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Pre-Construction Notirication (PCN) Application Form
For Section 404 and/or Section l0 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USAGE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
viwx,v.saw.usace.qLrny.mil/wetlands/Permits.html.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at www.saw.usace.gM.mil/wetlands/index.html, or contact one of the field offices
listed on page 3 of this application. The website also lists the responsible project manager for each
county in North Carolina and provides additional information regarding the identification and regulation
of wetlands and waters of the U.S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USAGE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://h2o.enr.state.nc.us/newetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for General Certifications is not required, provided
that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet should
contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on page 4 of this application) prior to submittal of the application.
Page 1 of 13
Coastal Area Management Act (CAMA) Coordination - If the project occurs in any of North Carolina's
twenty coastal counties (listed on page 4) the applicant should contact the North Carolina Division of
Coastal Management (DCM). DCM will determine whether or not the project is within a designated
Area of Environmental Concern, in which case DCM will act as the lead permitting agency. In such
cases, DCM will require a CAMA Permit and will coordinate the 404/401 Permits.
The applicant may also choose to coordinate with the United States Fish and Wildlife Service to ensure
that the proposed project will have no impact upon any endangered or threatened species or critical
habitat as regulated by the Endangered Species Act, and the State Historic Preservation Office, North
Carolina Department of Cultural Resources to ensure that the proposed project will have no impact upon
any properties listed or eligible for listing on the National Register of Historic Places. Compliance with
these regulations is required to be eligible for any Department of the Army permit. The addresses for
both agencies are listed on page 3 of this application.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office. Upon receipt of an application, the
USACE will determine if the application is complete as soon as possible, not to exceed 30 days. This
PCN form is designed for the convenience of the applicant to address information needs for all USACE
Nationwide, Regional or General permits, as well as information required for State authorizations,
certifications, and coordination. Fully providing the information requested on this form will result in a
complete application for any of the USACE Nationwide, Regional or General permits. To review the
minimum amount of information that must be provided for a complete PCN for each USACE
Nationwide permit, see Condition 13, 67 Fed. Reg. 2090 (Jan. 15, 2002), available at
httn://w-",rw.usace.ariny.mil/inet/functions/cw/cecwo/reg/200- vps pdf. Processing times vary by
permit and begin once the application has been determined to be complete. Please contact the
appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at hgp://h2o.ebnr.state.nc.us/ncwetlands/fees.html. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 13
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Caldwell Haywood McDowell Swain
US Army Corps of Engineers Alleghany Catawba Henderson Mecklenburg Transylvania
151 Patton Avenue Ashe Cherokee Iredell Mitchell Union
Room 208 Avery Clay Jackson Polk Watauga
Asheville, NC 28801-5006 Buncombe Cleveland Lincoln Rowan Yancey
Telephone: [phone] Burke Gaston Macon Rutherford
Fax: [phone] Cabarrus Graham Madison Stanley
Raleigh Regulatory Field Office Alamance Franklin Nash Surry
US Army Corps Of Engineers Caswell Forsyth Northampton Vance
6508 Falls of the Neuse Road Chatham Granville Orange Wake
Suite 120 Davidson Guilford Person Warren
Raleigh, NC 27615 Davie Halifax Randolph Wilkes
Telephone: [phone] Durham Johnston Rockingham Wilson
Fax: [phone] Edgecombe Lee Stokes Yadkin
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers Bertie Dare Lenoir Tyrrell
Post Office Box 1000 Camden Gates Martin Washington
Washington, NC 27889-1000 Carteret* Green Pamlico Wayne
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans *Croatan National Forest Only
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
North Carolina State Agencies
Division of Water Quality
Ecosystem Enhancement Program
1652 Mail Service Center
Raleigh, NC 27699-1652
Telephone: [phone]
Fax: [phone]
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
Telephone: [phone]
Fax: [phone]
US Fish and Wildlife Service / National Marine Fisheries Service
US Fish and Wildlife Service US Fish and Wildlife Service National Marine Fisheries Service
Raleigh Field Office Asheville Field Office Habitat Conservation Division
Post Office Box 33726 160 Zillicoa Street Pivers Island
Raleigh, NC 27636-3726 Asheville, NC 28801 Beaufort, NC 28516
Telephone: [phone] Telephone: [phone] Telephone: [phone]
Page 3 of 13
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator
3855 Idlewild Road
Kernersville, NC 27284-9180
Telephone: [phone]
Mountain Region Coordinator
20830 Great Smoky Mtn. Expressway
Waynesville, NC 28786
Telephone: [phone]
Fax: [phone]
Alleghany Caldwell
Ashe Mitchell
Avery Stokes
Burke Surry
Buncombe Henderson
Cherokee Jackson
Clay Macon
Graham Madison
Haywood McDowell
Watauga
Wilkes
Polk
Rutherford
Swain
Transylvania
Yancey
APPLICATION FORM BEGINS ON PAGE 5. PLEASE DO NOT SUBMIT PAGES 1- 4.
Page 4 of 13
1. Provide a written description of the proposed impacts: to place a culvert within an
intermittent stream (no greater than 30 linear feet) and buried at the most of 1 ft. for any
aquatic life passage or 20% of the diameter. No inlet or outlet protection is to be placed.
2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
separately list impacts due to both structure and flooding.
3.
Wetland Impact
Site Number
(indicate on map)
Type of Impact Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.) Located within
100-year
Floodplain
es/no) Distance to
Nearest
Stream
(linear feet) Area of
Impact
(acres)
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A
Total Wetland Impact (acres) N/A
4. List the total acreage (estimated) of all existing wetlands on the property: N/A
5. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
must be included. To calculate acreage, multiply length X width, then divide by 43,560.
Stream Impact
Number
(indicate on map)
Stream Name
Type of Impact
Intermittent? t?
mittent. Average
Stream Width
Before Impact Impact
Length
(linear feet) Area of
Impact
(acres)
1 UT to Moccasin
Creek Culvert Intermittent 1-2 ft. 301n. ft. 60 sq, ft.

Total Stream Impact (by length and acreage) 301n. ft. 60 sq.ft.
6. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, dredging, flooding, drainage, bulkheads, etc.
Page 8 of 13
Open Water Impact Name of Waterbody Type of Waterbody Area of
Site Number (if applicable) Type of Impact (lake, pond, estuary, sound, bay, Impact
(indicate on ma) ocean, etc.) (acres)
N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A
Total Open Water Impact (acres) N/A
7. List the cumulative impact to all Waters of the U.S. resulting from the project:
Stream Impact (acres): .001 ac.
Wetland Impact (acres): N/A
Open Water Impact (acres): N/A
Total Impact to Waters of the U.S. (acres) .001 ac.
Total Stream Impact (linear feet): 301n. ft.
8. Isolated Waters
Do any isolated waters exist on the property? ? Yes X No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.
N/A
9. 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 applies): N/A uplands N/A stream N/A wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): N/A
Current land use in the vicinity of the pond:
Size of watershed draining to pond: N/A Expected pond surface area: N/A
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. This is the only way that I
could gain access to the my property by buying the easement that intersects this stream. minimal
clearing will be done
VIII. Mitigation
Page 9 of 13
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on January 15, 2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/strmgide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
N/A
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at http://h2o.enr.state.nc.us/wrp/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:
Amount of stream mitigation requested (linear feet): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres) _N/A
Page 10 of 13
IX. Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ? No X
2. If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/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 X
3. If yes, has the document review been finalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SEPA final approval letter. Yes ? No X
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.
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify V Yes X No ?
2. If "yes", 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 1800 3 (2 for Catawba) N/A
2 1200 1.5 N/A
Total 3000 N/A
* Zone I extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration / Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B.0242 or.0244, or.0260. N/A
Page 11 of 13
XI. Stormwater (required by DWQ)
Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss
stormwater controls proposed in order to protect surface waters and wetlands downstream from
the property. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. N/A
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.
Septic field for House
XM. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes [] No X
Is this an after-the-fact permit application? Yes ? No X
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ? No 2
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
http://h2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative descriptionN/A
XV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).

Page 12 of 13
_z3 _o?f-
Applicant/Agent's
(Agent's signature is valid only if an
Date
letter from the applicant is provided.)
Page 13 of 13

