20020599 Ver 1_Complete File_20020408

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October 28, 2002
DWQ# 02-0599
McDowell County
MEMO
To:
From:
Re:
Alan W. Klimek, P.E., Director
Division of Water Quality
Fran Mace erson Uu
John Dorn
WAS
Reimbursrtof 1 e r Quality Certification Fee

Please process a reimbursement for the $200 401 Water Quality Certification fee paid by Mr. Mitch
Gillespie for the above listed project. He was issued a 404 Permit by the US Army Corps of Engineers
that did not require written authorization form DWQ and there fore did not require payment for the
fee.
Please call me at 733-9646 if you have any questions.
Cc: Laura DeVivo
Mitch Gillespie, 753 Lake Tahoma Road, Marion, NC 28752
File Copy
Jen
06
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
N. C. Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (http://h2o.enr.state.nc.us/ncwetlands
W A ]'? Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources

r Alan W. Klimek, P.E., Director
Division of Water Quality

October 28, 2002
DWQ# 02-0599
McDowell County
MEMO
To: Fran Mace erson
From: John Dorn
Re: Reimburse e t of 401 er Quality Certification Fee
Please process a reimbursement for the $200 401 Water Quality Certification fee paid by Mr. Mitch
Gillespie for the above listed project. He was issued a 404 Permit by the US Army Corps of Engineers
that did not require written authorization form DWQ and there fore did not require payment for the
fee.
Please call me at 733-9646 if you have any questions.
Cc: Laura DeVivo
Mitch Gillespie, 753 Lake Tahoma Road, Marion, NC 28752
File Copy
'J. C. Division of Water Quality, 401 Wetlands Certification Unit,
550 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
21 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
9) 733-1786 (phone), 919-733-6893 (fax), (http://h2o.enr.state.nc.us/ncwetlands
ty??
[Fwd. $$$]
Subject: [Fwd: $$$] 6 /q?J
Date: Thu, 26 Sep 2002 08:41:37 -0400 ( `t ( l
From: Laura DeVivo <[e-mail]>
Organization: NC Department of Environment and Natural Resou ces
To: John Dorney <[e-mail]>
,john: I think Rep. Gillespie paid a permit fee and then was not required to
have the permit. He thinks you're the person who can get the fee back. What
should I do?
Laura
"Cindy Hobbs (Rep. Gillespie) " wrote:
> Rep. Gillespie said the budget has passed and he wants his $200. He needs
> this by next week as their per diem is over as of Sept. 30. Thank you for
> your consideration.
i?
I of 1 9/26/02 9:30 AM
O?OF ?I ATFRQG Michael F. Easley
Governor
C10 r William G. Ross•Jr.Secretary
-Il Department of Environment and Natural Resources
O -C
Kerr T. Stevens
Division of Water Quality
DMr on Qfi Water Quality
Departrrient of E^> Dnmental and Natural Resources.,
,
W Jands1401 Unit
Location: 2321 Crrbtra~ B---ulevard: Suite 250 Raleiah, NC 27604-2260
MaiIina Addres, 1650 hfja? SL^nc-= Center Raleigh, NC 27699-1650
Contact Inforanation_ C-lira( S"19-733-1786 Fax: [phone]
Fax To: L-,o," Fax Number: 6 25 - ZS I • (&-A ? -Z
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Subject: Cross Creek S/D 020599L-- ZS? - GZ0b co')
Date: Wed, 01 May 2002 07:32:55 -0400
From: Bob Zarzecki <[e-mail]>
Organization: Division of Water Quality; 401 Certification Unit
To: Forrest Westall <[e-mail]>, "larry.frost" <[e-mail]>
Forrest & Larry: I?AP
I'll fax you a copy of the request for more information that was sent to
Rep. Gillespie for this project. I did not write the letter, but it
appears that it includes requests for Catawba n_ver buffer information
(Items 1 & 2) that don't seem appropriate for t-e project. Items 3, 4 &
5 however do seem appropriate. It appears that the PCN was originally
hand delivered to Larry's attention. I'll be sire to send another copy
-waT - naa, ,;t'4 tlga mgr-e info. -1ette-r attaehed_just- ire ca-you - ----
no longer have a copy. Let me know if there is anything else you need.
- Bob
Bob Zarzecki
NC DENR/DWQ 401 Wetlands Certification Unit
919-733-9726
,.f 1 C/1 /M '7.1'2 A A
?OF W A T?cRO Michael F. Easley, Governor
William G. Ross Jr., Secretary
?O G North Carolina Department of Environment and Natural Resources
r Gregory J. Thorpe, Ph.D.
Acting Director
D -r Division of Water Quality
April 26, 2002
DWQ# 02-0599
McDowell County
CERTIFIED MAIIrREQUEST RECEIPT REQUESTED
Robert Mitchell Gillespie
753 Lake Tahoma Road
Marion, NC 28752
Dear Mr. Gillespie:
On April 18, 2002, the Division of Water Quality (DWQ) was notified by receipt of your applications regarding
you plans to impact 120 feet of shoreline on the Catawba River at Cross Creek subdivision for the purpose of stabilizing
the shoreline of your lot in McDowell County. Approval from DWQ is required to impact these waters. Please provide
seven copies of the following information and refer to the DWQ number listed above in your reply.
1. The location of the proposed shoreline stabilization measures must be shown on map.
2. Also the Catawba River buffer rules become effective on June 30, 2001 and allow shoreline stabilization measures
within the protected buffers along the Catawba River. We are concerned that construction of these shoreline
stabilization measures will result in excessive impact to the protected buffers. Please provide details on how you
plan to install these shoreline stabilization measures, what measures you will take to minimize impact to the
buffers and then how and when you plan to replant the unavoidably impacted portions of these buffers. .
3. Please provide a site plan of the entire property including roads, utilities, lots and any surface waters subject to 401
jurisdiction.
4. Please provide design details of the proposed road crossings including any fill or inlet/outlet protection.
5. Please complete sections (I)(2), (V), (VII), (Additional justification), (XI) & (XII) of the application form.
Please telephone Bob Zarzecki [phone] or me at 919-733-9646 if you have any questions or would require
copies of our rules or procedural materials. This project will remain on hold as incomplete in accordance with 15A NCAC
2H .0505(c). The processing time for this application will begin when this information is received. If we do not hear from
you by writing within three (3) weeks we will assume you no longer want to pursue the project and will consider it
withdrawn.
Sincerely Yours,
cc: Asheville DWQ Regional Office
Asheville Corps of Engineers
Central Files
File Copy
O NR
North Carolina Division of Water Quality, Wetlands/401 Certification Unit
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
Ph: [phone], Fax: [phone], http://h2o.enr.state.nc.us/ncwetlands/

FIL f

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copy 3-??_oZ
APR 1 S MM

NNA X2059
r
Pre-Construction Notification (P CN) Application Fo; m
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, Re 'onal 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 fcr 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
hM://www.saw.usace.arTny.mil/wetlands/Penn app htm.
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 toi the
USACE website at hIP2://www.saw.usace.arm, .millwetlands/re ounhtrn or contact one of the field
offices listed at the.end of this application- e 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/nc wetlands 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 fall text of the General. Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for some 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 also 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 the last page of this application).

