): L 4 ke :c ,Ppro -t1 l7 a cr s ;A1 f'z t
7. Nearest body of water (stream/river/sound/ocean/lake): ffd?MJ Firm LJU.1801 kh,? creek
River Basin: r aoa ?'` ,,F
(1 RW- *Is p usV1Fe gQe RI North C olina's seventeen designated major river basins.
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
The
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Tl,e p rj?e c* -r:4 rugs r ? f JU /« ke 4.,4k r •,d -dx ward
-
eNd J f4c ISke T^e 4,yperf?v shrrutiN? Nc 'V4e l&ke E1eW?1,.1t7 [PXWrf of.r"451t,
E?v?,Pr 4 G&14aNJe w' k ,2o.1 u,/j +ecourf,t cwd a rPs/esf?fe of 'oe
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used: At p?det? L..,a, f,
--F 4-1 _ -1., . _ d F . /re._tl.. -r., -.14-1 51-1f- rlI../n11 s.2e /B?XR~) 4/o•?i f/ Q.
w4 //

M..0 bwt .4;11 6e r.4 . I tit w..u w:11 vary iN herd nr `Kt 70 V..rranrcr+ .r ".•Jar or VJ.6CO .a..a -
11. Explain the purpose of the proposed work: I f
6r 7 1.01 Crt f eJ ?P 4I t.ul Pr -11.r JOo s f,/C /a/cc C-NJ .I foh(C4 414 un1c/6iM1„1e e A c
?r
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. rr J I
A pLr,, 4- A, e- rek,l 11 e C-wcrer/te J?/lu/4V o? fl,? dtro. 41 714 1.?PJr(!r-, PA
0f At. La KC .i4.1 iJJ. eJ rr 300.? k/f Ccnr .nf• fVd 4'4t_ P? rw b?U /c 1.4+Z..rc t4e 141AC6 vNJ
.? claftJ
Ow(L •?4Mb14
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 1ap?pflication.
'V t. W)IJA eVPwr?h4 ///t't 7l0 INK'S I .r'A-/4 "//r Gre4N6 •10 MOtO If -?We /4/Ce.
6 ei<. it Nol 6t t irClti.lPel -J 771id q?plital?ruN le-t.1-1e W( e,-W;4 C.?,j QX4td/y 1AACr7
use w?,, 1 Li /;lce 'fo Ne)at e/A(t . 94'f I .re a {iV ? 1 .,F w4 ff
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
To041.1$ d'!W#019,d(g.le (del..rAe Pxposea Mal P'le) ,,:// 4t XI-,.fei .?.41. o Min/; f-"VOfo .,
1. Provide a written description of the proposed impacts: LL prelwce J jv e <<M 4"'-dtr eu^A
of4lo. t%eof &?4 -.// work Lw 'forrled wl„It r/u .4r,- 'a ?c?J-?? over r weir me,,-4 No
04e af' ,, ( r ak 0r Q.11 R.oj Cie . Trl ? ? L .l -n/'h -46, &C
C Go..c.(trcw [yy.J oT W4//.r ApLjd knvc 4 &Lf?iv0 imp.,, A ? -tAC AkC art ?•?l/ ?r,r/ ?let?c.
2. Individually list wetland impacts below:
Wetland Impact
Site Number
(ind' ate on ma
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
(linear feet
Type of Wetland***
?i

* List each impact separately and identify temporary impacts. Impacts include, but are not imutea to: mechanized clearing, grdatng, 1111,
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 0 anagement AgenLy's (FEO A) Flood Insurance Rate Maps
1TIRMF, or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://wtivw.fema.gov.
*** List a wetland type that best describes wetland to be impacted Fe.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.F Indicate if wetland is isolated Fdetermination of isolation to be made by USACE onlyF.
List the total acreage (estimated) of all existing wetlands on the property: 40
Total area of wetland impact proposed: 0
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
(linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
(please seci

* List each impact separately and identify temporary impacts. Impacts include, but are not limttea to: culverts ana assoctateu np-rap,
dams Fseparately list impacts due to both structure and floodingF,, relocation Enclude linear feet before and after, and net loss/gainF,
stabilization activities Rement wall, rip-rap, crib wall, gabions, etc.F, 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 tributaryFto the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.eov. Several intemet sites also allow direct download and printing of USGS maps R.g., wwwtonozonexom,
wwryv.mapouest.com, ete.F.
Cumulative impacts (linear distance in feet) to all streams on site: 0
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.
IA&i(F +t Exc? •f; 0. oS A2r,M r F9r L4 ke L /c
(.I( a I.' 4 Wr U 0.07 e V r l.ce C L ak

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
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., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
TAe 14ke. level w'/i At lc/n./ ?(c 14- of 'nc d,M e?V'FI.,.? WPer dtc:,%c w.It u,.J?rtiG1??y? ?yyo/I NI;?I,;?q?Le
l.e w,lk W.7/ ?e ??(td si%Sl?fl? er /Al /•+?t
ANY d.J 4r3Pd Jtd:,,P./f f,M P ?ftl: .•3 R.,il 2t., (reek_
,s 2e of erud:*r w4!lf 6Aert?t'- 4,44'11 4e /'n C •Ut4rl?,?cc of /-/ct d4N/c.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the c ederal o egister on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. c actors
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 wetlani
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 r SACE or a t n to consider the application complete for processing. Any application
lacking a required mitigation plan or NCt o P concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in D: Q's Draft Technical Guide Ior Streap t ork in North Carolina, available at
hLtp://h2o.enr.state.nc.us/ncwetlands/stnngide.htmi.
N 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 Fattach directions
and/or map, if offsiteF, affected stream and river basin, type and amount Facreage/linear feetF
Of mitigation proposed Festoration, enhancement, creation, or preservationF, a plan view,
preservation mechanism Fe.g., deed restrictions, conservation easement, etc.F, and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
Ala ,?,f;«TiOJ A^vAdJe
2. Mitigation may also be made by payment into the North Carolina t etlands o estoration
Program INCt o PF. Please note it is the applicant's resSonsiFility to contact the NO RP at
I9NFTPP-1COUto determine availability and to request written approval of mitigation prior
to submittal of a PCN. c or additional information regarding the application process for the
NCt o PI check the NCt o P website at http://h2o.enr.state.nc.us/wEp/index.htm. If use of
the NCt o P is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested Hinear feetE
Amount of buffer mitigation requested Fsquare feetF.
Amount of o iparian wetland mitigation requested FacresF.
Amount of Non-riparian wetland mitigation requested FacresE
Amount of Coastal wetland mitigation requested FacresE
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 ?
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 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify lS g n/coc 3R •obJ"? )?
Yes [ No ? 'I yRu WVvered "yep', SrRyide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Miti ation
1 13 15 a- 3 919,74
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NC AC 2B.0242 or .0260. q y,
{`•Pcrlc ?/ ?N ? ?tJ?pfaTitlrJ Aid d,W,,,SPC Frp,_J W.11 ?C ?I?TCC W i•l G o?nrl:y Src.lJP.r_
J
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
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.
r-.
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No FA
Is this an after-the-fact permit application?
Yes F? No ?
XIV. 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
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DryJ:ar N° . 2
'.MiSFARM COMMUNUYA SO N
NC Division of Water Quality
Date Type Reference
10/12/2006 Bill
10/12/2006
Original Amt. Balance Due Discount
200.00 200.00
Check Amount
2656
Payment
200.00
200.00
Wachovia - Comm. Checki Adams Farni Lake Retaining Wall Project 200.00