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Pre-Construction Notification (PCN) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
www. saw.usace.g.M.mil/wetlands/Permits.html .
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at www.saw.usace.gM.mil/wetlands/index.html, or contact one of the field offices
listed on page 3 of this application. The website also lists the responsible project manager for each
county in North Carolina and provides additional information regarding the identification and regulation
of wetlands and waters of the U.S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://h2o.enr.state.nc.us/ncwetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for General Certifications is not required, provided
that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet should
contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on page 4 of this application) prior to submittal of the application.
E 2@r M p
Page 1 of 13 DEC 2 8 2005
WETL ANDS AND STQRMWAUERRTEIBRANCH
Coastal Area Management Act (CAMA) Coordination - If the project occurs in any of North Carolina's
twenty coastal counties (listed on page 4) the applicant should contact the North Carolina Division of
Coastal Management (DCM). DCM will determine whether or not the project is within a designated
Area of Environmental Concern, in which case DCM will act as the lead permitting agency. In such
cases, DCM will require a CAMA Permit and will coordinate the 404/401 Permits.
The applicant may also choose to coordinate with the United States Fish and Wildlife Service to ensure
that the proposed project will have no impact upon any endangered or threatened species or critical
habitat as regulated by the Endangered Species Act, and the State Historic Preservation Office, North
Carolina Department of Cultural Resources to ensure that the proposed project will have no impact upon
any properties listed or eligible for listing on the National Register of Historic Places. Compliance with
these regulations is required to be eligible for any Department of the Army permit. The addresses for
both agencies are listed on page 3 of this application.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office. Upon receipt of an application, the
USACE will determine if the application is complete as soon as possible, not to exceed 30 days. This
PCN form is designed for the convenience of the applicant to address information needs for all USACE
Nationwide, Regional or General permits, as well as information required for State authorizations,
certifications, and coordination. Fully providing the information requested on this form will result in a
complete application for any of the USACE Nationwide, Regional or General permits. To review the
minimum amount of information that must be provided for a complete PCN for each USACE
Nationwide permit, see Condition 13, 67 Fed. Reg. 2090 (Jan. 15, 2002), available at
http://www.usace.army.mil/inet/functions/cw/cecwo/reg/2002nwps.pdf. Processing times vary by
permit and begin once the application has been determined to be complete. Please contact the
appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at http://h2o.ehnr.state.ne.us/newetlands/fees.html. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 13
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Caldwell Haywood McDowell
US Army Corps of Engineers Alleghany Catawba Henderson Mecklenburg
151 Patton Avenue Ashe Cherokee Iredell Mitchell
Room 208 Avery Clay Jackson Polk
Asheville, NC 28801-5006 Buncombe Cleveland Lincoln Rowan
Telephone: [phone] Burke Gaston Macon Rutherford
Fax: [phone] Cabarrus Graham Madison Stanley
Raleigh Regulatory Field Office Alamance Franklin Nash Surry
US Army Corps Of Engineers Caswell Forsyth Northampton Vance
6508 Falls of the Neuse Road Chatham Granville Orange Wake
Suite 120 Davidson Guilford Person Warren
Raleigh, NC 27615 Davie Halifax Randolph Wilkes
Telephone: [phone] Durham Johnston Rockingham Wilson
Fax: [phone] Edgecombe Lee Stokes Yadkin
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
North Carolina State Agencies
Division of Water Quality Division of Water Quality
401 Wetlands Unit Ecosystem Enhancement Program
1650 Mail Service Center 1652 Mail Service Center
Raleigh, NC 27699-1650 Raleigh, NC 27699-1652
Telephone: [phone] Telephone: [phone]
Fax: [phone] Fax: [phone]
US Fis
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
h and Wildlife Service / National M
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
Pitt
Tyrrell
Washington
Wayne
Swain
Transylvania
Union
Watauga
Yancey
*Croatan National Forest Only
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
Telephone: [phone]
Fax: [phone]
[arine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivers Island
Beaufort, NC 28516
Telephone: [phone]
Page 3 of 13
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax. [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kernersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
APPLICATION FORM BEGINS ON PAGE 5. PLEASE DO NOT SUBMIT PAGES 1- 4.
Page 4 of 13
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UTM 17 741841E 3977770N (WGS84/NAD8.
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Office Use Only: Form Version March 05
20000
USACE Action ID No. DWQ No. 0 6 7
kir any parncuiar item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. Processing
1. Check all of the approval(s) requested for this project:
X Section 404 Permit X Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
X 401 Water Quality Certification ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NW39, Tar-Pamlico Buffer
Authorization Need Buffer Authorization
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ® Only for NW 39, less than 150 linear feet.
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: N/A
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: N/A
II. Applicant Information 219@R0Yg@
1. Owner/Applicant Information Name: Mr. Donald Hathawa DEC 2 8 20005
Mailing Address: \.tGu _ nv P \1 Lr i v-? P DENQ
q- 5&-657
Telephone Number: ce114 919-880-7082 Fax Number: N/A
E-mail Address:
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: N/A
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
Page 5 of 13
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: Donald Hathaway Residential Drivewa
2. T.I.P. Project Number or State Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): 2708-19-7640,2708-18-4466(easement)
4. Location
County: Franklin Nearest Town: Pearces
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers/names, landmarks, etc.): Site is located off of Pilot
Riley Rd NC.
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum): 3977770 ON 741841 °E
UTM 17
6. Property size (acres): 12 AC. + A.59 AC (easement)
7. Name of nearest receiving body of water: UT to Moccasin Creek
8. River Basin:-Tar-Pamlico River Basin
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.eiir.state.nc.us/admin/mgps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Residential and Agriculture Subject area consist of
Wooded within the easement and open field for building lot
Page 6 of 13
10. Describe the overall project in detail, including the type of equipment to be used: to install
a driveway crossing to gain access to my property so that I may build a single family
residence, typical equipment used to install culvert(backhoe dumb truck and maybe a
bobcat)
11. Explain the purpose of the proposed work: to install a driveway crossing to gain access to
my property so that I may build a single family residence
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.-_Michael Horan of DWO, (Raleigh Regional Office) met on site for
Buffer Determination. I also met with Eric Alsmeyer of the US Army Corps of Engineers
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
(Required building permits for house) no wetlands or surface waters will be impacted with the
building of the house
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts are proposed to these systems.
Wetland and stream evaluation and delineation forms should be included as appropriate.
Photographs may be included at the applicant's discretion. If this proposed impact is strictly for
wetland or stream mitigation, list and describe the impact in Section VIII below. If additional
space is needed for listing or description, please attach a separate sheet.
Page 7 of 13
1. Provide a written description of the proposed impacts: to place a culvert within an
intermittent stream (no greater than 30 linear feet) and buried at the most of 1 ft for any
aquatic life passage or 20% of the diameter. No inlet or outlet protection is to be placed
2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
separately list impacts due to both structure and flooding.
3.
Wetland Impact
Site Number

(indicate on map)
Type of Impact Type of Wetland
(e.g., forested, marsh
,
herbaceous, bog, etc.) Located within
100-year

Floodplain
es/no) Distance to
Nearest

Stream
(linear feet) Area of
Impact

(acres)
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A
Total Wetland Impact (acres) N/A
4. List the total acreage (estimated) of all existing wetlands on the property: N/A
5. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
must be included. To calculate acreage, multiply length X width, then divide by 43,560.
Stream Impact
Number
(indicate onmap)
Stream Name
Type of Impact
Perennial or
Intermittent? Average
Stream Width
Before Impact Impact
Length
(linear feet) Area of
Impact
(acres)
1 UT toCM ccasin Culvert Intermittent 1-2 ft. 30 in, ft. 60 sq. ft.

Total Stream Impact (by length and acreage) 30 In. ft. 60 sq.fY.
6. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, dredging, flooding, drainage, bulkheads, etc.
Page 8 of 13
Open Water Impact
Site Number
(indicate on ma) Name of Waterbody
(if applicable)
Type of Impact Type of Waterbody
(lake, pond, estuary, sound, bay,
ocean, etc.) Area of
Impact
(acres)
N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A
Total Open Water Impact (acres) N/A
7. List the cumulative impact to all Waters of the U.S. resulting from the nroiect:
Stream Impact (acres): .001 ac.
Wetland Impact (acres): N/A
Open Water Impact (acres): N/A
Total Impact to Waters of the U.S. (acres) .001 ac.
Total Stream Impact (linear feet): 301n. ft.
8. Isolated Waters
Do any isolated waters exist on the property? ? Yes X No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.
N/A
9. 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 applies): N/A uplands N/A stream N/A wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): N/A
Current land use in the vicinity of the pond:
Size of watershed draining to pond: N/A Expected pond surface area: N/A
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. This is the only way that I
could gain access to the my property by buying the easement that intersects this stream minimal
clearina will be done
VIII. Mitigation
Page 9 of 13
DWQ - In accordance with 15A NCAC 2H .0500 mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on January 15, 2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
littp://h2o.enr.state.nc.us/ncwetlands/stitngide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
N/A
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at http://h2o.enr.state.n.c.us/wrp/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:
Amount of stream mitigation requested (linear feet): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
Page 10 of 13
IX. Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ? No X
2. If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/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 X
3. If yes, has the document review been finalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SEPA final approval letter. Yes ? No X
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.
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify )? Yes X No ?
2. If "yes", 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
(s uare feet) Multiplier Required
Miti Lion
1 1800 3 (2 for Catawba) N/A
2 1200 1.5 N/A
'total 3000 N/A
Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration / Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B .0242 or.0244, or .0260. N/A
Page 11 of 13
XI. Stormwater (required by DWQ)
Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss
stormwater controls proposed in order to protect surface waters and wetlands downstream from
the property. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. N/A
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.
Septic field for House
3M. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No X
Is this an after-the-fact permit application? Yes ? No X
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ? No D?
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
1-ittp://h2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative descriptionN/A
XV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).

Page 12 of 13

Applicant/Agent's Signatui
(Agent's signature is valid only if an
Date
letter from the applicant is provided.)
Page 13 of 13
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Map/Photo Info UTM 17 741841E 3977770N`(WGS84/NAD8.
Topo Download USGS Bunn West Quad
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DEC 2 8
DENR - WATER QUALITY
WETLANDS AND STORMWATER BRANCH

