20040988 Ver 1_COMPLETE FILE_20040618

M1118m C. Inca
251 Stewart Drive
Beaufort, NC 28516
June 17, 2004
Ms. Cindy Karoly
401 Wetlands Unit
2321 Crabtree Boulevard
Suite 250
Raleigh, NC 27604-2260
Re: NW 18 Nationwide Permit
Dear Ms. Karoly,
` ` A f) '
Enclosed please find two courtesy copies of the NW 18 permit issued to me by Mickey Sugg, U.S. Army Corps of
Engineers, along with my application and other supporting documentation. I am providing you with these copies
at the request of Joanne Steenhuis, NC Division of Water Quality, Wilmington NC. If you should have any
questions please contact me. Thank you.
Si e ,
William C. Rice
4; - -
enclosures
cc: Joanne Steenhuis & Mickey Sugg
"'TL ANDS /401 GROUP
JUN 1 S 2004
11A ISR QU'LITy SEC Tjot

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. 200400959
WETLANDS/ 401 GROUP
JUN 1 8 2004
WATER QUALITY SECTION
County Carteret
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property owner: William "Rill" Rice
251 Stewart Drive,, Beaufort NC ?8516
Telephone No: [phone]
040988
Size and Location of project (water body, road name/number, town, etc.) The property is located on Lot 8, in Bay Pines
Subdivision, on Stewart Drive, off Harkers Island Rnad, adjacent to Whitehurst Creek, in Straits Community, Carteret
County, North Carolina
Description of Activity: Authorization to discharge. fill material into 00 square feet (10' X 20') of Section 404
wetlands for the construction of a driveway to a residential home
Applicable Law: _X Section 404 (Clean Water Act, 33 U.S.C. 1344)
(check all that apply) Section 10 (River and Harbors Act of 1899)
Authorization: NW 18 Nationwide Permit Nrnmher
Your work is authorized by this Nationwide Permit (NWP) provided it is accomplished in strict accordance with the
attached conditions and your submitted plans. If your activity is subject to Section 404 (if Section 404 block above is
checked), before beginning work you must also receive a Section 401 water quality certification from the N.C. Division
of Water Quality, telephone [phone]. For any activity within the twenty coastal counties, before beginning work
you must contact the N.C. Division of Coastal Management, telephone [phone].
Please read and carefully comply with the attached conditions of the NWP. Any violation of the conditions of the NWP
referenced above may subject the perniittee to a stop work order, a restoration order, and/or appropriate legal action.
This Department of the Army NWP verification does not relieve the permittee of the responsibility to obtain any other
required Federal, State, or local approvals/permits. The pemzittee may need to contact appropriate State and local
agencies before beginning work.
If there are any questions regarding this authorization or any of the conditions of the Nationwide Permit, please
contact the Corps Regulatory Official specified below.
`
Date: June 4, 9,004
Corps Regulatory Official: Mickey T. Su Telephone No.: [phone]
Expiration Date of Verification: June 4, 2006
CESAW Form 591
Revised July 1995
William C. Rice
251 Stewart Drive
Beaufort, NC 28516
May 24, 2004
Mickey Sugg
Corp of Engineers
Post Office 1890
Wilmington, NC 28402-1890
Re: Pre-Construction Notification Application (Road Crossing Lot 8 Bay Pines Subdivision , Carteret Cty, NC)
Dear Mickey,
Enclosed is the completed application for the road crossing regarding the above referenced property. I have also
enclosed the map survey, by Powell Surveying Company, detailing my complete plan for the development of lot 8.
I will provide a courtesy copy of this application to Joann Steenhuis, NC Division of Water Quality. Should I
include your "Notification of Jurisdiction Determination" as well ?
Presently, the conditions of the site are excellent for the work to commence with minimal impact to the 404
wetlands. I look forward to receiving the permit, and your response. If you should have any questions or concerns
please contact me at [phone]. Thank you for your assistance.
Sinter y,
William C. Rice
enclosures
Office Use Only:
F m Version May 2002
USACE Action ID No. 040989
DWQ No.
(If anv oarticular item is not am l a} to r the
1J -- cuicr iNO[ Appucaote" or "N/A".)
I. Processing
1. Ch 1 of the approval(s) r ested folis proje
Section ? Ri a ers ed Buffer Rules
? ction ermi Isolated Permit from DWQ
ater Quality Certifica
2. Nationwide, Regional or General Permit Number(s) Requested: N?
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name: /;l I, ,,? /Cc
Mailing Address: Z.S/ STE i1r7- Dl.-
??9< `T G 2_A. ,1C
Telephone Number:WSA-Z -7-2 - ?B Fax Number: sj?1 6
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:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
Page 5 of 12
III. Project Information
1. Name of proj ect: AWIV? C. NGE 4o -1-45 S
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 MRCS 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.
2. T.I.P. Project Number or State Project Number (NCDOT Only):
c?•v?e7E.t6?'?,,
3. Property Identification Number (Tax PIN):? 7336 G 3. 3 ?L q 2?oao
4. Location
County: ?4r TE?t?' Nearest Town:_ ?kcx-S
-?-5
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): S A. A
NGSiQ / 33 _X0
5. Site coordinates, if available (UTM or Lat/Long):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): l? 2- O A L/l? S
7. Nearest body of water (stream/river/sound/ocean/lake): Al r
8. River Basin:
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
9. Describe the existing conditions on the s' e a d general land use in the vicinit of the project
at the time of this application: q/_iy? S- su??S?o?l
Page 6 of 12
10. Describe the overall oroiect in defml ;nrl,irlin,
IV.
I. Explain the
I/
Prior Project History
of the proposed work