CAMA Coordination - If the project occurs Zany of &rth Carolina's twenty coastal counties (listed on
the last page of this application) the app i*tkhoulo.' all o contact the North Carolina Division of Coastal
Management (DCM at (919) 733-22797?7)L"'M'. M-determine whether or not the project involves a
designated Area of Environmental Cone case DCM will act as the lead permitting agency.
In such cases, DCM will require a Coas ki! ?agement Act (CAMMA) Permit and will coordinate
the 404/401 Permits..., ,
USACE Permits - Submit one copy of this form,'along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office (addresses are listed at the end of this
application). 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, 65 Fed.Reg.12893
(March 9, 2000), available at htro://www.saw.usace army mil/wetiands/nwpfinalFedRe ndf.
Processing times vary by permit and begin once the application has been determiners 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 httv:/Aa2o.ehnr.state.ne.us/-ne-,vetlands/f`ees.,Ii1. 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.
.r
Ar ,
Office Use Only:
USACE Action ID No.
DWQ No.
Form Version April 2001
If any particular item is not applicable to this projec please enter "Not Applicable" or "N/A" rather than
leaving the space blank. ®? F
1. Processing
I. Check all of the approval(s) requested for this project: 5 200')_
? Section 404 Permit x
i
? Section 10 Permit
WATER WR NDS GROUP
? 401 Water Quality Certification WATER UAIITY SEGTiorj
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested:
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required„ check here: ?
4_ If payment into the North Carolina. Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section-VIE - Mitigation), check here: ?
II.
Applicant Information:
M,442,, o*_. t -Jr- 7-S--)S_Z .
I _ Owner/Applicant Information f?
Name: ? I _ I-C 4C4,
Mailing Address: `75 LAY-- `TAN
Telephone Number-
E-mail Address:
Fax Number:
N L Lz-& tier
2. Agent 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:

it -
4-
.LII. 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 maybe 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 I 1 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 foil-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: CaoSS Ca4CC, J•S,o?+ _
2. T.I.P. Project Number (NCDOT Only): NSA
3. Property Identification Number (Tax PIN): "9009271T(
4. Location
County: ?z Nearest Town:
Subdivision name (include phase/lot number): -?L-,?S Cie- C-,J1301 01
erections to site include road numbers landmarks etc.
5. Site coordinates, if available (UTM or Lat/Long):.ff
(Note - If project is linear, such as a road or utility line, attar a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
b. Describe the existing land use or condition of the site at the time of this application:
W? aA- LAPo - Tm-ben. W&, C.?r tr lgg8 t 1 r 0.4-;a
7. Property size (acres): 43." ACa6 tt.- `;? Abe
8. Nearest body of water (stream/river/sound/ocean/1 4: ?-1 Je(L
9. River Basin: P,13rCN-)((A
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at htti)://h2o.enr.state.ne.us/admin/maps/.)

10. Describe the purpose of the proposed work: 1i.? ,_4_ Ar' $? Auo
11. List the type of equipment to be used to construct the project: I "-r_NV k D i, 2
12. Describe the land use in the vicinity of this project: &50 VT7417At,
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 issues/ 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.LP. project, along with
construction schedules.
V.. Future Project Plans
Are any additional permit requests anticipated for this project in the-future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the curxent
application:
N
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 .neap, 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.
I V*
1. Wetland Impacts
Wetland Impact
Site Number Type of Impact*
indicate on mav)
Area of Located within Distance to
Impact 100-year Floodplain** Nearest Stream Type of Wetland***
(acres) (yes/no) (linear feet)
* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, 671,
excavation, flooding, ditching/drainage, eta For dams, separately list impacts due to both structure and flooding.
* 100-Year floodptains are identified throw e Federal Emergency Management Agency's (FEMA) Flood Insm'ance Rate Maps
(FIRM), or FMWA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online athtt :/1www.fema.2o_v. ,
*** List a wetland type that best describes wetland to be impacted (e g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Hay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property- N l?
Total area of wetland impact proposed:
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
(indicate on map)
Type of Impact* Length of
Impact
(linear feet)
- Stream Name* Average Width
of Stream
Before Impact Perenniai or
Intermittent g
(please specify)

L ''t©r I NTL'/t-M rrrey-r

---- ....t,...,. ,.,,,. a---y icutilucruy uupacis. impacts include, Dill are not 1lmlted to: Cuiverts and associated rip-rap,
darns (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 fbr 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
doWmstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
ww1%v.uses.sov. Several internet sites also allow direct download and printing of USGS maps (e.g., "w-topozone.corn
www.mauuaest.corn, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: t 120'

3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlanti c Ocean and any
other Water of the U.S.
Open Water Impact
Site Number
(indicate on map), Area of Name of Waterbody
Type of Impact'' Impact ( applicable)

(acres) Type of Waterbody
(lake, pond, estuary, sound,

hay, ocean, etc.)

?QTV

* List each impact se parately and identify temporary impacts. impacts include, but are not limited to: fill_ a^ccavatinn Arrr?n;n..
flooding; drainage, bulkheads, etc.
4. 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): F ? uplands F? stream 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., live ock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.,, ?l A
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. .If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
Ro,or Coat, J "AV RJIAL r1 erg'
1 19,
VIII. Mfigation
D WQ - 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 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
bt!p.//h2o.enr.state.nc.us/n wetlands/stnngidehtml.
Provide a brief description of the proposed mitigation plan. , The description should provide
as much.information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.

2. Mitigation may also be made by payment into the North Carolina Wetlands Reeomtion
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at 4ttp://h2o.enr.srate.ne-us/wM/;ndeY 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): ij JeA
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):
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ,0 No
If yes,. does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: , If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator-at [phone] to review current thresholds for environmental documentation.
Yes [] No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes No
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
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 roust 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
(Neese), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No [0"- If you answered "yes", provide the following information:
R

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.
un??u z
Zone* Multiplier Require
(square fee d
Mitigation
1
2 1.5
Total f -
Zone 1'extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1,
If buffer mitigation is required, please discuss what type of mitigation is proposed (Le., 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.
XZ. Stormwater (DWQ Only)
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.
XTL Sewage Disposal (DWQ Only)
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.
M. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 211,0500) or any Buffer Rules?
Yes [] No El
Is this an after-the-fact permit application?
Yes r-1 . No E

XW. 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).
Z
Arolicant/Agent's Signatureo Date
(Agent's signature is valid only if an authorization letter from the applicant is provided-)
d7,
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredeil Mitchell Union
US Army Corps of Engineers Avery Clay Jackson Polk Watauga
151 Patton Avenue Buncombe Cleveland Lincoln Rowan Yancey
Room.208. Burke Gaston Macon . Rutherford
Asheville, NC 28801-5006 Cabarrus G.-aham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell. Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham Wilson
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes Yadkin
6508 Falls of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
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 Perquimaw *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
US Fis
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
b. and Wildlife Service / Natiotial 1%
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
Division of Coastal Management
1638 Mail Service Center
Raleigh, NC 27699-1638
Telephone: [phone]
Fax: [phone]
Western Piedmont Regiou Coordinator
3 855 Idlewild Road
Kernersville, NC 27284-9180
Telephone: [phone]
Motmtain Region Coordinator
20830 Great Smoky Mtn. Expressway
Waynesville, NC 28786
Telephone: [phone]
Fax: [phone]
larine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivers Island
Beaufort, NC 28516
Telephone: [phone]
North Carolina State Agencies
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC •27699-1 6 1 9
Telephone: [phone]
Fax: [phone]
CA.MA and NC Coastal Counties
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
Telephone: [phone]
Fax: [phone]
Beaufort Chowan Hertford Pasquotank
Bertie Craven Hyde Pender
Brunswick Currituck New Hanover Perqu=ans
Camden Dare Onslow Tyrrell
Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Alleghany
Ashe
Avery
Burke
Buncombe
Cherokee
Clay
Graham
Haywood
Caldwell Watauga
Mitchell Wilkes
Stokes
Surry
Henderson Polk
Jackson Rutherford
Macon Swain
Madison Transylvania
McDowell Yancey

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Pre--Construction Notification (PCN) AppEcation Foy na
For Section 404 and/or Seicdon 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules

111is form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Re 'onal 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 fcr 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
httT):,I/www.saw.usace.annv.mil/wetiands/Perm. anp htm.
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 httn://www.saw.usace.arm .mil/wetlands/remmur.htm or contact one of the field
offices listed at the .end of this application- Tiie website also lists the responsible project manager for
each county in North Carolina and provider 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 40l/Wetiands Unit website at
htta://h2o.enr.state.nc.us/newetiands 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 some 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 also required for projects occurring in any of North Carolina's twency-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NC'WRC
regional coordinator (listed by county on the last pare of this application).
w
CA1tiiA Coordination - If the project occurs in any of North Carolina's twenty coastal counties (listed on
the last page of this application) the applicant should also contact the North Carolina Division of Coastal
Management (DCM) at [phone]. DCM. will determine whether or not the project involves a
designated Area of Environmental Concern, in which case DCM will act as the lead permitting agency.
In such cases, DCM will require a Coastal Area Management Act (CAlti):A) Permit and will coordinate
the 404/401 Permits.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps; data forms,
photos, etc_ to the applicable USAGE Regulatory Fieid Office (addresses are Listed at the end of this
application). 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, 65 Fed.Reg. 12893
(1Nfarch 9, 2000), available at h=:// vv w.saw.usace.army.mil/wetiands/nwpfinalFedReg odf.
Processing times vary by permit and begin once the application has been determiner) 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 feeds 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 httn://h2o.ebnr.state.ne.us/ncwettands/fees-htmi. 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 Ccrtification- 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
w
Office Use Only:
USAGE Action ID No.
DWQ No.
Form Version April 2001
If any particular item is not applicable to this project, please enter "riot Applicable" or "N/A" ranher thm
leaving the space blank.
I.
H.
Processing
I . Check all of the approval(s) requested for this project:
[1 Section 404 P=mit i
i
Section 10 Permit WETLANDS GRoUP
Q 401 Water Quality Certification WC?TE?1 QUALITY SECTION
Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested:
3 _ If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here:
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section`VIII - Mitigation), check here:
Applicant Information
1. Owner/Applicant Information ??
Name: 1 L
!?A-?L,oa. ?C 7?,75Z
Mailing Address:
Telephone Number-
E-mail Address:
Fax Number.
.PS'T'
2. Agent 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:
Comnanv Affiliation:
Mailing Address:
Telephone Number-
E-mail Address:
Fax Number.
w
III. Project Information
Attach a vicinity map clearly showing the location of :he property with respect to local
landmarks such as towns, rivers, and roads. ALo 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 ititap and MRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other mans 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 I I 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: C aV;o 1 C+z BD?•l?S,o?
2. T.I.P. Project Number (NCDOT Only): 14A
3 . Property Identification Number (Tax PIN: (af (JU$Z ?/ 7?
4. Location
County: ?Lt Nearest Town: r
Subdivision name (include phase/lot number): C?/Loy? ?91 NSror t?rAS?
directions to site?nclude road numbers, landmarks, etc.): 314 Muz ov Se-)5o
`F 5. Site coordinates, if available (UTNt or Lat/Long): 25- M q, Q
(Note - If project is linear, such as a road or utility line, attar a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Descr/?ib?en the a fisting land 'use ?orry?cond1 Witi/onn of t?hetrsite at the time of tthisp? application:
A?yi
R _/,_/1?., 4we r 1 i e-n t Ki C+1 it 898 A&,* (L A 1 ~ Dl4X41
FWre Pr FIZ Se Ler-'fenL TES
7. Property size (acres): -1 ?J. 07 Ac aLe t*• '_ Ase8. Nearest body of water (sti-am/river/sound/ocean/1 re ?f ??6A `??Jed
9. River Basin: tJ Awl
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basal map is available at httD-//h2o.enr.state.ne.us/admin/mars/.)
A
P r
10. Describe the purpose of the proposed work: ?i- ,tAcuL Ay- ,,o
- Q UL ka:;- r 2 Oro, ?4,..,,
1 1. List the type of equipment to be used to construct the project: G -Y,
YNV. t, Qnut
12. Describe the Land use in the vicinity of this project: ?? OV TMAt
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.
?oNg
N
V.. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this worm from the current
application:
lul-A
VL 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, pemaanent
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 descrption, please attach, a separate sheet
S
L Wetland Impacts
Wetiand Impact Area of Located widhin Distance to
Site Number Type of Impact* Impact 100-year Floodpiain- Nearest Stream Type of Wetland***
(indicate on map) (acres) _ (yes/no) (linear feet)
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 (F& MA) Flood Insmrance Rate Maps
(FIFuW, or Fri fA-approved local floodphiin maps. Maps are available through the FM 4A Map So-vice Center at l -S00-3511x9616, or
online athM://www.femasov.
*** List a wetland type that best descnffies wetland to be impacted (e g., freshwater/saltwater marsh, forested wetland, beaver pond,
C: rolina Hay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property:
Total area of wetland impact proposed:
2_ Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
(indicate on map)- -
Type of Impact* Length of
Impact
(linear feet)
Stream Name*" Average Width
of Stream
Before Impact Per ci niai or
Intermittent'z
(please specify)
I

*TC

L,sc cacn uitpact separately and identify temporary impacts. Impacts inciude, but are not limited to: culverts and associated rip- up,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net lossigain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If s m== relocation is
proposed, plans and profiles showing the linear footprint fbr both the original and relocated streams must be included-
Stream names can be found on USGS topogtaphic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named slx=m into which it flows- USGS maps are available through the USGS at 1-800-358-9616, or online at
www'Usgs.gov. Several internet sires also allow direct download and printing of USGS maps (e.g., www_torozone.Com
www.nanauestcotn etc.).
Cumulative impacts (linear distance in feet) to all sire-- m on site: ± I Zo"

3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Or= Water impact
Site Number
(indicate on map) T
Type of Impace Area of
Impact

(ate)
Name of Waterbody
(if applicabie) Type of Waterbody
(lake, on 3+
pond,
bay, ocean, etc.)
I

f
i.isT Baca Impact separately ana wentay temporary impacts. impacts meiuae, out are aot amnea to: tsll, excavation, dredgmg,
fiaoding; drainage, buik cada ere.
4. 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.): NIA
Proposed use or purpose of pond (e.g., lives ock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): -0 Q
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.

VIII. Mitigation
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 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 proposer- 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 mitiga#on'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
htti)://h2c.enr.state.nc.us/ncwetiands/strm6die--htmi.
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.
2_ mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicams
will be notified early in the review process by the 401 /Wetlands Unit if payment into the
NCWRP is available as an option- For additional information regarding the application
process for the NCWRP, check the NCWRP website at httnJ/h2o.enr_state.ne-us/wrn/indes.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):
IX. Environmental Documentation (DWQ Only)
p 1,4
Does the project involve an expenditure of public funds or the use of public (federal/s=rAocal)
land?
Yes F No [J,
If yes, does the project require pr paration 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 NEPASEPA document is required, call the SEPA
coordinator-at [phone] to review current thresholds for environmental documentation.
Yes No
If yes, has the document review: been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA approval letter-
Yes F? No
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
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. Correspondencc 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 EVT"'- If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the npaaan buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* uupacc Req=r-d
(square feet Multiplier
Mitigation
2 1.5
Total
Zone I eeitads out 30 feet perpeudi=lar from near bank of ciiannei; Zane 2 emends an
additional 20 feat from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (Le, 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. 02 60.
f f
XI. Stormwater (DWQ Only)
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.
XIL Sewage Disposal (DWQ Only)
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.
XM Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No ?
Is this an after-the-fact permit application? -
Yes ?] No ?
XI-V- 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).
3z
A*Iicant/Agent's Signatm-0 Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
US Army Carps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell
US Army Corps of Engineers Avery Clay Jackson Polk
151 Patton Avenue Buncombe Cleveland Lincoln Rowan
Room.208. Broke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabamrs Graham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell. Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes
6508 Falls of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post office Box 1000 Camdea Gates Martin
Washington, NC 27889-1000 Carteret4 Green Pamlico
Telephone: [phone]I6 Chowau Hertford Pasquotank
Fax: (=) 975-1399 Craven Hyde Perquimans
Wilmington Regulatory Field Ofticc Anson- Dunlin Onslow
US Army Corps Of Engineers Bladen Barnett Pender
Post Offi= Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus 1Vloore Samnson
Fax: [phone] Camberiand New Hanover Scotland
Pitt
Tyrrell
Washington
Wayne
tf -Z-
Union
Watauga
Yancey
Wilson
Yadkin
*C.-oatan National Forest Only
US Fish and Wildlife Service I 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]
North Carolina State Agencies
Division of Water Quality Division of Water Quality State Historic Preservation Offi

401 Wetlands Unit
Wetlands Restoration Program ce
Department Of Cultural Resour

1650 Mail Service Center
Raleigh
NC 27699-1650
1619 Mail Service Center =
4617 Mail Service, Center
,
Telephone: [phone] Raleigh, NC 27699-1 6 1 9 Raleigh, NC 27699-4617

Fax: [phone] Telephone: [phone] Telephone: [phone]
Fax: [phone] Fax: [phone]
CA31A and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bettie Craven Hyde Pender
Raleigh, NC 27699-1638
Telephone: [phone] Bnuiswick Cmrituck New Hanover Perquimans

Fax: [phone] Camden Dare
Carteret Gates Cnslow Tyrrell
Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kemersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain R:on Coardin=r Buncombe Henderson Poik
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
\4
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DEEP WOODS ESTATES
M.B. 4, PG. 299, ET SEQ.
APR 1 8 2002
WETLANDS MUP
WATER UALITY SECTION

/ilk In/ 't
?vErL,aNDS c?rol,'U??