Pre-Construction Notification (PCN) Application Form
,2
ZC ?
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
www.saw.usace.airny.mil/wetlands/Pertnits.htmi.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at Nkww.saw.usace.gM.mil/wetlands/index.html, or contact one of the field offices
listed on page 3 of this application. The website also lists the responsible project manager for each
county in North Carolina and provides additional information regarding the identification and regulation
of wetlands and waters of the U.S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://h2o.enr.state.nc.us/newetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for General Certifications is not required, provided
that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet should
contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on page 4 of this application) prior to submittal of the application.
Page 1 of 13
Coastal Area Management Act (CAMA) Coordination - If the project occurs in any of North Carolina's
twenty coastal counties (listed on page 4) the applicant should contact the North Carolina Division of
Coastal Management (DCM). DCM will determine whether or not the project is within a designated
Area of Environmental Concern, in which case DCM will act as the lead permitting agency. In such
cases, DCM will require a CAMA Permit and will coordinate the 404/401 Permits.
The applicant may also choose to coordinate with the United States Fish and Wildlife Service to ensure
that the proposed project will have no impact upon any endangered or threatened species or critical
habitat as regulated by the Endangered Species Act, and the State Historic Preservation Office, North
Carolina Department of Cultural Resources to ensure that the proposed project will have no impact upon
any properties listed or eligible for listing on the National Register of Historic Places. Compliance with
these regulations is required to be eligible for any Department of the Army permit. The addresses for
both agencies are listed on page 3 of this application.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office. Upon receipt of an application, the
USACE will determine if the application is complete as soon as possible, not to exceed 30 days. This
PCN form is designed for the convenience of the applicant to address information needs for all USACE
Nationwide, Regional or General permits, as well as information required for State authorizations,
certifications, and coordination. Fully providing the information requested on this form will result in a
complete application for any of the USACE Nationwide, Regional or General permits. To review the
minimum amount of information that must be provided for a complete PCN for each USACE
Nationwide permit, see Condition 13, 67 Fed. Reg. 2090 (Jan. 15, 2002), available at
http://www.usace.ai-my.mil/inet/functions/cw/cecwo/reg/2002nwps pdf. Processing times vary by
permit and begin once the application has been determined to be complete. Please contact the
appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at htip://h2o.ehnr.state.nc.us/newetlands/fees.html. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 13
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Caldwell Haywood McDowell Swain
US Army Corps of Engineers Alleghany Catawba Henderson Mecklenburg Transylvania
151 Patton Avenue Ashe Cherokee Iredell Mitchell Union
Room 208 Avery Clay Jackson Polk Watauga
Asheville, NC 28801-5006 Buncombe Cleveland Lincoln Rowan Yancey
Telephone: [phone] Burke Gaston Macon Rutherford
Fax: [phone] Cabarrus Graham Madison Stanley
Raleigh Regulatory Field Office Alamance Franklin Nash Surry
US Army Corps Of Engineers Caswell Forsyth Northampton Vance
6508 Falls of the Neuse Road Chatham Granville Orange Wake
Suite 120 Davidson Guilford Person Warren
Raleigh, NC 27615 Davie Halifax Randolph Wilkes
Telephone: [phone] Durham Johnston Rockingham Wilson
Fax: [phone] Edgecombe Lee Stokes Yadkin
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers Bertie Dare Lenoir Tyrrell
Post Office Box 1000 Camden Gates Martin Washington
Washington, NC 27889-1000 Carteret* Green Pamlico Wayne
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans *Croatan National Forest Only
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
North Carolina State Agencies
Division of Water Quality
Ecosystem Enhancement Program
1652 Mail Service Center
Raleigh, NC 27699-1652
Telephone: [phone]
Fax: [phone]
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
Telephone: [phone]
Fax: [phone]
US Fish and Wildlife Service / National Marine Fisheries Service
US Fish and Wildlife Service US Fish and Wildlife Service National Marine Fisheries Service
Raleigh Field Office Asheville Field Office Habitat Conservation Division
Post Office Box 33726 160 Zillicoa Street Pivers Island
Raleigh, NC 27636-3726 Asheville, NC 28801 Beaufort, NC 28516
Telephone: [phone] Telephone: [phone] Telephone: [phone]
Page 3 of 13
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kernersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
APPLICATION FORM BEGINS ON PAGE 5. PLEASE DO NOT SUBMIT PAGES I - 4.
Page 4 of 13
Office Use Only: Form Version March 05
USACE Action ID No. DWQ No. 2 0 0 6 0 0 0 7
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. Processing
1. Check all of the approval(s) requested for this project:
X Section 404 Permit X Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
X 401 Water Quality Certification ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NW39, Tar-Pamlico Buffer
Authorization Need Buffer Authorization
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ® Only for NW 39, less than 150 linear feet.
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: N/A
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), the OM? O
II. Applicant Information V
1. Owner/Applicant Information
DEC 2 8 2005
Name: Mr. Donald Hathawa
Mailing Address: I WETLANDS Iwo StmmAm BRANCH
1-c2& & - -7 657
Telephone Number: ce114 919-880-7082 Fax Number: N/A
E-mail Address:
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: N/A
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 13
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: Donald Hathaway Residential Driveway
2. T.I.P. Project Number or State Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): 2708-19-7640,2708-18-4466(easement)
4. Location
County: Franklin Nearest Town: Pearces
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers/names, landmarks, etc.): Site is located off of Pilot
Riley Rd NC.
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum): 3977770 ON 741841 °E
UTM 17
6. Property size (acres): 12 AC. + 1..59 AC (easement)
7. Name of nearest receiving body of water: UT to Moccasin Creek
8. River Basin: Tar-Pamlico River Basin
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available athttp://h2o.enr.state.n.c.us/admin/mgp,--it/.'),
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application:Residential and Agriculture Subject area consist of
Wooded within the easement and open field for building lot
Page 6 of 13
10. Describe the overall project in detail, including the type of equipment to be used: to install
a driveway crossing to gain access to my property so that I may build a single family
residence, typical equipment used to install culvert(backhoe dump truck and maybe a
bobcat)
11. Explain the purpose of the proposed work: to install a driveway crossing to gain access to
my property so that I may build a single family residence
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. Michael Horan of DWQ, (Raleigh Regional Office) met on site for
Buffer Determination. I also met with Eric Alsmeyer of the US Army Corps of Engineers
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
(Required building permits for house) no wetlands or surface waters will be impacted with the
building of the house
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts are proposed to these systems.
Wetland and stream evaluation and delineation forms should be included as appropriate.
Photographs may be included at the applicant's discretion. If this proposed impact is strictly for
wetland or stream mitigation, list and describe the impact in Section VIII below. If additional
space is needed for listing or description, please attach a separate sheet.
Page 7 of 13
1. Provide a written description of the proposed impacts: to place a culvert within an
intermittent stream (no greater than 30 linear feet) and buried at the most of 1 ft for any
aquatic life passage or 20% of the diameter. No inlet or outlet protection is to be placed.
2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditcbing/drainage, etc. For dams,
separately list impacts due to both structure and flooding.
3.
Wetland Impact
Site Number
(indicate on map)
Type of Impact Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.) Located within
100-year
Floodplain
es/no) Distance to
Nearest
Stream
(linear feet) Area of
Impact
(acres)
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A
Total Wetland Impact (acres) N/A
4. List the total acreage (estimated) of all existing wetlands on the property: N/A
5. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
must be included. To calculate acreage, multiply length X width, then divide by 43,560.
Stream Impact
Number
(indicate on ma)
Stream Name
Type of Impact
Perennial or
Intermittent? Average
Stream Width
Before Impact Impact
Length
(linear feet) Area of
Impact
(acres)
1 UT to Moccasin

Creel,
Cre Culvert Intermittent 1-2 ft.
30 in. ft.
60 sq. ft.

Total Stream Impact (by length and acreage) 301n. ft. 60 sq.ft.
6. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, dredging, flooding, drainage, bulkheads, etc.
Page 8 of 13
Open Water Impact
Site Number
(indicate on ma) Name of Waterbody

(if applicable)
Type of Impact Type of Waterbody
(lake, pond, estuary, sound, bay,

ocean, etc.) Area of
Impact

(acres)
N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A
Total Open Water Impact (acres) N/A
7. List the cumulative impact to all Waters of the U.S. resultina from the oroiect:
Stream Impact (acres): .001 ac.
Wetland Impact (acres): N/A
Open Water Impact (acres): N/A
Total Impact to Waters of the U.S. (acres) .001 ac.
Total Stream Impact (linear feet): 301n. ft.
8. Isolated Waters
Do any isolated waters exist on the property? ? Yes X No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USAGE.
N/A
9. 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 applies): N/A uplands N/A stream NIA wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): N/A
Current land use in the vicinity of the pond:
Size of watershed draining to pond: N/A Expected pond surface area: N/A
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. This is the only Way that I
could gain access to the M propgrty by burg the easement that intersects this stream minimal
clearing will be done
VIII. Mitigation
Page 9 of 13
DWQ - In accordance with 15A NCAC 2H .0500 mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on January 15, 2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project; a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
http:/rh2o.enr.state.nc.us/newetlands/stimgide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
N/A
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at htip://h2o.enr.state.nc.us/wrp/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:
Amount of stream mitigation requested (linear feet): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres) _N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
Page 10 of 13
IX. Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ? No X
2. If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/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 X
3. If yes, has the document review been finalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SEPA final approval letter. Yes ? No X
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 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify )? Yes X No ?
2. If "yes", 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 1800 3 (2 for Catawba) N/A
2 1200 1.5 N/A
Total 3000 N/A
* Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration / Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B .0242 or .0244, flr .{1250. N/A
Page 11 of 13
XI. Stormwater (required by DWQ)
Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss
Stormwater controls proposed in order to protect surface waters and wetlands downstream from
the property. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. N/A
X11I. 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.
Septic field for House
3M. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No X
Is this an after-the-fact permit application? Yes ? No X
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ? No E
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
zttp://h2o.enr.state.nc.us/newetlands. If no, please provide a short narrative descriptionNIA
XV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).

Page 12 of 13

Applicant/Agent's
Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 13 of 13
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Pre-Construction Notification (PCN) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
www.saw.usace.almy.mil/wetlands/Pennits.html.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at www.saw.usace.gM.mil/wetlands/index.html, or contact one of the field offices
listed on page 3 of this application. The website also lists the responsible project manager for each
county in North Carolina and provides additional information regarding the identification and regulation
of wetlands and waters of the U.S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://h2o.enr.state.nc.us/ncwetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for General Certifications is not required, provided
that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet should
contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on page 4 of this application) prior to submittal of the application.
Page 1 of 13
Coastal Area Management Act (CAMA) Coordination - If the project occurs in any of North Carolina's
twenty coastal counties (listed on page 4) the applicant should contact the North Carolina Division of
Coastal Management (DCM). DCM will determine whether or not the project is within a designated
Area of Environmental Concern, in which case DCM will act as the lead permitting agency. In such
cases, DCM will require a CAMA Permit and will coordinate the 404/401 Permits.
The applicant may also choose to coordinate with the United States Fish and Wildlife Service to ensure
that the proposed project will have no impact upon any endangered or threatened species or critical
habitat as regulated by the Endangered Species Act, and the State Historic Preservation Office, North
Carolina Department of Cultural Resources to ensure that the proposed project will have no impact upon
any properties listed or eligible for listing on the National Register of Historic Places. Compliance with
these regulations is required to be eligible for any Department of the Army permit. The addresses for
both agencies are listed on page 3 of this application.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office. Upon receipt of an application, the
USACE will determine if the application is complete as soon as possible, not to exceed 30 days. This
PCN form is designed for the convenience of the applicant to address information needs for all USACE
Nationwide, Regional or General permits, as well as information required for State authorizations,
certifications, and coordination. Fully providing the information requested on this form will result in a
complete application for any of the USACE Nationwide, Regional or General permits. To review the
minimum amount of information that must be provided for a complete PCN for each USACE
Nationwide permit, see Condition 13, 67 Fed. Reg. 2090 (Jan. 15, 2002), available at
http://w-?Nru7.usace.army.rrzil/inet/functions/evv/cecwo/reg/2002riwps pdf. Processing times vary by
permit and begin once the application has been determined to be complete. Please contact the
appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401 /Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at http://h2o.ehnr.state.nc.us/newetlands/fees.ht?nI. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 13
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Caldwell Haywood McDowell Swain
US Army Corps of Engineers Alleghany Catawba Henderson Mecklenburg Transylvania
151 Patton Avenue Ashe Cherokee Iredell Mitchell Union
Room 208 Avery Clay Jackson Polk Watauga
Asheville, NC 28801-5006 Buncombe Cleveland Lincoln Rowan Yancey
Telephone: [phone] Burke Gaston Macon Rutherford
Fax: [phone] Cabarrus Graham Madison Stanley
Raleigh Regulatory Field Office Alamance Franklin Nash Surry
US Army Corps Of Engineers Caswell Forsyth Northampton Vance
6508 Falls of the Neuse Road Chatham Granville Orange Wake
Suite 120 Davidson Guilford Person Warren
Raleigh, NC 27615 Davie Halifax Randolph Wilkes
Telephone: [phone] Durham Johnston Rockingham Wilson
Fax: [phone] Edgecombe Lee Stokes Yadkin
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers Bertie Dare Lenoir Tyrrell
Post Office Box 1000 Camden Gates Martin Washington
Washington, NC 27889-1000 Carteret* Green Pamlico Wayne
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans *Croatan National Forest Only
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
North Carolina State Agencies
Division of Water Quality
Ecosystem Enhancement Program
1652 Mail Service Center
Raleigh, NC 27699-1652
Telephone: [phone]
Fax: [phone]
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
Telephone: [phone]
Fax: [phone]
US Fish and Wildlife Service / National Marine Fisheries Service
US Fish and Wildlife Service US Fish and Wildlife Service National Marine Fisheries Service
Raleigh Field Office Asheville Field Office Habitat Conservation Division
Post Office Box 33726 160 Zillicoa Street Pivers Island
Raleigh, NC 27636-3726 Asheville, NC 28801 Beaufort, NC 28516
Telephone: [phone] Telephone: [phone] Telephone: [phone]
Page 3 of 13
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: (9'19) 733-1495 Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kernersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
APPLICATION FORM BEGINS ON PAGE 5. PLEASE DO NOT SUBMIT PAGES I - 4.
Page 4 of 13
Office Use Only: Form Version March 05
20060007
USACE Action ID No. DWQ No.
kir any parncuiar item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. Processing
1. Check all of the approval(s) requested for this project:
X Section 404 Permit X Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
X 401 Water Quality Certification ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NW39, Tar-Pamlico Buffer
Authorization Need Buffer Authorization
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ® Only for NW 39, less than 150 linear feet.
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: N/A
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) cb erg "( 1.5 O
II. Applicant Information p
1. Owner/Applicant Information DEC 2 8 2005
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: N/A
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
Page 5 of 13
11-46 & - -7 (e S 7
Telephone Number: cell# 919-880-7082 Fax Number: N/A
E-mail Address:
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: Donald Hathaway Residential Driveway
2. T.I.P. Project Number or State Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): 2708-19-7640, 2708-18-4466(easement)
4. Location
County: Franklin Nearest Town: Pearces
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers/names, landmarks, etc.): Site is located off of Pilot
Riley Rd NC.
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum): 3977770 ON 741841 °E
UTM 17
6. Property size (acres): 12 AC. + 1.59 AC (easement)
7. Name of nearest receiving body of water: UT to Moccasin Creek
8. River Basin: Tar-Pamlico River Basin
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://'li2o.ez-zr.state.nc.us/admin/maps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Residential and Agriculture Subject area consist of
Wooded within the easement and open field for building lot
Page 6 of 13
10. Describe the overall project in detail, including the type of equipment to be used: to install
a driveway crossing to gain access to My pro >l erty so that I may build a sin lg e family
residence, typical equipment used to install culvert(backhoe dump truck and maybe a
bobcat)
11. Explain the purpose of the proposed work: to install a driveway crossing to gain access to
my property so that I may build a single family residence
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. Michael Horan of DWQ, (Raleigh Regional Office) met on site for
Buffer Determination. I also met with Eric Alsmeyer of the US Army Corps of Engineers
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
(Required building permits for house) no wetlands or surface waters will be impacted with the
building of the house
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts are proposed to these systems.
Wetland and stream evaluation and delineation forms should be included as appropriate.
Photographs may be included at the applicant's discretion. If this proposed impact is strictly for
wetland or stream mitigation, list and describe the impact in Section VIII below. If additional
space is needed for listing or description, please attach a separate sheet.
Page 7 of 13
1. Provide a written description of the proposed impacts: to place a culvert within an
intermittent stream (no greater than 30 linear feet) and buried at the most of 1 ft for any
aquatic life passage or 20% of the diameter. No inlet or outlet protection is to be placed
2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
separately list impacts due to both structure and flooding.
3.
Wetland Impact
Site Number
(indicate on map)
Type of Impact Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.) Located within
100-year
Floodplain
es/no) Distance to
Nearest
Stream
(linear feet) Area of
Impact
(acres)
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A
Total Wetland Impact (acres) N/A
4. List the total acreage (estimated) of all existing wetlands on the property: N/A
5. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
must be included. To calculate acreage, multiply length X width, then divide by 43,560.
Stream Impact
Number
(indicate on ma)
Stream Name
Type of Impact or
Perennial oIntermittentr Average
Stream Width
Before Impact Impact
Length
(linear feet) Area of
Impact
(acres)
1 UT to Moccasin
Creek Culvert Intermittent 1-2 ft. 30 In. ft. 60 sq. ft.