of equipment to be used:
71 r? GlLo
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. _
.2d!
V.
Future Project Plans
Are any future permit requests anticipated for this project?
and provide justification fore exclusion f this work frorr
AL.
- e&z-774-4nV
If so, describe the anticipated work,
they current placation1.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
Provide a written description of the proposed impacts:
2. Individually list wetland impacts below:
Wetland Impact Area of Located within Distance to
Site Number Type of Impact* Impact 100-year Floodplain** Nea est Stream
(indicate on ma
L $ ) (acres) (es/no) (linear feet)
G ES
**

/!S Y?11
Type of Wetland***
List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due r both structure and flooding.
100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplairi maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://W?vw fema oov.
List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property:
Total area of wetland impact proposed:
3. Individually list all intermittent and perennial stream impacts below
Stream Impact Length of ---T
Site Number Type of Impact* Impact Stre
indicate on man) r-

List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditch ing/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
Stream names can be found on USGS. topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.toj)ozone.com,
www.maoquest corn, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:/
144

am Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)

Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
)Ocean and any other water of the U.S.) below:
l1N
Open Water Im
act
p
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres)
Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,

bay, ocean, etc.)

t et-- c , •?• r? u r Va?w. irnpac[s inciuae, but are not limited to: fill, excavation, dredging,
flooding, drai nage, - bull l -kh-eads, , etc.'
.
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic,, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed dun' g cons tction to reduce impac s. r %
/N !?" /?'lisl?iA1 i1 /
l ,
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Pehnits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
httP://h2o.enr.state.nc.us/ncwetlands/stmigide.html.
Provide a brief description of the proposed mitigation plan. The description should provide
as rritich information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed. ,
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP. website at htti)://h2o.enr.state.nc.us/wrp/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
f VIt,
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ? No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at (919) 733-508 to review current thresholds for environmental documentation.
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEP fi al approval letter.
Yes ? No
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required'state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify
Yes F-1 No ? If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact Required
(square feet) Multiplier Mitigation
1 3
2 1.5
Total -
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone I.
Page 11 of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater gynerated fpm tie proRosed project, oI available capacity of the subiect fac;l;ty
-6`702:
XIII. Violations (required by DWQ)
Is this site in violation of D?W? etland Rules (I 5A NCAC 2H .0500) or any Buffer Rules?
Yes ? No tl'f
Is this an after-the-fact permit application?
Yes ? No [J'
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, ccessibty ro le s or ther issues outside of the applicant s control).
Applicant/Agent's Signature at
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
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?s