Pre-Construction Notification (P°CN) 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, Re 'onal 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 fcr 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 CerEdcation_ The USACE Individual Permit application form is available online at
httz)://www.saw.usace.armv.mil/wetiands/Perm amp htm.
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 httn://www.saw.usace.,9rTn.mil/wetlands/reatounhtrn or contact one of the field
offices listed at the.end of this application' a website also lists the responsible project manager for
each county in North Carolina and provider 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
httu://h2o.enr.state_nc.us/ncwedands to read about cur=nt 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 some 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 ResOurcCS
Commission (NCWRC) is also 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 the last page of this application).
.a
CANIA Coordination - If the project occurs in any of North Carolina's twenty coastal counties (listed on
the last page of this application) the applicant should also contact the North Carolina Division of Coastal
Management (DCN.I) at [phone]. DCM, will determine whether or not the project involves a
designated Area of Environmental Concern, in which case DCM will act as the lead permitting agency.
In such cases, DCM will require a Coastal Area Management Act (CAItiIA) Permit and will coordinate
the 404/401 Permits.
USACE Permits - Submit one copy of this forna, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office (addresses are listed at the end of this
application). 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 eaeh USACE Nationwide permit, see Condition 13, 65 Fed-Reg. 12893
(March 9, 2000), available at htro://www.saw.usace.a=v.mil/wettands/-nwofLnalFedRea.l)df.
Processing times vary by permit and begin once the application has been determiner) to be complete.
Please contact the appropriate regulatory field'offce 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 Qualify, 40l/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 $475 is
required- A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at htti)://h2o.ehnr.state.nc.as/ncwetlands/fees-htm - The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issuer) from a separate o$-ice. 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-bold letter pending receipt of additional
requested information, or denial-

Off-ice Use Only:
USAGE Action ID No.
DWQ No.
Form Version ADri1 2001
If any particular item is not applicable to this project, please eater "Not Applicable" or "N/A" rather than
leaving the space blank.
I. Processing
1. Check all of the approval(s) requested for this project: 2902
[] Section 404 Permit c
section 10 Permit ' WETLANDS GR 3
OUP
401 Water Quality Certification EuQUALITY SECTION
f ] Riparian or Watershed Buffer Rules _.
2. Nationwide, Regional or General Permit Number(s) Requested.
3 _ If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here:
4_ If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section-VIE - lAitigation), check here:
H. Applicant Information
I. Owner/Applicant Information f?
Name: b 1 Lre
Mailing Address: LAY-t-'T7w
Mss-fL.ov NC
Telephone Number 2.0 '7til ggq5 Fax Number-
E-mail Address: H i Tc !? G?_) N LLrb - t-j OT
2. Agent 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.
.„
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 mans and plans should
include the appropriate USGS Topographic Quad TVlap 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 I I 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 fall-size plans are
reduced to a small scale such that the final version is hlegi'bie, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
I . Name of project: Cj2oSS Ca
2. T.I.P. Project Number (NCDOT Only). M-A
3 . Property Identification Number (Tax PIN): ?dJ 0092 7/ 7
4. Location N0
County: Nearest Town: r
-- tA?
Subdivision name (include phase/lot number): C9?NS,rar t?I?SE
erections to site include road numbers, landmarks, etc.): 314 Mlix, oc.? 54 )501
(f-ff1Z'?Gir?S QZAO-) ?iv?i f ?Q6 (N re- AP 1',7-0t
S. Site coordinates, if available (UTiV1 or Lat/Long): 5 r-)
(Note - If project is linear, such as a mad or utility line, attar a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
9.
n
b. Describe the existing land use or condition of the site at the time of this application:
F"?A- ELZ ScLer-16v
TES
7. Property size (acres): LK 1J P? ?AS?
S. Nearest body of water (stream/river/sound/oce='1 e4: 1, b?v?SA ?-' I)e(L
River Basin: U AtPNJ(?A _
(Note - this must be one of North Carolina's seventeen designated maior river basins
River Basin map is available at httu://h2o.enr.state.-ne.us/admin/ria-cs/.)
The
.
A
10. Describe the purpose of the proposed work: 1i Acu A- 'alf Ac,
11. List the type of equipment to be used to construct the project: Ic Qn,"t
12. Describe the land use in the vicinaty of this project: G950 YTMA L
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 TT-P. project, along with
construction schedules.
V.. Future Project Plans
Are any additional permit requests anticipated for this project in d e -future? If so, describe the
anticipated woric, and provide justification for the exclusion of this work from the current
application:
VL 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 applicants 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_

I . Wetland Impacts
Wetland lr p a
Site Number
(indicate on map)
Area
to
Type of imnact* Impact 1100-year Floodplain** Nearest Stream Type of Wetland***
(acres) f (yesino) (linear feet)
List eacu unpact separately and ideunfy temporary mrpacts Impacts include, bur are not limited to: mechanized cieuring, grading, ?,
** excavation, flooding, ditching/drainage, eta For dams, scparawiy list impacts due to both structure and flooding.
100-Year floodplains are identified through the Federal Emergency Management Agency's (FadA) Flood Insurance Rule Maps
(FiRW, or FE1i rfA-approved local floodpiain maps. Maps are available through the FB4A Map Service Center at 1-500-358-9616, or
online at httnJ/wwv.fema.zoV.
#** List a wetland type that best describes wetland to be impacted (e g„ freshwater/saitwater marsh, forested wetland, beaver pond,
Crolina Hay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: N JA
Total area of wetland impact proposed:
2- Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number Type of Impact*
(azdicate on man) Length of
Impact
(linear feet)
Stream Nam*.'
7 Average Width
of Stream
Before Impact Perennial or
Intermittenri
(please specify)
--
4-' I r-T?Key-tier
I '

I

n I _L
impact separately and tnentity temporary tmpaM 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 lossigam),
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.
+x 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 wbich it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
ww11v.oses.sov. Several internet sires also allow direct download and printing of USGS maps (e.g., www_tooozone corn,
www,manouest.cam etc.).
Clunuiative impacts (linear distance in feat) to all streams on site: t l ZO'
w '
Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact

Site Number
on man

Type of Impact' Area of

Impact

(acres)

(if Name appplicabicle) Wat) Type of'
atezboay
(lake, pond,,=Mary,
sound,
bay, ocean, etc.)

MA

j
f
List =ca impart separately and identify temporary impacts. Impacts include, but arc not limited to: till, =cavation, dredging,
flooduig; dramage, bulkheads, etc.
4. 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, excavat ion, installation of
draw-down valve or spillway, etc.): NIA
Proposed use or purpose of pond (e.g.,, lives ock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): 0 A'
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts-

A
VIII- Mtigation
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 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. Eumples 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
laeidng 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
hrtr).//h2o.enr.state.ne.us/newetiands/strmgide-htmi.
I. 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 (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.
•.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWR.P) with the NCWRP's -written agreement. Check the box indicating that
you would lime to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at httnJ/h2o.enr.s=e.nc.us/wro/index.hun. 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 bu$er 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):
Ix Environmental Documentation (DWQ Only)
p Je4
Does the project involve an expenditure of public funds or the use of public (federal/statellocal)
land? .
Yes M No k,
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) -M-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 dj?al approval letter-
Yes 0 No
Y. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map ail impacts to
required state and local buffers associated with the project. The appli cant must also pro
vide
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
(Neese), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B _0250 (Randleman Rules and
Water Supply Buffer Requirements), or other- (please identify-----------_______---)?
Yes [-I 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.
Zane ?L Multiplier Kequzed
(square feet) Mitigation
1 ?
2 1.5
Total
# Zone 1 extends out 30 feel perpendirilar from near bank of channel; Zone 2 extends an
additional 20 fezt from the edge of Zone 1.
U buffer mitigation is required, please discuss what type of mitigation is proposed (Le., 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 .0241 or. 02 60.