Total Stream Impact (by length and acreage) 30 In. ft. 60 sq.tt.
6. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, dredging, flooding, drainage, bulkheads, etc.
Page 8 of 13
Open Water Impact
Site Number
(indicate on ma) Name of Waterbody
(if applicable)
Type of Impact Type of Waterbody
(lake, pond, estuary, sound, bay,
ocean, etc.) Area of
Impact
(acres)
N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A
Total Open Water Impact (acres) N/A
7. List the cumulative impact to all Waters of the U.S. resulting from the nroiect:
Stream Impact (acres): .001 ac.
Wetland Impact (acres): N/A
Open Water Impact (acres): N/A
Total Impact to Waters of the U.S. (acres) .001 ac.
Total Stream Impact (linear feet): 301n. ft.
8. Isolated Waters
Do any isolated waters exist on the property? ? Yes X No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USAGE.
N/A
9. 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 applies): N/A uplands N/A stream NIA wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): N/A
Current land use in the vicinity of the pond:
Size of watershed draining to pond: N/A Expected pond surface area: N/A
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. This is the only way that I
could gain access to the my prouerty by buying the easement that intersects this stream, minimal
clearing will be done
VIII. Mitigation
Page 9 of 13
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on January 15, 2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
ht.tn://h2o.enr.state.nc.us/iiewetlands/strnigide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
N/A
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at htlp://h2o.enr.state.nc.us/wrp/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:
Amount of stream mitigation requested (linear feet): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
Page 10 of 13
IX. Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ? No X
2. If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/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 X
3. If yes, has the document review been finalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SEPA final approval letter. Yes ? No X
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.
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify V Yes X No ?
2. If "yes", 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
(s uam feet) Multiplier Required
mitigation
1 1800 3 (2 for Catawba) N/A
2 1200 1.5 N/A
'T'otal 3000 N/A
t Gone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration / Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B.0242 or .0244, or .,0260. N/A
Page 11 of 13
XIi. Stormwater (required by DWQ)
Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss
stormwater controls proposed in order to protect surface waters and wetlands downstream from
the property. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. N/A
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.
Septic field for House
-XM. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (I 5A NCAC 2H .0500) or any Buffer Rules?
Yes 0 No X
Is this an after-the-fact permit application? Yes ? No X
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ? No
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
http://li2o.eiu.state.ne.us/ncwetlands. If no, please provide a short narrative descriptionN/A
XV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).

Page 12 of 13

Applicant/Agent's Signatui
(Agent's signature is valid only if an
Date
letter from the applicant is provided.)
Page 13 of 13
L-11V11V1V v IVvv,1
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http://www.co.franklin.nc.us/ROK/mapviewer/MapFrame.htm 12/23/2005

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C4,
DWQ# Q& ` 0067 Date Who Reviewed:
Plan Detail Incomplete
? Please provide a location map for the project.
Please show all stream impacts including all fill slopes, dissipaters, and bank stabilization on the site plan.
? Please show all wetland impacts including fill slopes on the site plan.
Please indicate all buffer impacts on the site plan.
Please indicate proposed lot layout as overlays on the site plan.) 1 vx c_ 4'4 ? !' Ol ptriJ c,v
Please indicate the location of the protected buffers as overlays on the site plan.
Please locate all isolated or non-isolated wetlans, stye and other waters of the State as overlays on the site plan.
Please provide cross section details showing the provisions for aquatic life passage.
? Please locate any planned sewer lines on the site plan.
? Please provide the location of any proposed stormwater management practices as required by GC
? Please provide detail for the stormwater management practices as required by GC
? Please specify the percent of project imperviousness area based on the estimated built-out conditions.
? Please indicate all stormwater outfalls on the site plan.
? Please indicate the diffuse flow provision measures on the site plan.
? Please indicate whether or not the proposed impacts already been conducted.
Avoidance and/or Minimization Not Provided
? The labeled as on the plans does not appear to be necessary. Please eliminate the or provide additional
information as to why it is necessary for this project.
? This Office believes that the labeled on the plans as can be moved or reconfigured to avoid the impacts to the
Please revise the plans to avoid the impacts.
? This Office believes that the labeled on the plans as can be moved or reconfigured to minimize the impacts to the
. Please revise the plans to minimize the impacts.
? The stormwater discharges at the location on the plans labeled will not provide diffuse flow through the buffer because
. Please revise the plans and provide calculations to show that diffuse flow will be achieved through the entire buffer. If it
is not possible to achieve diffuse flow through the entire buffer then it may be necessary to provide stormwater management
practices that remove nutrients before the stormwater can be discharged through the buffer.
Other
? The application fee was insufficient because over 150 feet of stream and/or over 1 acre of wetland impacts were requested. Please
provide $ This additional fee must be received before your application can be reviewed.
? Please complete Se(. ion(s) on the application.
? Please provide a signed copy of the application.
? Please provide copies of the application, copies of the site plans and other supporting information.
? Please submit electronic CAD files showing via email to [e-mail] and CD.
Mitigation
? of compensatory mitigation is required for this project. Please provide a compensatory mitigation plan. The
plan must conform to the requirements in 15 A NCAC 2H .0500 and must be appropriate to the type of impacts proposed.
? Please indicate which 404 Permit the USACE would use to authorize this project.
., -?4- 1s uh?1?ardam n :sit lie dae?me?- r,?1n ,
.L '/M^11 Ins ?n??i 1n i? -1-?, )r, r.. ?` .?. ? J f??iv r?jQ?-l ? i ?? nv? ?r-e? ?
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: Donald Hathaway Residential Driveway
2. T.I.P. Project Number or State Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): 2708-19-7640, 2708-18-4466(easement)
4. Location
County: Franklin Nearest Town: Pearces
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers/names, landmarks, etc.): Site is located off of Pilot
Riley Rd NC.
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum): 3977770 ON 741841 °E
UTM 17
6. Property size (acres): 12 AC. + 1.59 AC (easement)
7. Name of nearest receiving body of water: UT to Moccasin Creek
8. River Basin: Tar-Pamlico River Basin
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/mgps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Residential and Agriculture Subject area consist of
Wooded within the easement and open field for building lot
Page 6 of 13
10. Describe the overall project in detail, including the type of equipment to be used: to install
a driveway crossing to gain access to my property so that I may build a single family
residence, typical equipment used to install culvert, (backhoe, dump truck and maybe a
bobcat)
11. Explain the purpose of the proposed work: to install a driveway crossing to gain access to
my property so that I may build a single family residence
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. Michael Horan of DWQ, (Raleigh Regional Office) met on site for
Buffer Determination. I also met with Eric Alsmgyer of the US Army Corps of Engineers.
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
(Required building permits for house) no wetlands or surface waters will be impacted with the
buildings of the house
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts are proposed to these systems.
Wetland and stream evaluation and delineation forms should be included as appropriate.
Photographs may be included at the applicant's discretion. If this proposed impact is strictly for
wetland or stream mitigation, list and describe the impact in Section VIII below. If additional
space is needed for listing or description, please attach a separate sheet.
Page 7 of 13
?0F Vv n t ?.9p Michael F. Easley, Governor
William G. Ross Jr., Secretary
' r- North Carolina Department of Environment and Natural Resources
d Alan W. Klimek, P.E. Director
Division of Water Quality
January 9, 2006
DWQ Project # 06-0007
Franklin County
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
Mr. Donald Hathaway
5621 Quail Covey Lane
Wendell, NC 27591
Subject Property: Donald Hathaway
Ut to Moccasin Creek [030407,27-86-2, C, NSW]
REQUEST FOR MORE INFORMATION
Dear Mr. Hathaway:
On December 28, 2005, the Division of Water Quality (DWQ) received your application dated
December 23, 2005, to impact 30 linear feet of stream to construct a driveway to access property.
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 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:
Please show all stream impacts including all fill slopes, dissipaters and bank stabilization
on the site plan.
2. Please indicate all buffer impacts on the site plan.
3. Please indicate proposed lot layout as an overlay on the site plan, including driveway
location.
4. Please indicate location of protected buffers as overlays on the site plan.
5. Please indicate all isolated wetlands, streams, and other waters of the State as overlays
on the site plan.
6. Please provide cross-section details showing the provision for aquatic life passage.
One Carna
401 Oversight/Express Review Permitting Unit EllCl1!<?J
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: htty//h2o.enr.state.nc.us/ncwetlands
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/ 10% Post Consumer Paper
Certification of Completion
DWQ Project No.: U " 00 0 - County: VC&rmin
Applicant:
Project Name:
Date of Issuance of Isolated Wetland Permit:
Certificate of Completion

Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules, and any
subsequent modifications, the applicant is required to returnthis certificate to the 401/Wetlanas Unit, North Carolina
Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650. This form may be returned to DWQ by
the applicant, the applicant's authorized agent, or the project engineer. It is not necessary to send certificates from all of
these.
Applicant's Certification
I, 0. , hereby state that, to the best of my abilities, due care and diligence was
used in the observation of the cons ction such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and specifications,
and other suppo
Signature: Date:
Agent's Certification
I,
used in the observation of the
compliance and intent of the 401
and other supporting materials.
Signature:
, hereby state that, to the best of my abilities, due care and diligence was
construction such that the construction was observed to be built within substantial
Water Quality Certification and Buffer Rules, the approved plans and specifications,
Date:
If this project was designed by a Certified Professional
I, as a . duly registered Professional (i.e., Engineer,
Landscape Architect, Surveyor, etc.) in the State of iSTorth Carolina, having been authorized to-observe (periodically,
weekly, full time) the construction of the project, for the Permittee hereby state that, to the best of my abilities, due care
and diligence was used in the observation of the construction such that the construction was observed to be built within
substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications,.and other supporting materials.
Signature:
Registration No.
Date
mn -71
LOWE
MAY 1 2 2006
DENR - WATER QUALITY
WETLANDS AND STQRMWATER BRANCH
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SENDING CONFIRMATION
DATE • FEB-27-2006 MON 10:13
NAME DWQ-WETLANDS
TEL [phone]
PHONE : [phone]
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Division of Water Quality
Department of Environmental and Natural Resources
401. OversighdExpress Review, Program Development and
Transportation Permitting Units
Street Address: 2331 Crarircc Boiilevard, Suite 2>U
Rateigh. NC 276(M-2260
Mailing Address: 1650 Mail Scni::e Center'4C 27699-1650
Contact Information: Phone S: ')19-7;;- 1786
F- T u19-733-6893
To: Ginny Ca; RRO Fax 8: 571-4718
Company: Date: 2;27/06
From: Laurie Dennison
Number of pares including cover sheet: 5
Notes or special instructions: 06-0007 401 D',VQ Approval Ltr
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Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
Division of Water Quality
Department of Environmental and Natural Resources
401 Oversight/Express Review, Program Development and
Transportation Permitting Units
Street Address: 2321 Crabtree Boulevard, Suite 250
Raleigh, NC 27604-2260
Mailing Address: 1650 Mail Service Center
Raleigh, NC 27699-1650
Contact Information: Phone #: [phone]
Fax #: [phone]
To: Ginny @ RRO Fax #: [phone]
Company: Date: 2/27/06
From: Laurie Dennison
Number of pages including cover sheet: 5
Notes or special instructions: 06-0007 401 DWQ Approval Ltr
Nose Carolina
Division of Water Quality, Wetlands and Stormwater Branch ?,?thta?"y
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: http://h2o.enr.state.nc.us/ncwetlands
An Equal Opportunity/Affirmative Action Employer- 50% Recycled/10% Post Consumer Paper

r
y
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
January 12, 2005
Mr. Donald Hathaway
5621 Quail Covey Lane
Wendell, NC 27591
Subject Property:
Donald Hathaway
Ut to Moccasin Creek [030407, 27-86-2, C, NSW]
Approval of 401 Water Quality Certification with Additional Conditions
Dear Mr. Hathaway:
Alan W. Klimek, P.E. Director
Division of Water Quality
DWQ Project # 06-0007
Franklin County
You have our approval, in accordance with the attached conditions and those listed below, to place fill
within or otherwise impact 30 linear feet of stream waters and 3,000 square feet (fl) of protected riparian
buffers (1,800 square feet Zone 1, and 1,200 square feet Zone 2) for the purpose of facilitating access to a
residence on the subject property as described within your application dated December 23, 2005 and
received by the N.C. Division of Water Quality (DWQ) on December 28, 2005, with additional
information received by the DWQ on January 11, 2006. After reviewing your application, we have
decided that the impacts are covered by General Water Quality Certification Number(s) 3404 (GC3404).
The Certification(s) allows you to use Nationwide Permit(s) 14 (NW14) when issued by the US Army
Corps of Engineers (USACE). This letter shall also act as your approved Authorization Certificate for
impacts to the protected riparian buffers per 15A NCAC 2B .0259. 'In addition, you should obtain or
otherwise comply with any other required federal, state or local permits before you go ahead with your
project including (but not limited to) Erosion and Sediment Control, and Non-discharge regulations.
Also, this approval to proceed with your proposed impacts or to conduct impacts to waters as
depicted in your application shall expire upon, expiration of the 404 or CAMA Permit.
This approval is for the purpose and design that you described in your application. If you change your
project, you must notify us and you may be required to send us a new application. If the property is sold,
the new owner must be given a copy of this Certification and approval letter and is thereby responsible for
complying with all conditions. If total fills for this project (now or in the future) exceed one acre of
wetland or 150 linear feet. of stream, compensatory mitigation may be required as described in 15A
NCAC 2H.0506 (h). This approval requires you to follow the conditions listed in the attached
certification and any additional conditions listed below.
Conditions of Certification:
1. Impacts Approved
The following impacts are hereby approved as long as all of the other specific and general
conditions of this Certification (or Isolated Wetland Permit) are met. No other impacts are
approved including incidental impacts:
401 OversighUExpress Review Permits Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: http://h26.enr.state.nc.us/ncwetlands

