20041790 Ver 1_COMPLETE FILE_20041103

401 OSSUE®
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II.
FILE COM
Use, Only: Form Version May 2002
041790.
E Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
Processing
Check all of the approval(s) requested for this project:
0' Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
? 401 Water Quality Certification';
Name: Toy
Mailing Address: 204
Ty
2. Nationwide, Regional or General Permit Number(s) Requested:NATIONWIDE #39
3. If this notificatio}? 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 No Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), cheek here: ?
Applicant Information
1 Owner/Applicant Information
Telephone Number: (828)-632-221
E-mail Address:
>.. Agent/ConsultantInformation (A
must be attached if the Agent has si
AT..--- I AT/ A
Fax Number: (828)-632-7964
and dated copy of the Agent Authorization letter
y authority for the owner/applicant.)
Company Affiliation:
Mailing Address: r= 4z
V 0 4 2n-4-
Telephone Number: Fax Number: warER QuauTv
E-mail Address: wer
NCH
Paige 5 of 12

III, Project Information
Attach a vicinity giap clearly showing the location of the property with respect to local
landmarks such as t wns, rivers, and roads. Also provide a detailed site plan showing property
boundaries' and development plans in rolation 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 m accept paperwork of any size. DWQ prefers full-size construction
drawings rather th a sequential sheet version of the full-size plans. If full-size plans are
reduce 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.
1Name of project: JU Drive Water pnd Sewer CDBG Project
I2. T.I.P. Project Number or State Project Number (NCDOT Only): N/A
Property Identification Number (Tax PIN): N/A
Location
County: Alexander Nearest Town: Taylorsville
Subdivision name (include phase/lot'number): N/A
Directions to site (include road numbers, landmarks, etc.): On S.W. Milstead St. (SR 1104)
j a East by Dr. SRI 106) annrox 015 mi south of US 64, Hwy 90
Site coordinates, if available (UTM or Lat(Long):N 35*-55-.12.652" W81 °-11'- 28.059"
(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.)
Property size (acres): N/A
Nearest body of Water (stream/nver/sound/ocean/lake): Unnamed tributary to Little River
River Basin: Catawba
(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/.)
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Describe the existing conditions on t e site and general land use in the vicinity of the project
at the time of this application: Residential Development
Page 6 of 12
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10. Describe the ov1
Installation of a
track backhoe. ]
waterline is in n:
IV.
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project in
including the type of equipment to be used:
v rerl ne will be placed across the small branch with a
tabilization will be placed on the stream banks after the
11. Explain the purpose of the proposed work: , construct a waterline for. residential
Prior Project History
N 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 iID Number, DWQQ 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.
N/A --
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.
N/A
Impacts to Waters of the United States/Waters..of the State
is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
-tlands, open water, and stream channels associated with the project. The applicant must also
ovide justification for these impacts in Section VII below. All proposed impacts, permanent
d temporary, must'be listed herein, aid must be clearly identifiable on an accompanying site
tn.' All wetlands aid waters, and all streams (intermittent and perennial) must be shown on a
lineation 'map, whether or not impa4s are proposed to these systems. Wetland and stream
aluation and delineation forms sho d be included as appropriate. Photographs may be
Dluded at the applicant's discretion. If this proposed impact is strictly for wetland or stream
tigation, list and describe the impact in Section VIII below. If additional space is needed for
ting or description, please attach a separate sheet.
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1. Provide a written description of the proposed impacts: Stream will be disturbed to install a
waterline The impacts will be temnorarv and will occur only during construction
?I 2. Individually list wetland impacts below: N/A
W d Impact Area of Located within Distance to
Sit Number Type of Impact* Impact 100 year Floodplain** Nearest Stream Type of Wetland***
(indi a on ma) (acres) es/no linear feet)

List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, gmaing, tut,
ex vation, 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
, or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
e,at httn://www.ferna.gov.
** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Car hna Bay, bog, etc.) Indicate if wetland is isolated (de?mination of isolation to be made by USACE only).
II
List the total acreage (estimated) of 01 existing wetlands on the property:
Total area of wetland impact proposed:
2Individually list all intermittent and perennial stream impacts below: N/A
Str
Site
(indic Impact
umber
a on ma)
Type of Impact* Length of
Impact
(linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
lease specify)
1 waterline 10 unnamed 4' perennial

List
dam
stab
pro]
Stm
Cumulative impacts (linear distance in feet) to all streams on site: 10'
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Page 8 of 12
icb impact separately ana lpenury temporary iu?p". uupmts nowauu, uta my nu1, lu mlix, tV. vwv,a W auu CWJWl(11 M1L ll?lfx1/,
;separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net losstgain),
,ation activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
ed, plans and profiles showing the linear footprint for both the original and relocated streams. must be included.
i names can be found on USGS topographic maps.i, If a stream has no name, list as UT (unnamed tributary) to the nearest
tream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
xs_gs.gov. Several intetnft sites also allow direct download and printing of USGS maps (e.g., www.to=one.com,
pffluest.com, etc.).
3. Individually list; all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U. S.) below: N/A
Open
Si a
indi ater Impact
Number
a on ma)
Type of Impact* Arela of
Imps
(acres) Name of
Wate)
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
ba , ocean, etc.