WETLANDS / 401 GROUP
JUN Z 8 2004
U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. 200400859
WATER QUALITY SECTION
County Cartere
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Propertyowner: William "Rill" Rice
251 Stewart Drive, Beaufort NC 29516
Telephone No: [phone]
,)49988
Size and Location of project (water body, road name/number, town, etc.) 'Me propeM is located on Lot 9_ in Ray Pines
Subdivision on Stewart Drive, off Harkers Island Road, adjacent to Whitehurs Creek, in Straits Community, Carteret
County, North Carolina
Description of Activity: Authorization to discharge fill material intn 200 square,. feet (10' X 20') of Section 404
wetlands for the constniction of a driveway to a residential home,
Applicable Law: _X Section 404 (Clean Water Act, 33 U.S.C. 1344)
(check all that apply) Section 10 (River and Harbors Act of 1899)
Authorization: NW 19 Nationwide Permit Numher
Your work is authorized by this Nationwide Permit (NWP) provided it is accomplished in strict accordance with the
attached conditions and your submitted plans. If your activity is subject to Section 404 (if Section 404 block above is
checked), before beginning work you must also receive a Section 401 water quality certification from the N.C. Division
of Water Quality, telephone [phone]. For any activity within the twenty coastal counties, before beginning work
you must contact the N.C. Division of Coastal Management, telephone [phone].
Please read and carefully comply with the attached conditions of the NWP. Any violation of the conditions of the NWP
referenced above may subject the permittee to a stop work order, a restoration order, and/or appropriate legal action.
This Department of the Army NWP verification does not relieve the permittee of the responsibility to obtain any other
required Federal, State, or local approvals/permits. The permittee may need to contact appropriate State and local
agencies before beginning work.
If there are any questions regarding this authorization or any of the conditions of the Nationwide Permit, please
contact the Corps Regulatory Official specified below.
Date:.hme 4, 7004
Corps Regulatory Official: Mickey T. Sugg; Telephone No.: [phone]
Expiration Date of Verification: Jane 4, 2006
CESAW Form 591
Revised July 1995
William C. Rice
251 Stewart Drive
Beaufort, NC 28516
May 24, 2004
Mickey Sugg
Corp of Engineers
Post Office 1890
Wilmington, NC 28402-1890
Re: Pre-Construction Notification Application (Road Crossing Lot 8 Bay Pines Subdivision , Carteret Cty, NC)
Dear Mickey,
Enclosed is the completed application for the road crossing regarding the above referenced property. I have also
enclosed the map survey, by Powell Surveying Company, detailing my complete plan for the development of lot 8.
1 will provide a courtesy copy of this application to Joann Steenhuis, NC Division of Water Quality. Should I
include your "Notification of Jurisdiction Determination" as well ?
Presently, the conditions of the site are excellent for the work to commence with minimal impact to the 404
wetlands. I look forward to receiving the permit, and your response. If you should have any questions or concerns
please contact me at [phone]. Thank you for your assistance.
Sinter y,
William C. Rice
enclosures
Office Use Only:
A Form Version May 2002
USACE Action ID No. DWQ No
(If anv narticular itp, i? .,.,r
-- -- ---- -rr-•- •? „•? yv?cci, y,caac C[ILCr ivot applicable" or "N/A".)
I. Processing
1. Ch l of the approval(s) r ested folis proje
Section r ? Ri a ers ed Buffer Rules
? ctio ermI Isolated Permit from DWQ
ater Quality Certifica '
2. Nationwide, Regional or General Permit Number(s) Requested: N?
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name:_ /;1 (?f , X /4
Mailing Address: 25`1 -'rEkj^r-7-
Telephone Number: Z,S 7-? - ?B Fax Number: SX1416
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:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
Pa?e5of12
III. Project Information
AtQach 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. Nameofproject: of ?. CC /-01L_#B 7`/'iV2?_S 5441/111J90,,V)
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN):3G G 3 .3 q 2?oc7o
4. Location
County: 6?,rTEk E7" Nearest Town:
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): S
NGs,e /33 ? 7?o S?zk??y-.
5. Site coordinates, if available (UTM or Lat/Long):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. 'Property size (acres): f. 2 0 A G _. S
7. Nearest body of water (stream/river/sound/ocean/lake):?1•
8. River Basin:
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://l12o.enr.state.iic.us/admin/maps/.)
9. Describe the existing conditions on the s' e a d general lan use in the vicinit of the project
at the time of this application: A? iy5 ?uv?S?d^
Page 6 of 12
IV.
V.
VI.
10. Describe the overall project in detail ,nrl„ri;nr
11. Explain the
Prior Project History
of equipment to be used:

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.
/ 4
Future Project Plans
Are any future permit requests anticipated for this project?
and provide justification for the exclusion of this wnrl- F,,,„-
- CCU4-r4l, to ,
If so, describe the anticipated work,
:he current annlirntinn .
Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.

of the proposed work:
//
/ A f4
Page 7 of 12
I . Provide a written description of the proposed impacts: 19 1,
19 N r q0 /? i?v o
r G ivc?- '
/-
2. Individually list wetland impacts below:
Wetland Impact Area of Located within Distance to
Site Number Type of Impact* Impact 100-year Floodplain** Nearest Stream ***
indicate on ma) acres Type of Wetland
) (es/no) (linear feet)
'a G - E5
**

List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplairi maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://w,.vw fema eov.
List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property:
Total area of wetland impact proposed:_
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact Length of
Site Number Type of Impact* Impact Str
indicate on ma) (linear feet)
List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts.due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
Stream names can be found on USGS. topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
w%vw.usgs•gov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.tooozone.com,
www.maoauest corn, etc.). -

Cumulative impacts (linear distance in feet) to all streams on site:

cam Name** Average Width
of Stream
Before Im act Perennial or
Intermittent?
leasespecify)

Pale 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
)Ocean and any other water of the U.S.) below:
t?/,v
Open Water Im
act
p
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres)
Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,

bay, ocean, etc.)

- - - ?? ^.v 11111r--Y 1111PaUw. impac[s include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic,-trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
= VII. Impact Justification (Avoidance and .Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followgd duri g cons tction to reduce impac s. //
/N /on/ '044- - /n1?NiA1'I /
9 ^t vie ' /l _ / _ ,

VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Pdmits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/stm-igide.html.
Provide a brief description of the proposed mitigation plan. The description should provide
as nittch information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed. ,
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP. website at http://h-?o.enr.state.nc.us/wm/iiidex.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
r1/11
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ? No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at (919) 733-508 to review current thresholds for environmental documentation.
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEP fi al approval letter.
Yes ? No
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required'state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify
Yes ? No ? If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
I Impact Zone* I Required
(square feet) Multiplier
F Mitigation
3
2 1.5
Total
* Zone I extends out 30 feet perpendicular from near bank of channel;tZone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 1 1 of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e. Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
f XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater g nerated from the pro osed project, o av ilabl _ e ca city of the sXG 'faci 'ty.
-Alee_? 11-5 Jr 6,- 'a S _ c i? ?. .
XIII. Violations (required by DWQ)
Is this site in violation of DW? etland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No 2
Is this an after-the-fact permit application?
Yes ? No Fr
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threa ned Species, ccessibil y, ro le s, or ther issues outside of the applican ' contr l). 19 r
?? ? C - r )o r???svV- ct?? ?ti? / ?,p? c-?` ?uor cf/,? ,Lr%.r/?sr/ 1,

4.
Applicant/Agent's Signature at
v
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
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