An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
Donald Hathaway
Page 2 of 3
January 12, 2005
Amount Approved nits Plan Location or Reference
Stream 30 linear feet PCN page 8 of 13
Zone 1 TPBR Buffer Impacts 1,800 (square feet PCN page 12 of 13
Zone 2 TPBR Buffer Impacts 1,200 (square feet PCN page. 12 of 13
Sediment and Erosion Control:
2. Erosion and sediment control practices must be in full compliance with all specifications governing
the proper design, installation and operation and maintenance of such Best Management Practices in
order to protect surface waters standards:
a. The erosion and sediment control measures for the project must be designed, installed,
operated, and maintained in accordance with the most recent version of the North Carolina
Sediment and Erosion Control Planning and Design Manual.
b. The design, installation, operation, and maintenance of the sediment and erosion control
measures must be such that they equal, or exceed, the requirements specified in the most
recent version of the North Carolina Sediment and Erosion Control Manual. The devices
shall be maintained on all construction sites, borrow sites, and waste pile (spoil) projects,
including contractor-owned or leased borrow pits associated with the project.
c. Sufficient materials required for stabilization and/or repair of erosion control measures and
stormwater routing and treatment shall.be on site at all times.
3. 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.404/401Permit Application. 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;
4. Sediment and erosion control measures shall not be placed in wetlands or waters to the maximum extent
practicable. If placement of sediment and erosion control devices in wetlands and waters is
unavoidable, they shall be removed and the natural grade restored within six months of the date that the
Division of Land Resources has released the project;
5. Protective Fencing - The outside buffer, wetland or water boundary and along the construction corridor
within these boundaries approved under this authorization shall be clearly marked with orange warning
fencing (or. similar high visibility material) for the areas that have been approved to infringe within the
buffer, wetland or water prior to any land disturbing activities to ensure compliance with 15 NCAC 2H,
Section.0500;
eed Notifications - Deed notifications or similar mechanisms shall be placed on all retained
jurisdictional wetlands, waters and protective buffers in order to assure compliance for fixture
wetland, water and buffer impact. These mechanisms shall be put in place prior to impacting any
wetlands, waters and/or buffers approved for impact under this Certification Approval and
Authorization Certificate. A sample deed notification can be downloaded from the 401/Wetlands Unit
web site at http://h2o.enr.state.nc.us/ncwetlands. The text of the sample deed notification may be
modified as appropriate to suit to this project;
Donald Hathaway
Page 3 of 3
January 12, 2005
7. Culvert Installation
Culverts required for this project shall be installed in such a manner that the original stream profiles
are not altered. Existing stream dimensions (including the cross section dimensions, pattern, and
longitudinal profile) must be maintained above and below locations of each culvert. Culverts shall be
designed and installed to allow for aquatic life movement as well as to prevent head cutting of the
streams. If any of the existing pipes are or become perched, the. appropriate stream grade shall be re-
established or, if the pipes installed in a perched manner, the pipes shall be removed and re-installed
correctly.
Culvert(s) shall not be installed in such a manner that will cause aggradation or erosion of the stream
up or down stream of the culvert(s). Existing stream dimensions (including the cross section
dimensions, pattern and longitudinal profile) shall be maintained above and below locations of each
culvert.
Placement of culverts and other structures in waters, streams, and wetlands must be placed below the
elevation of the streambed by one foot for all culverts with a diameter greater than 48 inches, and 20
percent of the culvert diameter for culverts having a diameter less than 48 inches, to allow low flow
passage of water and aquatic life. Design and placement of culverts and other structures including
temporary erosion control measures shall not be conducted in a manner that may result in dis- .
equilibrium of wetlands or streambeds or banks, adjacent to or upstream and down stream of the above
structures. The applicant is required to provide evidence that the equilibrium shall be maintained if
requested in writing by DWQ.
The establishment of native, woody vegetation and other soft stream bank stabilization techniques.
must be used where practicable instead of rip rap or other bank hardening methods. If rip-rap is
necessary, it shall not be placed in the stream bed, unless specifically approved by the Division of
Water Quality.
Installation of culverts in wetlands must ensure continuity of water movement and be designed
to adequately accommodate high water or flood conditions.
Upon completion of the project, the Applicant shall complete and return the enclosed "Certificate of
Completion" form to notify NCDWQ when all work included in.the §401 Certification has been
completed. The responsible party shall complete.the attached form and return it to the 401 /Wetlands
Unit of the NC Division of Water Quality upon completion of the project. Please send photographs
upstream and downstream of each culvert site to document correct installation along with the
Certificate of Completion form.
8. Diffuse Flow (No Review)
All constructed stormwater conveyance outlets shall be directed and maintained as diffuse flow, at
non-erosive velocities through the protected stream buffers such that it will not re-concentrate before
discharging into a stream as identified within 15A NCAC 2B .0233 (5). If this is not possible, it may
be necessary to provide stormwater facilities that are considered to remove nitrogen. This may require
additional approval from this Office.
Certificate of Completion:
9. Upon completion of all work approved within the 401 Water Quality Certification or applicable
Buffer Rules, and any subsequent modifications, the applicant is required to return the attached
Donald Hathaway
Page '4 of 3
January 12, 2005
certificate of completion to the 401/Wetlands Unit, North Carolina Division of Water Quality, 1650
Mail Service Center, Raleigh, NC, 27699-1650.
Violations of any condition herein set forth may result in revocation. of this Certification and may-result in
criminal and/or civil penalties. The authorization to proceed with your proposed impacts or to conduct
impacts to waters as depicted in your application and as authorized by this Certification shall expire upon
expiration of the 404 or CAMA Permit.
If you do not accept any of the conditions of this Certification (associated with the approved wetland or
stream impacts), you may ask for an adjudicatory hearing. You must act within 60 days of the date that
you receive this letter. To ask for a hearing, send a written petition, which conforms to Chapter 150B of
the North Carolina General Statutes to the Office of Administrative Hearings, 6714 Mail Service Center,
Raleigh, N.C. 27699-6714. This certification and its conditions are final and binding unless you ask for a
hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water
Act. If you have any questions, please telephone Cyndi Karoly or Ian McMillan in the Central Office in
Raleigh at 919-733-1786 or Mike Horan in the DWQ Raleigh Regional Office at 919-791-4200.
AWK/#m
Enclosures: GC 3404
Certificate of Completion
Sincerely,.
Xl L
Alan W. Klimek, P.E.
1141, cc: USACE Raleigh Regulatory Field Office
Mike Horan, DWQ Raleigh Regional Office
DLR Raleigh Regional Office
File Copy
Central Files
Filename: 060007DonaidHathaway(Fnmklin)101+TPBR
SENDING CONFIRMATION
DATE JAN-18-2006 WED 15:04
NAME DWQ-WETLANDS
TEL [phone]
PHONE [phone]
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Division of Water Quality
Department of Environmental and Natural Resources
401 Uversigbt/Express Review, Program Development and
Transportation Permitting Units
Street Address: 2321 Crabtree Boulevard, Suite 250
Raleigh, NC 27604-2260
Mailing Address: 1650 Mail Service Center
Raleigh, NC 27699-1650
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Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
Division of Water Quality
- Department of Environmental and Natural Resources
401 Oversight/Express Review, Program Development and
Transportation Permitting Units
Street Address: 2321 Crabtree Boulevard, Suite 250
Raleigh, NC 27604-2260
Mailing Address: 1650 Mail Service Center
Raleigh, NC 27699-1650
Contact Inform tion: Phone #: [phone]
Fax #: [phone] r/
To: AWA Fax #0
Company: Date: C
From: C- )V("V'
Number of pages including cover sheet:
Notes or special instructions:
DithCaro
Division of Water 1VpJr J,r?a
Quality,, Wetlands and Stormvrater Branch ?/?/ll !1(??/
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone]/ FAX [phone] / Internet: http:02o.enr.state.nc.us/ncwetlands
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
WQC #3404
GENERAL CERTIFICATION FOR PROJECTS ELIGIBLE FOR CORPS OF ENGINEERS
AND RIPARIAN AREA PROTECTION RULES (BUFFER RULES)
This General Certification is issued in conformity with the requirements of Section 401,
Public Laws 92-500 and 95-217 of the United States and subject to the North Carolina Division of
Water Quality (DWQ) Regulations in 15A NCAC 2H, Section .0500 and 15A NCAC 213 .0200 for
the discharge of fill material to waters and adjacent wetland areas or to wetland areas that are not
a part of the surface tributary system to interstate waters or navigable waters of the United States
(i.e., isolated wetlands) as described in 33 CFR 330 Appendix A (B) (14) of the Corps of
Engineers regulations (Nationwide Permit No. 14 and Regional General Permit 198200031) and
for the Riparian Area Protection Rules (Buffer Rules) in 15A NCAC 2B .0200. The category of
activities shall include any fill activity for road crossings and is limited to fill less than one-third
acre in tidal waters and less than one-half acre in non-tidal waters. This Certification replaces
Water Quality Certification Number 2177 issued on November 5, 1987, Water Quality Certification
Number 2666 issued on January 21, 1992, Water Quality Certification Number 2732 issued on
May 1, 1992, Water Quality Certification Number 3103 issued on February 11, 1997, Water
Quality Certification Number 3289 issued on June 1, 2000 and Water Quality Certification
Number 3375 issued March 18, 2002. This WQC is rescinded when the Corps of Engineers re-
authorizes Nationwide Permit 14 or Regional General Permit 198200031or when deemed'
appropriate by the Director of DWQ.
The State of North Carolina certifies that the specified category of activity will, not violate
applicable portions of Sections 301, 302, 303, 306 and 307 of the Public Laws 92-500 and 95-217
if conducted in accordance with the conditions hereinafter set forth.
Conditions of Certification:
1. Enumerating and Reporting of Impacts:
Streams - Impacts to streams as determined by the Division of Water Quality shall be
measured as length of the centerline of the normal flow channel. Permanent and/or
temporary stream impacts shall be enumerated on the entire project for all impacts
regardless of which 404 Nationwide Permits are used. Stream relocations and stream
bed and/or bank hardening are considered to be permanent stream impacts. Any
activity that results in a loss of use of stream functions including but not limited to
filling, relocating, flooding, dredging and complete shading shall be considered
stream impacts. Enumeration of impacts to streams shall include streams enclosed
by bottomless culverts, bottomless arches or other spanning structures when a 404
Permit is used anywhere in a project unless the entire structure (including
construction impacts) spans the entire bed and both banks of the stream, is only
used for a road, driveway or path crossing, and is not mitered to follow the stream
pattern. Impacts for dam footprints and flooding will count toward the threshold for
stream impacts, but flooding upstream of the dam will not (as long as no filling,
excavation, relocation or other modification of the existing stream dimension, pattern
or profile occurs) count towards mitigation requirements.
Wetlands - Impacts to wetlands as determined by the Division of Water Quality shall
be measured as area. Permanent and/or temporary wetland impacts shall be
enumerated on the entire project for all impacts regardless of which 404 Nationwide
Permits are used. Any activity that results in a loss of use of wetland functions
including but not limited to filling, draining, and flooding shall be considered wetland
impacts. Enumeration of impacts to wetlands shall include activities that change the
hydrology of a wetland when a 404 Permit is used anywhere in a project.
WQC #3404
• Lakes and Ponds - Lake and Pond Impacts Enumeration- Impacts to waters other
than streams and wetlands as determined by the Division of Water Quality shall be
measured as area. Permanent and/or temporary water impacts shall be enumerated
on the entire project for all impacts proposed regardless of which 404 Nationwide
Permits are used. Any activity that results in a loss of use of aquatic functions
including but not limited to filling and dredging shall be considered waters impacts;
2. Proposed fill or substantial modification of wetlands or waters (including streams) under
this General Certification requires application to and prior written concurrence from the
Division of Water Quality;
3. Application to and payment of a fee to DWQ is not required for construction of a driveway
to a single family lot as long as the driveway impacts less than 25 feet of stream channel
including any in-stream stabilization needed for the crossing;
4. Impacts to any stream length in the Neuse, Tar-Pamlico or Randleman River Basins (or
any other major river basins with Riparian Area Protection Rules [Buffer Rules] in effect at
the time of application) requires written concurrence for this Certification from DWQ in
accordance with 15A NCAC 213.0200. Activities listed as "exempt" from these rules do not
need to apply for written concurrence under this Certification. New development activities
located in the protected 50-foot wide riparian areas (whether jurisdictional wetlands or not)
within the Neuse and Tar-Pamlico River Basins shall be limited to "uses" identified within
and constructed in accordance with 15A NCAC 2B .0200. All new development shall be
located, designed, constructed, and maintained to have minimal disturbance to protect
water quality to the maximum extent practicable through the use of best management
practices;
5. Irrespective of other application thresholds in this General Certification, all impacts to
perennial waters and their associated buffers require written approval from DWQ since
such impacts are allowable as provided in 15A NCAC 2B. 0212 (WS-1), 2B .0213 (WS-II),
213.0214 (WS-III) and 213.0215 (WS-IV). Only water dependent activities, public projects
and structures with diminimus increases in impervious surfaces will be allowed as outlined
in those rules. All other activities require a variance from the delegated local government
and/or the NC Environmental Management Commission before the 401 Water Quality
Certification can be processed. In addition, a 30 foot wide vegetative buffer for low
