20011185 Ver 1_COMPLETE FILE_20010801

OF vvnrFR ivucnaei r. rasiey, governor
William G. Ross Jr., Secretary
y North Carolina Department of Environment and Natural Resoutces
Gregory J. Thorpe, Ph.D.
p .C Acting Director
Division of Water Quality
August 22, 2001
Stanly County
DWQ Project # 011185
COE# 19993480
APPROVAL of 401 Water Quality Certification
Victor & Joanne Larson
305 Park Road
Wadesboro, NC 28170
Dear Mr. & Ms. Larson:
You have our approval, in accordance with the attached conditions, to place fill material in 200 square feet of waters for the
purpose of stabilizing a shoreline at 910 Curran Point Drive, as you described in your application dated August 1, 2001. After
reviewing your application, we have decided that this fill is covered by General Water Quality Certification Number 3280. This
Certification allows you to use Regional Permit Number 030 when the Corps of Engineers issues it. In addition, you should get
any other federal, state or local permits before you go ahead with your project including (but not limited to) Sediment and Erosion
Control, Coastal Stormwater, Non-Discharge and Water Supply Watershed regulations. Also this approval will expire when
the accompanying 404 or CAMA permit expires unless otherwise specified in the General Certification.
This approval is only valid for the purpose and design that you described in your application. If you change your project, you
must notify us and send us a new application. If the property is sold, the new owner must be given a copy of this Certification and
approval letter and is thereby responsible for complying with all conditions. If total wetland fills for this project (now or in the
future) exceed one acre, compensatory mitigation may be required as described in 15A NCAC 2H .0506 (h). For this approval to
be valid, you must follow the conditions listed in the attached certification. This approval shall expire when the corresponding
Nationwide Permit expires or as otherwise provided in the General Certification.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must act within
60 days of the date that you receive this letter. To ask for a hearing, send a written petition which conforms to Chapter 150B of
the North Carolina General Statutes to the Office of Administrative Hearings, P.O. Box 27447, Raleigh, N.C. 27611-7447. This
certification and its conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If you have any
questions, please telephone Todd St John at 919-733-9584 or Pete Colwell at our Mooresville Regional Office at 704-663-1699.
Attachment
cc: Corps of Engineers Asheville Field Office
Mooresville DWQ Regional Office
File Copy
Central Files
Wetlands/401 Unit 1650 Mail Service Center Raleigh, NC 27699-1650 Ph: [phone] Fax: [phone]
MAX
9 EZ, E..
F
Customer Service
1 800 623-7748

Q Project No.: D 1 1 / ?? County:
Applicant: 'V 1GTO y„
Project Name: 5ADR g?I I AJ P_ ST14 b i i ,z i DQ,4s?
Date of Issuance of 401 Water Quality Certification: g-aa-o+
Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable Buffer Rules, and any subsequent
modifications, the applicant is required to return this certificate to the 401/Wetlands Unit, North Carolina Division of Water Quality,
1621 Mail Service Center, Raleigh, NC, 27699-1621,This form may be returned to DWQ by the applicant, the applicant's
authorized agent, or the project engineer. It is not necessary to send certificates from all of these.
Applicant's Certification
Ij C,+ 0 r $ kA tZSe n , hereby state that, to the best of my abilities, due care and diligence was
used in the observation of the construction such that the construction was observed to be built within substantial
compliance and intent of the 401, Water Quality Certification and Buffer Rules, the approved plans and specifications,
and other su o i materials.
Signature: C-64 ?Date:
Agent's Certification
I, , hereby state that, to the best of my abilities, due care and diligence was
used in the observation of the construction such that the construction was observed to be built within substantial
compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and specifications,
and other supporting materials.
Signature: Date:
If this project was designed by a Certified Professional
I, , as a duly registered Professional (i.e., Engineer, Landscape
Architect, Surveyor, ect.) in the State of North Carolina, having been authorized to observe (periodically, weekly, full
time) the construction of the project, for the Permittee hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built within
substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the approved plans and
specifications, and other supporting materials.
Signature Registration No. Date
!?? Yom;:. ?;.-:.. ,.• :fl
15,
• ?1- ?-? , 2001
County
DWQ Proje t# L 11t 5-
APPROVAL of 401 Water Quality Certification
66 f;;; *? (g9939, 2) 1)