X1 Stormwater (DWQ Only)
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.
XIL Sewage Disposal (DWQ Only)
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.
UM Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC ZH.0500) or any Buffer Rules?
Yes ? No F
Is this an after-the-fact permit application?
Yes 7 . No 7

XIV. Otter 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
worst schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility probleras, or other issues outside of the applicant's control).
?( Z
A licant/Agent's S i Date
(Agent's signature is valid only if an authorization letter from the applicant is provided-)
d7-
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee IredelI Mitchell Union
US Army Corps of Engineers Avery Clay Jackson Polk Watauga
151 Patton Avenue Buncombe Cleveland Lincoln Rowan Yancey
Room. 208.
Burke
Gaston
Macon
Rutherford
Asheville, NC 28801-5006 Cabanas G..aham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell. Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham Wilson
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes Yadkin
6508 Falls of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers Berrie Dare Lenoir Tyrrell
Post Offlce Box 1000 Camden Gates Martin Washington
Washington, NC 2788.9-1000 Carteret* Green Pamlico Wayne
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde P=Iuimans *Croatan National Forest Only
Wilmington Regulatory Field Office Anson- Duniin Ouslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1390 Carteret Mont,omery Robeson
Telephone: [phone] Columbus ;Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland

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 O$-ice Box 33726 160 Zillicoa Street Pivers Island
Raleigh, NC 27636-3726 Asheville, NC 28801 Beaufort; NC 28516
Telephone: [phone] Telephone: [phone] Telephone: [phone]
North Carolina State Agencies
Division of Water Quality Division of Water Quality State Historic Preservation Office
401 Wetlands Unit Wetlands Restoration Program Department of Cultural Resource

1650 Nail Service Center
1619 Mail Service Center s
4617 Mail Service Center
Raleigh., NC 27699-1650 Raleigh, NC 27699-1619 Raleigh
NC 27699-4,617
Telephone: [phone] Telephone: [phone] ,
Telephone: [phone]
Fax: [phone] Fax: [phone] Fax: (P19) 715-2671
CA.MA 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 Currituek New Hanover Pesquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gazes Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kernenville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Headerson Polk
20830 Great Smoky Mtn- Expressway Cherokee Jackson Rutherford
WaynesvilIe, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey

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Pre-Construction Notifiitcation (PCN) Application Fos m
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, Re 'onal 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 Peunit or Individual 401
Water Quality Certification- The USACE Individual Permit application form is available online at
httn:/ /www_saw.usace army mil/wetlands/Perm anp.htm.
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 httn://www.saw.usace.arm .mid/wetlands/rep-tour. or contact one of the field
offices listed at the-end of this application' Tiie 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
htt-o://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 some 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 also 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 anpropriate NCWRC
regional coordinator (listed by county on the last page of this application).
A
CAMA Coordination - If the project occurs in any of North Carolina's twenty coastal counties (listed on
the last page of this application) the applicant should also contact the North Carolina Division of Coastal
Management (DC.M) at [phone]. DCM. will determine whether or not the project involves a
designated Area of Environmental Concern, in which case DCM will act as the lead permitting agency.
In such cases, DCM will require a Coastal Area Management Act (CAIVIA) Permit and will coordinate
the 404/401 Permits-
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms.
photos, etc. to the applicable USAGE Regulatory Field Offce (addresses are listed at the end of this
application). 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
providers for a complete PCN for each USACE Nationwide permit, se; Condition 13, 65 Fed-Reg- 12893
(March 9, 2000), available at h=://www.saw.usace.army.mil/wetiands/nwpfinalFedRea ndf.
Processing times vary by permit and begin once the application has been determined to be complete-
Please contact the appropriate regulatory fieid'office for specific'answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise staters
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 htti):/Ai2o.ehnr.state.ne.us/newettands/feesltmi- 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-bold letter pending receipt of additional
requested information, or deniaL
office Use Only:
USACE Action ID No.
Processing
DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" der than
Leaving the space blank.
i.
1. Check all of the approval(s) requested for this project:
? Section 404 Permit
? Section 10 Permit
? 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
Form Version April 2001
i i
WETLANDS GROUP
NJATER UALITY SEr inn
2. Nationwide, Regional or General Permit Number(s) Requested:
3 _ If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: []
4. If payment into the North Carolina Wetlands Restoration Program (NC`VW) is proposed for
mitigation of impacts (see section-VIII - Mitigation), check here: ?
II. Applicant Information
M,+V2_,o6. N C 7_s
1. Owner/Applicant Information (?
Name: 1 _ I-Q?,V4,
Mailing Address: `153 LAY-t- -Oro
Telephone Number:
E-mail Address:
Fax Number.
2. Agent 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.
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,
impemous 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 maybe included at the applicant's discretion,
so long as the property is clearly dehned_ For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 1I by 17-inch format;
however, DWQ may accept paperwork of any size- DWQ prefers fu11-size construction
drawings rather than a sequential sheet version of the fu11-size plans. If full-size plans are
reduced to a smati 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: Cao? Ca4c ? ?uGO%'J's,oN ??t4p'?r
2. T.I.P. Project Number (NCDOT Only): IVIA
3. Property Identification Number (Tax PIN): Q'jaJ u(1F'2 7/
4. Location
County: Nearest Town: r
Subdivision name (include phase/lot number): (/eo C?? Gst6!>o,4 r- 1AA5F
Directions to site_znclude road numbers, landmarks; etc.): 314 Mqx oN Se- )501
h 5. Site coordinates, if available (UTNI or Lat/Long):
(Note - If project is linear, such. as a road or utility line, attar a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
9
b. Describe the existing land use or condition of the site at the time of this application:
I-LQ.* - O Mben. Lu ?s COT (?- tWgB L&,.yr 1 ? r D?
7. Property size (acres): I ?3."6 f-- a, fs tr-
S. Nearest body of water (str-,-am/river/sound/ocean/I re-LPAcvx'iA ?-' I)e(-
River Basin: LA-,(N j(?A
(Note - this must be one of North Carolina's seventeen designated maior river basins.
River Basin map is available at htto://h2o.enr.smte.-ne.us/admin/man--/.)
The
Y
10. Describe the purpose of the proposed work: Vi-*q,,,- A- 9ifp A?,o LO
Q U ? r Z Oi Firer ,,tcki!m _
1 I. List the type of equipment to be used to construct the project: 1 ?A-?? ?t 077-v2
12. Describe the land use in the vicinity of this projects
IV. Prior Project History
If jurisdictional determinations and/or permits have been requester) 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 pem2its,
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.LP. project, along with
construction schedules.
N
V.. Future Project Plans
Are any additional permit requests anticipated for this project in the-future? If so, describe the
anticipated woric, and provide justification for the exclusion of this work from the current
application:
N
VL 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-

1. Wetland Impacts
w etiana impact Area of Located within - - Distance to
Site Number Type of Impact* Impact 100-year Floodplain-** Nearest Stream Type of Wetland***
(indicate on map) - (acres) (yea/no) (linear feet)
* List each impact separately and identify temporary impacts Impacts incitide, but are not limited to: mechanized ciearing, grading, ?U,
excavation, flooding ditchinraJdrainage, eta For dams, separately list impacts due to both structure and flooding.
100-Year floodplams are identified through the Federal Emergency Management Agency's (FEAT tA) Flood Insnrance Rate Maps
(FIRM), or FE MA-approved local IIoodpiain maps Maps arc available through the Flr'4A Map Service C=ter at 1-800-358-9616, or
online athttDJ/www-fema.zov.
*** List a wetland type that best describes wetland to be impacted (e g., freshwatar/saltwater marsh, fnr=tr-d wetland, beaver pond,
Carolina Hay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property:
Total area of wetland impact proposed:
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
(medicate on man)
Type of Impact* Length of
Impact
(linear feet)
Stream Name*' Average Width
of Stream
Before Impact Perennial or
Intermittent3
(please specify)
I
;t 50