density development or a 100 foot wide vegetative buffer for high density development
must be maintained adjacent to all perennial waters except for allowances as provided
under the Water Supply Watershed Protection Rules. For the purposes of this condition,
perennial waters are defined as those shown as perennial waters on the most recent
USGS 1:24,000 topographic map or as otherwise determined by local government
studies;
6. Additional site-specific stormwater management requirements may be added to this
Certification at DWQ's discretion on a case by case basis for projects that have or are
anticipated to have impervious cover of greater than 30 percent. Site-specific stormwater
management shall be designed to remove 85% TSS according to the latest version of
DWQ's Stormwater Best Management Practices manual at a minimum.
Additionally, in watersheds within one mile and draining to 303(d) listed waters, as well as
watersheds that are classified as nutrient sensitive waters (NSW), water supply waters
(WS), trout waters Jr), high quality waters (HQW), and outstanding resource waters
(ORW), the Division shall require that extended detention wetlands, bio-retention areas,
and ponds followed by forested filter strips (designed according to latest version of the NC
DENR Stormwater Best Management Practices Manual) be constructed as part of the
stormwater management plan when a site-specific stormwater management plan is
required.
WQC #3404
Alternative designs may be requested by the applicant and will be reviewed on a case-by-
case basis by the Division of Water Quality.
Approval of stormwater management plans by the Division of Water Quality's other
existing state stormwater programs including appropriate local programs are sufficient to
satisfy this Condition as long as the stormwater management plans meet or exceed the
design requirements specified in this condition. This condition applies unless more
stringent requirements are in effect from other state water quality programs.
• Unless specified otherwise in the approval letter, the final, written stormwater
management plan shall be approved in writing by the Division of Water Quality's
Wetlands Unit before the impacts specified in this Certification occur.
• The facilities must be designed to treat the runoff from the entire project, unless
otherwise explicitly approved by the Division of Water Quality.
• Also, before any permanent building or other structure is occupied at the subject site,
the facilities (as approved by the Wetlands Unit) shall be constructed and operational,
and the stormwater management plan (as approved by the Wetlands Unit) shall be
implemented.
• The structural stormwater practices as approved by the Wetlands Unit as well as
drainage patterns must be maintained in perpetuity.
• No changes to the structural stormwater practices shall be made without written
authorization from the Division of Water Quality.
7. Compensatory stream mitigation shall be required at a 1:1 ratio for not only perennial but
also intermittent stream impacts that require application to DWQ in watersheds classified
as ORW, HQW, Tr, WS-1 and WS-11 unless the project is a linear, publicly-funded
transportation project, which has a 150-foot per-stream impact allowance;
8. In accordance with North Carolina General Statute Section 143-215.3D(e), any
application for a 401 Water Quality Certification must include the appropriate fee.
If a project also requires a CAMA Permit, one payment to both agencies shall be
submitted through the Division of Coastal Management and will be the higher of the two
fees;
9. In accordance with 15A NCAC 2H .0506 (h) compensatory mitigation may be required for
impacts to 150 linear feet or more of streams and/or one acre or more of wetlands. For
linear public transportation projects, impacts equal to or exceeding 150 feet per stream
may require mitigation. In addition, buffer mitigation may be required for any project with
Buffer Rules in effect at the time of application for buffer impacts resulting from activities
classified as "allowable with mitigation" within the "Table of Uses" section of the Buffer
Rules or require a variance under the Buffer Rules. A determination of buffer, wetland
and stream mitigation requirements shall be made for any Certification for this Nationwide
Permit. The most current design and monitoring protocols from DWQ shall be followed
and written plans submitted for DWQ approval as required in those protocols. When
compensatory mitigation is required for a project, the mitigation plans must be approved
by DWQ in writing before the impacts approved by the Certification occur, unless
otherwise specified in the approval letter. The mitigation plan must be implemented and/or
constructed before any permanent building or structure on site is occupied. In the case
of public road projects, the mitigation plan must be implemented before the road is
opened to the travelling public. Projects may also be implemented once payment is made
to a private mitigation bank or other in-lieu fee program, as specified in the written
concurrence of 401 Certification for a project. Please note that if a stream relocation is
conducted as a stream restoration as defined in The Internal Technical Guide for Stream
Work in North Carolina, April 2001, the restored length can be used as compensatory
mitigation for the impacts resulting from the relocation;
WQC #3404
Alternative designs may be requested by the applicant and will be reviewed on a case-by-
case basis by the Division of Water Quality.
Approval of stormwater management plans by the Division of Water Quality's other
existing state stormwater programs including appropriate local programs are sufficient to
satisfy this Condition as long as the stormwater management plans meet or exceed the
design requirements specified in this condition. This condition applies unless more
stringent requirements are in effect from other state water quality programs.
• Unless specified otherwise in the approval letter, the final, written stormwater
management plan shall be approved in writing by the Division of Water Quality's
Wetlands Unit before the impacts specified in this Certification occur.
• The facilities must be designed to treat the runoff from the entire project, unless
otherwise explicitly approved by the Division of Water Quality.
• Also, before any permanent building or other structure is. occupied at the subject site,
the facilities (as approved by the Wetlands Unit) shall be constructed and operational,
and the stormwater management plan (as approved by the Wetlands Unit) shall be
implemented.
• The structural stormwater practices as approved by the Wetlands Unit as well as
drainage patterns must be maintained in perpetuity.
• No changes to the structural stormwater practices shall be made without written
authorization from the Division of Water Quality.
7. Compensatory stream mitigation shall be required at a 1:1. ratio for not only perennial but
also intermittent stream impacts that require application to DWQ in watersheds classified
as ORW, HQW, Tr, WS-1 and WS-II unless the project is a linear, publicly-funded
transportation project, which has a 150-foot per-stream impact allowance;
8. In accordance with North Carolina General Statute Section 143-215.3D(e), any
application for a 401 Water Quality Certification must include the appropriate fee.
If a project also requires a CAMA Permit, one payment to both agencies shall be
submitted through the Division of Coastal Management and will be the higher of the two
fees;
9. In accordance with 15A NCAC 2H .0506 (h) compensatory mitigation may be required for
impacts to 150 linear feet or more of streams and/or one acre or more of wetlands. For
linear public transportation projects, impacts equal to or exceeding 150 feet per stream
may require mitigation. In addition, buffer mitigation may be required for any project with
Buffer Rules in effect at the time of application for buffer impacts resulting from activities
classified as "allowable with mitigation" within the "Table of Uses" section of the Buffer
Rules or require a variance under the Buffer Rules. A determination of buffer, wetland
and stream mitigation requirements shall be made for any Certification for this Nationwide
Permit. The most current design and monitoring protocols from DWQ shall be followed
and written plans submitted for DWQ approval as required in those protocols. When
compensatory mitigation is required for a project, the mitigation plans must be approved
by DWQ in writing before the impacts approved by the Certification occur, unless
otherwise specified in the approval letter. The mitigation plan must be implemented and/or
constructed before any permanent building or structure on site is occupied. In the case
of public road projects, the mitigation plan must be implemented before the road is
opened to the travelling public. Projects may also be implemented once payment is made
to a private mitigation bank or other in-lieu fee program, as specified in the written
concurrence of 401 Certification for a project. Please note that if a stream relocation is
conducted as a stream restoration as defined in The Internal Technical Guide for Stream
Work in North Carolina, April 2001, the restored length can be used as compensatory
mitigation for the impacts resulting from the relocation;
WQC #3404
Certifications. For road construction purposes, this Certification shall only be utilized from
natural high ground to natural high ground;
18. When written concurrence is required, the applicant is required to use the most recent
version of the Certification of Completion form to notify DWQ when all work included in the
401 Certification has been completed;
19. Concurrence from DWQ that this Certification applies to an individual project shall expire
three years from the date of the cover letter from DWQ or on the same day as the
expiration date of the corresponding Nationwide Permit 14 or Regional General Permit
198200031, whichever is sooner.
. Non-compliance with or violation of the conditions herein set forth by a specific fill project
may result in revocation of this Certification for the project and may also result in criminal and/or
civil penalties.
The Director of the North Carolina Division of Water Quality may require submission of a
formal application for Individual Certification for any project in this category of activity that
requires written concurrence under this certification, if it is determined that the project its likely to
have a significant adverse effect upon water quality or degrade the waters so that existing uses of
the wetland or downstream waters are precluded.
Public hearings may be held for specific applications or group of applications prior to a
Certification decision if deemed in the public's best interest by the Director of the North Carolina
Division of Water Quality.
Effective date: March 2003
DIVISION OF WATER QUALITY
By
Alan W. Klimek, P.E.
Director
WQC # 3404
Certification of Completion
DWQ Project No.:
Applicant:
Project Name:
Date of Issuance of Isolated Wetland Permit:
County:
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Cert'if'ication and Buffer Rules, and any
subsequent modifications, the applicant is required to return this certificate to the 401/Wetlands Unit, North Carolina
Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650. This form may be returned to DWQ by
the applicant, the applicant's authorized agent, or the project engineer. It is not necessary to send certificates from all of
these.
Applicant's Certification
I, , hereby state that, to the best of my abilities, due care and diligence was
used in the observation of the construction such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer. Rules, the approved plans and specifications,
and other supporting materials.
Signature: Date:
Agent's Certification
I, , hereby state that, to the best of my abilities, due. care and diligence was
used in the observation of the construction such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and specifications,
and other supporting materials.
Signature:
Date:
If this project was designed by a Certified Professional
I, as a duly registered Professional (i.e., Engineer,
Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized to-observe (periodically,
weekly, full time) the construction of the project, for the Permittee hereby state that, to the best of my abilities, due care
and diligence was used in the observation of the construction such that the construction was observed to be built within
substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature: Registration No. Date
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
January 12, 2005
Mr. Donald Hathaway
5621 Quail Covey Lane
Wendell, NC 27591
Subject Property:
Donald Hathaway
Ut to Moccasin Creek [030407, 27-86-2, C, NSW]
Approval of 401 Water Quality Certification with Additional Conditions
Dear Mr. Hathaway:
Alan W. Klimek, P.E. Director
Division of Water Quality
DWQ Project # 06-0007
Franklin County
You have our approval, in accordance with the attached conditions and those listed below, to place fill
within or otherwise impact 30 linear feet of stream waters and 3,000 square feet (ft) of protected riparian
buffers (1,800 square feet Zone 1, and 1,200 square feet Zone 2) for the purpose of facilitating access to a
residence on the subject property as described within your application dated December 23, 2005 and
received by the N.C. Division of Water Quality (DWQ) on December 28, 2005, with additional
information received by the DWQ on January 11, 2006. After reviewing your application, we have
decided that the impacts are covered by General Water Quality Certification Number(s) 3404 (GC3404).
The Certification(s) allows you to use Nationwide Permit(s) 14 (NW14) when issued by the US Army
Corps of Engineers (USACE). This letter shall also act as your approved Authorization Certificate for
impacts to the protected riparian buffers per 15A NCAC 2B .0259. 'In addition, you should obtain or
otherwise comply with any other required federal, state or local permits before you go ahead with your
project including (but not limited to) Erosion and Sediment Control, and Non-discharge regulations.
Also, this approval to proceed with your proposed impacts or to conduct impacts to waters as
depicted in your application shall expire upon expiration of the 404 or CAMA Permit.
This approval is for the purpose and design that you described in your application. If you change your
project, you must notify us and you may be required to send us a new application. If the property is sold,
the new owner must be given a copy of this Certification and approval letter and is thereby responsible for
complying with all conditions. If total fills for this project (now or in the future) exceed one acre of
wetland or 150 linear feet of stream, compensatory mitigation may be required as described in 15A
NCAC 2H .0506 (h). This approval requires you to follow the conditions listed in the attached
certification and any additional conditions listed below.
Conditions of Certification:
1. Impacts Approved
The following impacts are hereby approved as long as all of the other specific and general
conditions of this Certification (or Isolated Wetland Permit) are met. No other impacts are
approved including incidental impacts:
401 Oversight/Express Review Permits Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone]/ FAX [phone] / Internet: htta://h2o.enr.state.nc.us/ncwetiands
.1
T * ?? 7 J
An Equal Opportunity/Affirmative Action Employer- 50% Recycled1l0% Post Consumer Paper