Li each impact separately and identity temporary impacts. Impacts mclude, but are not imutea to: nu, excavauon, areagutg,
fl , drainage, bulkheads, etc.
4. Pond Creation N/A
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
i be described here and illustrated on any maps included with this plication.
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 (6.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
i nformation related to site constraints such as topography, building ordinances, accessibility, and
ancial viability of the project. The applicant may attach drawings of alternative, lower-impact
ite layouts, and explain why these design options were not feasible. Also discuss how impacts
ere' minimized once the desired site plan was developed. If applicable, discuss construction
echniques to be followed during construction to reduce impacts.
alternative would be not to con t swat 'ne t the r iden s. This al rnative oul
be continued s of private ells. Er sio c ro methods will be s _dmfing c n io .
1 AIR itigaton
WQ - In ;accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
ivis}on of Water Quality for projects involving greater than or equal to one acre of impacts to
eshwater wetlands or greater than or equal to 150 linear feet of total, impacts to perennial
treams. N/A
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USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values) by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the, application complete for processing. Any application
lacking a required I, 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/ncwettands/strmmide.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 strearn and river basin, type and amount (acreagellinear 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
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2. Mitigation may also be made by payment into the North Carolina, Wetlands Restoration
Program (NCWRP). Please note it is the applicant°s responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at http://h2o.enr; state.nc.us/wrp/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information: i
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 12
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IX
Environmental Documentation (required by DWQ)
Does the project involve an expenditl, re 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 j not sure whether I a NEPA/SEPA document is required, call the SEPA
coordinator at (919)1733-5083 to review current thresholds for environmental documentation.
Yes ? No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
Proposed Impacts On Riparian and Watershed Buffers (required by DWQ)
It is the applicant's ',(or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 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:
the square feet and acreage of impact to each zone of the riparian buffers. If buffer
in is required calculate the required amount of mitigation by applying the buffer
;rs.
*
Zone Impact
(square feet)
Multiplier Required
Miti tion
1 3
2 1.5
Total
fi Zone 1 extends out 30 feet perpendicuW trom near bank of channel; 'Lone 2 extends an
additional 20 feet from the edge of Zono 1.
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Page 11 of 12
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If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242or .0260.
N/A
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Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.

1 "ID%oUO.3 AWIMWOLVL VV11L1V1A 1l1VIPLAO 14 111 Vl%t%4 LV J/1V4VV4 gM11fLVV PtµLVlp "&&1A ?t VLl(Ll1VU
downstream from the property.
n/a
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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.
ALL LOTS WILL RE SERVED BYITIE TOWN OF TAYLQRSVILLE PUBLIC SEWER
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II SERVICE
x Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
1 s this an after the-fapt permit application?
?I Yes' ? No
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11W. then Circumstances (Optional):
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t 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
hoose to list constraints associated with construction or sequencing that may impose limits on
ork schedules (e.g.fi draw-down schedules for lakes, dates associated with Endangered and
hreatened Species, accessibility problems, or other issues outside of the applicant's control).

tt' 1- ------ of - -- -- .v_--------
ssignature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
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WEST CONSULTANTS, PLLC
Consulting Engineers
405 South Sterling Street
MORGANTON, NORTH CAROLINA 28655
Phone [phone] !Fax [phone]
TO 401 Wetlands Unit
NCDENR - Div. Of Water Quality
1650 Mail Service Center
Raleigh NC 27699-1650

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JOB NUMBER/PHONE DATE
0/29/04 it
A ; ENTION l
RE:
Taylorsville, NC - Jay Drive Water/Sew er (?, B(j
Project, Town of Taylorsville
W ARE SENDING YOU X Attached Under separate cover via the follow) g items. j i
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Shop drawings Prints Plans Specifications Sabi les
Copy of letter Change order Other:
-COPIES DATE NUMBER DESCRIPTION
1 PCN Application Form D -t
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NOV
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kTLAND
S? pFR QUALI
TY
AN
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THESE ARE TRANSMITTED as checked below: j I
X For your approval Approved as submitted
I Resubmit copies for approval
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For your use Approved as noted Submit copies for distributio ;

As requested i

Returned for corrections Y I
1
Return corrected prints

For review and comment
Other j
FOR BIDS DUE/DATE: PRINTS RETURNED AFTER LOAN TO U
i
REMARKS
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COPY TO 1
SIGNED
if enclosures are not as noted, please notify us at once.
PRODUCT 13127M USE WITH 771 ENVELOPE NEBS To Reorder: 1-800-225-6380 or www.neb8.C? m PRINTED IN U,S.A. A -