List each impact se parately and identify temporary impa cts. Impacts include, but are not limited to: enive zs and associated rip-=
dams (separately list impacts due to both stricture and flooding), relocation (include linear feet before and after, and net lossigain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, eta If scam relocation is
proposed, plans and profiles showing the linear footprint fbr both the original and relocated strcams must be included.
t* Strum 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.uses.Qov. Severai interact sites also allow direct download and printing of USGS maps (e.g., www-tonozonc.corn
www.manouestcom. eta).
MA
Clmmuiative impacts (linear distance in feet) to all streams on site: ± 1 zc

Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact
Site Number
(indicate on man).
Type of Impace Area of
Impact
(acres) Name or Waterbody
)
(if anplilicabicabie -- Type of Waterbody
(lake, pond, eamary, soup
bay, occan,

?
I
List rch impact separately and identify temporary impacts impacts include, but are not limited to: fill. =cavation, dredging,
flooding; drainage, buikhc c* em
4. 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): F-] uplands [] stream wetlands
Describe the method of construction (e.g. dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): NIA
Proposed use or purpose of pond (e.g'.' livesock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): f A'
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
infonnation 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 developers. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
S?r Q -S vr- Cot-'N*c PL-At- AT rAc 0M-ei--T-

VM_ Mitigation
D WQ - 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 Modifcation 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 fimetion and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. E.-ramples 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
fractions 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
httr)://h2o.enr.state.nc.us/newetiands/strmglde-htmi.
I. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin,. type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc_), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at htW://h2o.enr_state.ne.us/wTm/l*ndex.htm. If
use of the NC %W is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet): ?'eA
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):
Ix Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public fiends or the use of public (federal/state/local)
land?
Yes r-1 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 NEPAISEPA document is required, call the SEPA
coordinator-at [phone] to review current thresholds for environmental documentation.
Yes No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA dilal approval letter.
Yes F ? No
X. Proposers Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agents) 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
(Neese), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please idesltify )?
Yes 7 No f"' 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* I (,rnin fL+.) I Multiplier 1
f
I 2
I Total I f -
" Zone ]' extends out 30 feet perpendicalar from near bank of channel; Zone 2 extends an
additional 20 feat from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (Le., 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.

XT. Stormwater (DWQ Only)
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 (DWQ Only)
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.
VIM Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No ?
Is this an after-the-fact permit application?
Yes ? . No ?
XGV. 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
worm 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).
3z
Arolicant/Agent's Signatures Date
(Agent's signature is valid only if an authorization letter from the applicant is provided-)
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell
US Army Corps of Engineers Avery Clay Jackson Polk
151 Patton Avenue Buncombe Cleveland Lincoln Rowan
Room.208. Bud a Gaston Macon . Rutherford
Asheville, NC 23801-5006 Cabarrus Graham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell. Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes
6508 Falls of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort C:urituck 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 Pusquotank
Fax: (25.) 975-1399 Craven Hyde Perquimans
Wilmington Regulatory Field Oflzcx Anson- Dupiin Onslow
US Army Corps Of Bngmeers Biaden Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 2 8402-1 3 90 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Samnson
Fax: (910) 251=4)25 Cumberland New Hanover Scotland
Pitt
Tyrrell
Washington
Wayne
dZ
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
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 33725 160 ZiMcoa Street Pivers Island
Raleigh, NC 27636-3726 Asheville, NC 28801 Beaufort, NC 28516
Telephone: [phone] Telephone: [phone] Telephone: [phone]
North Carolina State Agencies
Division of water Quality Division of Water Quality State Historic Preservation Offi

401 Wetlands Unit
1650 Mail Service Cente
Wetlands Restoration Program ce
Department Of Cultural Resources
r
Raleigh, NC 27699-1650 1619 Mail Service Center
Raleigh
NC 27699-1619 4617 Mail Service Center

Telephone: [phone] ,
Telephone: [phone] Raleigh, NC 27699-4617
Telephone: [phone]
Fax: [phone] Fax: [phone] Fax: [phone]
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
Telephone: [phone] Brunswick Currituck New Hanover Perquimans

Fat: [phone] Camden Dare
Carteret Gates Onslow Tyrmll
Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kemersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Roizien Coordinator Buncombe Headerson 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
?a
16
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WETLANDS GROUP
WATE1t UALITY
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-1
Pre-Construction Notification (PCN) Application Fom
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 Engin=rs' (USACE)
Nationwide, Re 'onal or General Permits as required by Section 404 of the CIean 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 fcr 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
httn://www.saw.usace army miVwetlands/Perm app.htm.
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 httr3://www.saw.usace.a-rmv. mi1/wetlands/rep-tour.httn or contact one of time field
offices listed at the.end of this application- a 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 D WQ's 401 /Wetlands Unit website at
htto://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 some General Certifications is -not required,
provided that the applicant adheres to all conditions of the GC_ Applicants lacking access to the inter-net
should contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination = Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is also 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 NC rW, RC
regional coordinator (listed by county on the last page of this application).
..? ' ? 'Ja'?7
y
,--? 'J
6',
77TD,SG,S rim..

CAMA Coordination - If the project occurs in any of North Carolina's twenty coastal counties (listed on
the last page of this application) the applicant should also contact the North Carolina Division of Coastal
Management (DCM) at [phone]. DCI , will determine whether or not the project involves a
designated Asea of Environmental Concern, in which case DCM will act as the lead permitting agency.
In such cases, DCM will require a Coastal Area Management Act (CA1MA) Permit and will coordinate
the 404/401 Permits.
USAGE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms.
photos, etc. to the applicable USACE Regulatory Field Office (addresses are listed at the end of this
application). 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, se; Condition 13, 65 Fed.Reg.12893
(March 9, 2000), available at h=://www.saw.usace.army.n2u/wettands/nwpfLnalFedR?g.Ddf.
Processing times vary by permit and begin once the application has been determiners to be complete-
Please contact the appropriate regulatory field'office for specifie'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 Mali Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refimdable 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 httr3:/Ai2o.ebnr.state.ne.us/newettands/feeshtmi- 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.
Office Use Only:
USAGE Action ID No.
Processing
Farm Version April 2001
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
L
1. Check all of the approval(s) requested for this project: - 5 2,902
[] S
Section 404 Pit
section 10 Permit WETLANDS GROUP
F? 401 Water Quality Certification MMOUf L SECTION
Riparian or Watershed Buffer Rules
2 Nationwide, Regional or General Permit Number(s) Requested:
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: []
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section-VIII - Mitigation), check here:
II. Applicant Information
MA-a, o•• Mc ZVKSZ
1. Owner/Applicant Information
Name: ?b?
Mailing Address: 153 LAS- _V?-0
Telephone Number. 67,0 '72#
E-mail Address: M I To H- C
DWQ No.
a9S Fax Number.
2. Agent Information (A signed and dated copy of the Agent Authori=tion 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.
M. 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 Nlap and MRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps maybe 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 1 I by 17-inch format;
however, D WQ may accept paperwork of any size. D WQ 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: Ci2oss CtG4 ?u go%,i,S,ot
2. T.I.P. Project Number (NCDOT Only):
3 . Property Identification Number (Tax PIN): 02?; 0092 7/
4. Location
County: ?ZZt Nearest Town: c'
Subdivision name (include phase/lot number): 1..-44AA3p,N5rvr letJFSF
rrerections to site include road numbers, landmarks, etc.): 314 Mu4 ov Se- moi
5. Site coordinates, if available (UTIM or Lat/Long): 67M M q, Q
(Note - If project is linear, such as a road or utility line, attar a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
9
6. Describe the existing land use or condition of the site at the time of this application:
LQA- LAwo r T M 6ert_ Wk, C.n it 848 A&Ae- W r C)14-km?rL
FXeO RZ SCLer--r'ev TES
7. Property size (acres): 3.45 Aca6 tt-
S. Nearest body of water (streaanvnver/sound/ocean/1 e: ?Acv?X'?A ?-'Jen-
River Basin: U A-fN.J8N
(Note - this must be one of North Carolina's seventeen designated major river basins.
River Basin map is available at htw://h2o.enr.state.ne.us/admiia/1-na-cs/.)
The
p w
10. Describe the purpose of the proposed work: `j-?X t- Ar' $? Auo L6
Q Uc.,kJZ,- 11-- 2 Oi qi7, 7T;P s? --_
11. List the type of equipment to be used to construct the project: +D- 1? Cb7,e`L
12. Describe the land use in the vicinity of this project: &51 V?rmht
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obcnined for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn- Provide photocopies of previously issued permits,
certifications or other useful information- Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
V.. Future Project Plans
Are any additional permit requests anticipated for this project in tote future? If so, describe the
anticipated work, and provide justif cation for the exclusion of this work from the current
application:
lul-A
VL 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
I. Wetland Impacts
Wetland Impacz
Site Number Type of Impact*
indicate on maal
Area of Located within Distance to
Impact 100 year Floodpla.n** Nearest Stream Type of Wetland***
(acres) (yes/no) (linear feet)
List each impact separately and identify temporary impacts- Impacts include, but are not limited to: mechanid clearing, grading, tEl,
axcav=on, .flooding, ditchmg/drimagr, eta For dams, separately list impacts due to both structure and flooding.
100-Year floodplains are identified through the Federal Emergency Management Agency's (M A) Flood Insurance Race Maps
(FIRM), or FEMA-approved local floodplain maps Maps are available through the FELLA Map Service Center at 1-500-358-9616, or
online at hfnJ/www.femiL Ov.
** List a wetland type that best desc:ribes wetland to be impacted (e.g., freshwatcr/saltwater marsh, fnrested wetland, beaver pond,
Carolina Hay, bog etc.)
List the total acreage (estimated) of existing wetlands on the property: J?
Total area of wetland impact proposed:
2. Stream Impacts, including all intermittent and perennial streams
Steam Impact
Site Number
(indicate on map)-
Type of Impact* Length of
Impact
(linear feet)
Stream Name*' Average Width
of Stream
Before Impact Perennial or
Intermittenrz
(please specify)