Donald Hathaway
Page 2 of 3
January 12, 2005
Amount Approved (Units) Plan Location or Reference
Stream 30 linear feet PCN page 8 of 13
Zone 1 TPBR Buffer Impacts 1,800 (square feet PCN page 12 of 13
Zone 2 TPBR Buffer Impacts 1,200 (square feet PCN page 12 of 13
Sediment and Erosion Control:
2. Erosion and sediment control practices must be in full compliance with all specifications governing
the proper design, installation and operation and maintenance of such Best Management Practices in
order to protect surface waters standards:
a. The erosion and sediment control measures for the project must be designed, installed,
operated, and maintained in accordance with the most recent version of the North Carolina
Sediment and Erosion Control Planning and Design Manual.
b. The design, installation, operation, and maintenance of the sediment and erosion control
measures must be such that they equal, or exceed, the requirements specified in the most
recent version of the North Carolina Sediment and Erosion Control Manual. The devices
shall be maintained on all construction sites, borrow sites, and waste pile (spoil) projects,
including contractor-owned or leased borrow pits associated with the project.
c. Sufficient materials required for stabilization and/or repair of erosion control measures and
stormwater routing and treatment shall be on site at all times.
3. 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 404/401Permit Application. 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;
4. Sediment and erosion control measures shall not be placed in wetlands or waters to the maximum extent
practicable. If placement of sediment and erosion control devices in wetlands and waters is
unavoidable, they shall be removed and the natural grade restored within six months of the date that the
Division of Land Resources has released the project;
5. Protective Fencing - The outside buffer, wetland or water boundary and along the construction corridor
within these boundaries approved under this authorization shall be clearly marked with orange warning
fencing (or similar high visibility material) for the areas that have been approved to infringe within the
buffer, wetland or water prior to any land disturbing activities to ensure compliance with 15 NCAC 2H,
Section.0500;
Weed Notifications - Deed notifications or similar mechanisms shall be placed on all retained
jurisdictional wetlands, waters and protective buffers in order to assure compliance for future
wetland, water and buffer impact. These mechanisms shall be put in place prior to impacting any
wetlands, waters and/or buffers approved for impact under this Certification Approval and
Authorization Certificate. A sample deed notification can be downloaded from the 401/Wetlands Unit
web site at http://h2o.enr.state.nc.us/newetlands. The text of the sample deed notification may be
modified as appropriate to suit to this project;
Donald Hathaway
Page 4 of 3
January 12, 2005
certificate of completion to the 401/Wetlands Unit, North Carolina Division of Water Quality, 1650
Mail Service Center, Raleigh, NC, 27699-1650.
Violations of any condition herein set forth may result in revocation. of this Certification and may result in
criminal and/or civil penalties. The authorization to proceed with your proposed impacts or to conduct
impacts to waters as depicted in your application and as authorized by this Certification shall expire upon
expiration of the 404 or CAMA Permit.
If you do not accept any of the conditions of this Certification (associated with the approved wetland or
stream impacts), you may ask for an adjudicatory hearing. You must act within 60 days of the date that
you receive this letter. To ask for a hearing, send a written petition, which conforms to Chapter 150B of
the North Carolina General Statutes to the Office of Administrative Hearings, 6714 Mail Service Center,
Raleigh, N.C. 27699-6714. This certification and its conditions are final and binding unless you ask for a
hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water
Act. If you have any questions, please telephone Cyndi Karoly or Ian McMillan in the Central Office in
Raleigh at 919-733-1786 or Mike Horan in the DWQ Raleigh Regional Office at 919-7914200.
Sincerely,
AWK/Ym
Enclosures: GC 3404
Certificate of Completion
cc: USACE Raleigh Regulatory Field Office
Mike Horan, DWQ Raleigh Regional Office
DLR Raleigh Regional Office
File Copy
Central Files
Alan W. Klimek, P.E.
Filename: 060007DonaldHathaway(Fmnklin)401+TPBR
Donald Hathaway
Page 3 of 3
January 12, 2005
7. Culvert Installation
Culverts required for this project shall be installed in such a manner that the original stream profiles
are not altered. Existing stream dimensions (including the cross section dimensions, pattern, and
longitudinal profile) must be maintained above and below locations of each culvert. Culverts shall be
designed and installed to allow for aquatic life movement as well as to prevent head cutting of the
streams. If any of the existing pipes are or become perched, the. appropriate stream grade shall be re-
established or, if the pipes installed in a perched manner, the pipes shall be removed and re-installed
correctly.
Culvert(s) shall not be installed in such a manner that will cause aggradation or erosion of the stream
up or down stream of the culvert(s). Existing stream dimensions (including the cross section
dimensions, pattern and longitudinal profile) shall be maintained above and below locations of each
culvert.
Placement of culverts and other structures in waters, streams, and wetlands must be placed below the
elevation of the streambed by one foot for all culverts with a diameter greater than 48 inches, and 20
percent of the culvert diameter for culverts having a diameter less than 48 inches, to allow low flow
passage of water and aquatic life. Design and placement of culverts and other structures including
temporary erosion control measures shall not be conducted in a manner that may result in dis-
equilibrium of wetlands or streambeds or banks, adjacent to or upstream and down stream of the above
structures. The applicant is required to provide evidence that the equilibrium shall be maintained if
requested in writing by DWQ.
The establishment of native, woody vegetation and other soft stream bank stabilization techniques.
must be used where practicable instead of rip rap or other bank hardening methods. If rip-rap is
necessary, it shall not be placed in the stream bed, unless specifically approved by the Division of
Water Quality.
Installation of culverts in wetlands must ensure continuity of water movement and be designed
to adequately accommodate high water or flood conditions.
Upon completion of the project, the Applicant shall complete and return the enclosed "Certificate of
Completion" form to notify NCDWQ when all work included in the §401 Certification has been
completed. The responsible party shall complete the attached form and return it to the 401/Wetlands
Unit of the NC Division of Water Quality upon completion of the project. Please send photographs.
upstream and downstream of each culvert site to document correct installation along with the
Certificate of Completion form.
8. Diffuse Flow (No Review)
All constructed stormwater conveyance outlets shall be directed and maintained as diffuse flow at
non-erosive velocities through the protected stream buffers such that it will not re-concentrate before
discharging into a stream as identified within 15A NCAC 2B .0233 (5). If this is not possible, it may
be necessary to provide stormwater facilities that are considered to remove nitrogen. This may require
additional approval from this Office.
Certificate of Completion:
9. Upon completion of all work approved within the 401 Water Quality Certification or applicable
Buffer Rules, and any subsequent modifications, the applicant is required to return the attached
Office Use Only: Form Version March 05
2
USACE Action ID No. DWQ No. 0 0 6 0 0 0 7
(It any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. Processing
1. Check all of the approval(s) requested for this project:
X Section 404 Permit X Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
X 401 Water Quality Certification ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NW39, Tar-Pamlico Buffer
Authorization Need Buffer Authorization
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ® Only for NW 39, less than 150 linear feet.
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: N/A
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 IffeIR OWLS D
II. Applicant Information V D
1. Owner/Applicant Information
Name: Mr.
Mailing Address:
D E G• 2 8 2005
?'- C?& - - 7 Co 57
Telephone Number: ce114 919-880-7082 Fax Number: N/A
E-mail Address:
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: N/A
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 13
DWQ# D ` OaO? Date Who Reviewed: c
Plan Detail Incomplete
? Please provide a location map for the project.
Please show all stream impacts including all fill slopes, dissipaters, and bank stabilization on the site plan.
? Please show all wetland impacts including fill slopes on the site plan.
Please indicate all buffer impacts on the site plan.
Please indicate proposed lot layout as overlays on the site plan.) 1 t? C 1 n? ????
Please indicate the location of the protected buffers as overlays on the site plan.
Please locate all isolated or non-isolated wetlans, stre and other waters of the State as overlays on the site plan.
A Please provide cross section details showing the provisions for aquatic life passage.
? Please locate any planned sewer lines on the site plan.
? Please provide the location of any proposed stormwater management practices as required by GC
? Please provide detail for the stormwater management practices as required by GC
? Please specify the percent of project imperviousness area based on the estimated built-out conditions.
? Please indicate all stormwater outfalls on the site plan.
? Please indicate the diffuse flow provision measures on the site plan.
? Please indicate whether or not the proposed impacts already been conducted.
Avoidance and/or Minimization Not Provided
? The labeled as on the plans does not appear to be necessary. Please eliminate the or provide additional
information as to why it is necessary for this project.
? This Office believes that the labeled on the plans as can be moved or reconfigured to avoid the impacts to the
Please revise the plans to avoid the impacts.
? This Office believes that the labeled on the plans as can be moved or reconfigured to minimize the impacts to the
. Please revise the plans to minimize the impacts.
? The stormwater discharges at the location on the plans labeled will not provide diffuse flow through the buffer because
. Please revise the plans and provide calculations to show that diffuse flow will be achieved through the entire buffer. If it
is not possible to achieve diffuse flow through the entire buffer then it may be necessary to provide stormwater management
practices that remove nutrients before the stormwater can be discharged through the buffer.
Other
? The application fee was insufficient because over 150 feet of stream and/or over 1 acre of wetland impacts were requested. Please
provide $ This additional fee must be received before your application can be reviewed.
? Please complete Se(-,. ion(s) on the application.
? Please provide a signed copy of the application.
? Please provide copies of the application, copies of the site plans and other supporting information.
? Please submit electronic CAD files showing via email to [e-mail] and CD.
Mitigation
? of compensatory mitigation is required for this project. Please provide a compensatory mitigation plan. The
plan must conform to the requirements in 15 A NCAC 2H .0500 and must be appropriate to the type of impacts proposed.
? Please indicate which 404 Permit the USACE would use to authorize this project. ??,,.,..o
uki(_iea'--Pzm lien docikm ' ' `'-.
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UNITED STATES POSTAL SERVICE First-Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address., and ZIP+4 in this box •
NC DENR Division of Water Quality
401 Oversight/Express Unit
2321 Crabtree Boulevard, Suite 250
Raleigh, NC 27604
coax #?#,##,:###,#I,::i?,#>>#F#:#1#,##????##E?#.#?##,t+;?##,#
Complete items 1, 2, and 3. Also complete
Rem 4 if Restricted Delivery is desired.
Print your name and address on the reverse
so that we can return the card to you.
Attach this card to the back of the mailpiece,
or on the front if space permits.
Article Addressed to:
Mr. Donald Hathaway
5621 Quail covey Lane
Wendell,NC 27591
)WQ# 06-0007-Franklin
13 Agent
S/
X
? Addressee
B. Received by( . Ptinted Name) C. Date of Delivery
D. Is delivery address different from Item 1? ? Yes
If YES, enter delivery address below: ? No
3. SE71os Type
Certified Mail ? Express Mail
? Registered .0 Return Receipt for Merchandise
13 Insured Mail 13 C.o.b.
4. Restricted Delivery? (Extra Fee) 0 yes
s. Article Number 7005 1160 0000 9954 8355
fl wm*r from service labeq
Q5211 CeL.... ... jnnn n : o .. o a
Complete items 1, 2, and 3. Also complete
item 4 If Restricted Delivery is desired.
Print your name and address on the reverse
so that we can return the card to you.
Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Mr. Donald Hathaway
5621 Quail Covey Lane
Wendell,NC 27591
DWQ# 06-0007-Franklin
4. Restricted Delivery? (Extra Fee) 0 yes
A. Signature
B. Received by (Printed Name)
D..Is delivery address different frorrritem
If YES, enter delivery address below:
E3 Agent
? Addressee
Date of Deliyen
? Yes
13 No
3. Service Type
id Certified Mail 0 Express Mail
13 Registered X Return Receipt for Merchandise
? Insured Mail 0 C.O.D.
!. Article Number
(Transfer from service lab ?005 1160 0000 9954 8508
4AR11 s:ahm- onnd Il-.M Ph.- R-I
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UNITED STATES POSTAL SERVICE
LISPS
Sender: Please print your name, address, and ZIP+4 in this box •
NC DENR Division of Water Quality
401 Oversight/Express Unit
2321 Crabtree Boulevard, Suite 250
Raleigh, NC 27604
First-Class Mail
Postage & Fees Paid
Permit No. G-10
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