?1t,.JrM.?f J?O P' 14,?zyt f-r-?cy ?

List each impact se parately and identify temporary impa cts Impacts include, but are not limited to: culve rt and assocmn:d rin-ran_
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, eta), excavation, ditching/straightening, eta T saream relocation is
proposed, plans and profiles showing the linear footprint fbr both the original and relocated strums must be included.
t* 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 mans are available through the USGS at 1-800-358-9616, or online at
wwNV.vses.sov. Several interact sites also allow direct download and printing of USGS maps (e.g., www.tonozone com.
www.manauestcom. eta).
Culnuiat:ive impacts (linear distance m feat) to ail streams on site: t k 7.Ot
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact
Site Number
(indicate on map)
Type of Im ace
P Area of
Im act
P
(acres)
p
Name Waterbody
(if applicable) Type of Warerboay
(ice Pond, estuary, sound,
bay, ocean, etc.)

Lj esrh empac t separately and identify temporary impacts. Impacts mciude, but are not limited to: fill, . c:Lyatlon, dredging.
flooding; drainage, tnsi eaa , em
4. 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): F? uplands [] stream wetlands
Describe the method of construction (e.g. dam/embankment, excavation, installation of
draw-down valve or spillway, etc-): NIA
Proposed use or purpose of pond (e.g., lives ock watering, irrigation, aesthetic, trout pond,
local stonnwater requirement, etc.): h1 A
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 werenot feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.

VIII- Mitigation
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 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 proposer- 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 mitiga#on'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
htti)://h2 o. enr.state.nc.us/ncwetlands/strm gide.htmi.
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.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NC VW) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option For additional information regarding the application
process for the NCWRP, check the NCWRP website at httD://h2o.enr.5=e.nc.us/wrn/indec.htrn. 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): ?',A
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 requesters (acres):
IX Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/statrAocal)
land?
Yes r_? No [J,
If yes, does the project require pr,, partition of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: . If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator-at [phone] to review current thresholds for environmental documentation.
Yes [] No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No
Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan.. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 213 .0233
(Neese), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes 7 No .,I 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.
* Impact Required
Zone (square feet) Multiplier ,
1 3
2 1.5
Total I i
* Zone l exten
`ds out 30 feet perpendi tar from` near bank of channel, Zone 2 emends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (Le, 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.

XL Stormwater (DWQ Only)
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.
M Sewage Disposal (DWQ Only)
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.
XM Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes [] No ?
Is this an after-the-fact permit application? -
Yes 7 . No 7
XI-V- Other Circuatstances (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),
S2
Applicant/Agent's Signature6 Date
(Agent's signature is valid only if an authorization letter from the applicant is provided-)
US Army Carps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee IredelI Mitchell
US Army Corps of Engineers Avery Clay Jackson Polk
151 Patton Avenue Buncombe Cleveland Lincoln Rowan
Room.208. Burke Gaston Macon Rutherford
Asheville, NC 28301-5006 Cabarrus Graham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell . Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes
6508 Fails of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Waxen
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Carritudc Jones
US Army Carps 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 Offices Anson- Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1390 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
Pitt
Tyrrell
Washington
Wayne
d'Z....
Union
Watauga
Yancey
Wilson
Yadkin
*Croat m National Forest Only
US Fish and Wildlife Service / National Marine Fisheries Se3-vice
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 Ziillicoa Street Pivers Island
Raleigh, NC 27636-3726 Asheville, NC 23801 Beaufort; NC 28516
Telephone: [phone] Telephone: [phone] Telephone: [phone]
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit Division of Water Quality State Historic Preservation Offic
e

1630 Mail Service Cente Wetlands Restoration Program Department Of CulttnaI Resources
r
Raleigh
NC 27699-1650 1619 Mail Se: vice Center 4617 Mail Service Center
,
Telephone: [phone] Raleigh, NC 27699-1619 Raleigh, NC 27699-4617

Fax: [phone] Telephone: [phone] Telephone: [phone]
Fax: [phone] Fax: (9I9) 715-2671
CAMA and NC Coastal Counties
Division of Coastal Management , Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Berne Craven Hyde Pender
Raleigh, NC 27699-1 63 8
Telephone: [phone] Brunswick Currituck New Hanover Perquimans

Fax: [phone] Camden Dare Onslow Tyrrell
Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 IdMewild 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

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APR 1 8M.
wETUras GROUP
WATER QUALITY SECTION. _
n .n' 1 s
•,r, ?FTLANDS
A
Y?
06
Pre-Construction -Noti ication (PCN) AppEembon 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
l r
This foma is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USAC; j
Nationwide, Re onal 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
httn:,I/viww-saw.usace.armv.mil/wetiands/Perm. am.htm.
The USACE is the lead.regulatory agency.. To review the requirements for the use of Nationwide,
Regional or General perruits, and to determine which permit applies to your project, please go to. the
USACE website at httu://www.saw.usace.arm??. . mil/wetlands/icatour.htm or contact one of the field
offices listed at the.end of this application- Tiie 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 D WQ 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 D WQ's 401 /Wetlands Unit website at
httu://h2o.enr.state.nc.us/ncwetlands to read about current requirements for the 401 Water Quality
Certification Pro mm 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 some General Certifications is not required,
provided that the applicant adheres to all conditions of the GC. Applicants lacking access to the inteznet
should contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is also 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 the last page of this application).

LAMA Coordination - If the project occurs in any of North Carolina's twenty coastal counties (listed on
the last page of this application) the applicant should also contact the North Carolina Division of Coastal
Management (DC1Vl) at [phone]. DCM. will determine whether or not the project involves a
designated Area of Environmental Concern, in which case DCM will act as the lead permitting agency.
In such cases, DCM will require a Coastal Area Management Act (CAiti1A) Permit and will coordinate
the 404/401 Permits.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office (addresses are listed at the end of this
application). 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
providers for a complete PCN for each USACE Nationwide permit, see Condition 13, 65 Fed.Reg. 12893
(Nfarch 9, 2000), available at httn://www.saw.usace.army.mil/wetiands/nwpfinalFedRe r pdf
Processing times vary by permit and begin once the application has been determiner) to be complete.
Please contact the appropriate regulatory field'oface 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 httn://h2o.ehnr.state.nc.us/ncwetiands/fees. it - The fee must be
attached with the application unless the appiacaat 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
N
Office Use Only:
USACE Action ID No.
D WQ No.
Form version Anrii 2001
If any particular item is not applicable to this project, please enter 'Not Applicable" or "N/A" rather than
leaving the space blank.
1.
II.
Processing
1. Check all of the approval(s) requested for this project:
Fj Section 404 Permit 4
I
Section 10 Permit WETLANDS GROUP
401 Water Quality Certification WATER QUALITY SECTION
Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested-
3 . If this notification is solely a courtesy copy because written approval for the 401 Ce•rtincation
is not required, check here: []
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section-VIE - Mitigation), check here:
Applicant Information
1. Owner/Applicant-Information
1 1
Name: Qtez
Mailing Address: X53 LAIGZ' `VA14 _+-
o., N C
Telephone Number ZS '7Z# OAg5 Fax Number.
E-mail Address: H ITc R G?_) tV L U-6 -wr
2. Agent 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.
a
0
M. Project Information
Attach a vieinity 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 vicm' ity 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 maybe included at the applicant's discretion,
so long as the property is clearly defined For administrative and distribution purposes, the
USAGE requi information to be submitted on sheets no larger than I I 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: Cep BD?•I•S?o?'
2. T.I.P. Project Number (NCDOT Only). NilA
3 . Property Identification Number (Tax PN: ?aJ 0092 71 ?5?
4. Location No
,yam
County: ?LZ Nearest Town: ?/t r
Subdivision name (include phase/lot number): C-4?
ections to site include road numbers, landmarks, etc.): 314 Maz
r5 uA{Fp ??"???1 ?b N ve, Le,-A- . eft
5. Site coordinates, if available (UTM or Lat/Long):
(Note - If project is linear, such as a road or utility line, attar a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application:
I)-
F'Ke?r FtV- SeLe216V 771_dzvS
7. Property size (acres): LK ,?5 ?C pr-
8. Nearest body of water (str°,am/river/sound/ocean/1 e, c8?d?"iA
9. River Basin: 04_'rN-J8A
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at htt-o://h2o.enr.state.ne.us/admin/mars/.)

10. Describe the purpose of the proposed work: ?iY,lku, At-1 U? A,, Lfg
- Q yt,,ir&-l r Z Oi -ERAt,! ,
11. List the type of equipment to be used to construct the project: 1 f c ?Nc? , Dal
12. Describe the land use in the vicinity of this project:- &51 M-NIA-L,
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) is 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.
N
V.. Future Project Plans
Are any additional permit requests auticipaied for this project in fire -future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application:
VL 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 she--

L Wetland Inmacts
Wetland Impact Area of Located Within Distance to
Site Number Type of Impact* Impact 100-year Floodplam** Nearest Stream Type of Wetland***
(indicate an map) (acres) (yea/no) (linear feat)
i.L?a cu n impact separately ann identify temporary impacts. Impacts mciude, but are not limited t0: mechantzed cieanng, grading
** excavation, flooding; dMiing/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 UM IA) Flood Insurance Rate, Maps
(FIRM), or FEtii fA-approved local floodplaiuu maps. Maps are available through the FEii fA Map Service Center at 1-800-358-9616, or
online at h=://www.fema.zov.
**" List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, fbrm7ed wetland, beaver pond,
Carolina Say, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: N JA
Total area of wetland impact proposed:
2- Stream Impacts, including ail intermittent and perennial streams
Stream impact
Site Number
(indicate on map)-
Type of Impact'" Length of
Impact
(linear feet)
Stream Name*' Average Width
of Stream
Before Impact Perennial or
Intermittent'?
(please specify)

c, + `TDr 1 P-Wfi-m ?rrer-r

"L41 aupW;L separately ana iaea[ny temporary Impacts. impacts mclude, but are not limited to: culverts and associated rip-ran,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net lossigain),
stabilization activities (cament wall, rip-tap, crib wall, gabions, etc.), excavation, ditching/straightening etc. If sarcam relocation is
proposed, plans and profiles showing the linear foomrint fbr 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 mans are available through the USGS at 1-800-358-9616, or online at
ww\v.uses.eov. Several internet sites also allow direct download and printing of USGS maps (e.g., www_tonozone corn
www.manuuest.cam, ele.).
Cumulative impacts (linear distance in feet) to all streams on site: t l Zo
Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact
Site Number
(indicate on map)
Type of Impac:4 Area of
Impact

(ate) Type of Waterbouy
Name of Waterbody i
(if applicabie) ( pond, estuary, sound,
bay, ocean, etc.)

I

* List =cu impact separately and identify temporary impacts Impacts include, but arc not limited to: 811, em cavano
? Eng.
fioodmg, drainage, b.1 c etc,
4. 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 illustrate& 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.): N] A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): N. A
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during constriction to reduce impacts.

VIII. Mitigation
D WQ - 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 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 reiative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed F_xamples 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 mitiga#on'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
httD.-//h2o.enr.state..nc.us/ncwetlands/strm *de.html.
I. 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/Iinear 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) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at httD:J/h2o.enr-state.ne.us/wrp/indec.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): 1,4
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):
Ix Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes 0 No k'
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: . If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator-at [phone] to review current thresholds for environmental documentation.
Yes [] No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA firal approval letter.
Yes [] No
Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
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 mast 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
(Neese), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes F] No [Lim 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* "" Required
/crmmr. f?,.r.` Multiplier .
I i 1 I , 1 2 ?
1.5
Total ' f
* Zone ] =tends out 30 feet perpendicular from near bank of channe3; Zane 2 extrnds an
additional 20 feet from the edge of Zone 1.
Ubuffer mitigation is required, please discuss what type of mitigation is proposed (Lem 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.

XL Stormwater (DWQ Only)
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.
M Sewage Disposal (DWQ Only)
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.
M. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No ?
Is this an after-the-fact permit application? -
Yes 7 No 7
XIV. Otter Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficientiy 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
worm 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).
-21e 7Z-
Apf6licant/Agent's SignatureO Date
(Agent's signature is valid only if an authorization letter from the applicant is provided-)
US Army Carps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell
US Army Corps of Engineers Avery Clay Jackson Polk
151 Patton Avenue Buncombe Cleveland Lincoln Rowan
Room. 208. Budce Gaston Macon Rutherford
Asheville, INC 28801-5006 Cabarrm Gzuham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell. Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes
6508 Falls of the Neese Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Chatham Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Waxen
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort C:urituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carte:et* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Wilmington Regulatory Field Off= .Anson- Dunlin Onslow
US Army Corps Of Engineers Bladen Barnett Pender
Post Office Box 1890 Brmnswick Hoke Richmond
Wilmington, NC 28402-1390 Cartemr Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: (910) 251-=4025 Cumberland New Hanover Scotland
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*C.-oatan National Forest Only
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 Pivets Island
Raleigh, NC 27636-3726 Asheville, NC 28801 Beaufort, NC 23516
Telephone: [phone] Telephone: [phone]. Telephone: [phone]
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit Division of Water Quality State Historic Preservation office

1650 Mail Service Cente Wetlands Restoration Program Department Of Cultural Resour=
r
Raleigh, NC 27699-1650 1619 Mail Service Center
Raleigh
NC 27699-1619 4617 Mail Service Center

Telephone: [phone] ,
Telephone: [phone] Raleigh, NC 27699-4617
Telephone: [phone]
Fax: [phone] Fax: [phone] Fax: [phone]
CAMA and NC Coastal Counties
Division of Coastal Management
1 Beaufort Chowan Hertford Pasquotank
638 Mail Service Center Berrie Craven Hyde Pender
Raleigh, NC 27699-1 63 8
Telephone:
(919)-733-2293 Brunswick Cunituck New Hanover PP
"?an?

Fax: [phone] Camden Dare
Carteret Gates Onslow Tyrrell
Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga.
3855 Idlewild Road Ashe Mitchell Wilkes
Kemersviile, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Re?den Coordinator Buncombe Headeison 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

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