l1J'\ 3a,-
. u
?CJ
Dear Mr. &W< fv?S,
You ha ye our ro al, in accordance with the attached conditi s, to place fill material in
p'fl aoF?tiwet r-?uatefS for the purpose of , as you
descri ed in our application dated ?' , 2001. After reviewing your application, we
have decided that this fill is covered by Ge eral Water Quality Certification Number `3 -2-k) U
This Certification allows you Pride Permit Number 0130 when the Corps of
Engine Iles-I In addition, you should get any other federal, state or local permits before you go
ead with your project including (but not limited to) Sediment and Erosion Control, Coastal Stormwater,
Non-Discharge and Water Supply Watershed regulations. Also this approval will expire when the
accompanying 404 or CAMA permit expires unless otherwise specified in the General
Certification.
This approval is only valid for the purpose and design that you described in your application. If you
change your project, you must notify us and send us a new application. If the property is sold, the new
owner must bey given a copy of this Certification and approval letter and is thereby responsible for
complying walI conditions. If total wetland fills for this project (now or in the future) exceed one acre,
compensatory mitigation may be required as described in 15A NCAC 2H .0506 (h). For this approval to
be valid, you must follow the conditions listed in the attached certification. This approval shall expire when
the corresponding Nationwide Permit expires or as otherwise provided in the General Certification.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory
hearing. You must act within 60 days of the date that you receive this letter. To ask for a hearing, send a
written petition which conforms to Chapter 150B of the North Carolina General Statutes to the Office of
Administrative Hearings, P.O. Box 27447, Raleigh, N.C. 27611-7447. This certification and its conditions
are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water QQ? aIity`?Inder ection 401 of the Clean
2 ,11 __t. If you have any uestions please telephone 1 W J-b at 919-733-1786 or
4f at our Regional Office at
- - Sincerely,
Kerr T. Stevens
Attachment
cc:
Corps of Engineers Field Office
Mrlpff'sy Ve DWQ Regional Office
File Copy
,Central Files
V
Michael F. Easley
Governor
William G. Ross, Secretary
Department of Environment and Natural Resources
Kerr T. Stevens
Division of Water Quality
Division of Water Quality 1650 Mail Service Center Raleigh, NC 27699-1650
Wetlands/401 Unit: [phone]
Fax: [phone]

U.S. ARMY OR DISTRICT ENGINEERS o
WILMINGTON
Action Id. 19993480 county Stanl
y
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property owner: Victor S. & Joanne C. Larson
Address: 305 PIUR ROAD
Wadesboro, North Carolina 28170
Telephone No.: 704 694-3828
Size and Location of project (water body, road name/number, town, etc.):
Project is located at 910 Curran Point Drive, near Norwood, Stanly County,
North Carolina.
Description of Activity:
Install approximately 200 linear feet of rock at the mean high pool elevation (278' contour)
of Lake Tillery to prevent shoreline erosion.
Applicable Law: X Section 404 (Clean Water Act, 33 U.S.C.1344).
(check all that apply) Section 10 (River and Harbor Act of 1899). I`-'
r
Authorization: 198200030 Regional General Permit Number.
Nationwide Permit Number.
Your work is authorized by this Regional General (RGP) or Nationwide Permit (NWP) provided it is
accomplished in strict accordance with the attached conditions and your submitted plans. If your activity
is subject to Section 404 (if Section 404 block above is checked), before beginning work you must also
receive a Section 401 water quality certification from the N.C. Division of Environmental Management,
telephone [phone]. For any activity within the twenty coastal counties, before beginning work you
must contact the N.C. Division of Coastal Management, telephone,[phone].
Please read and carefully comply with.the attached conditions of the RGP or NWP. Any violation of the
conditions of the RGP or the NWP referenced above may subject the permittee to a stop work order, a
restoration order, and/or appropriate legal action.
This Department of the Army RGP or NWP verification does not relieve the permittee of the responsibility
to obtain any other required Federal, State, or local approvals/permits. The permittee may need to contact
appropriate State and local agencies before beginning work.
If there are any questions regarding this authorization or any of the conditions of the General Permit or
Nationwide Permit, please contact the Corps Regulatory Official specified below.
Date 24 Februarv 1999
Corps Regulatory Official Steve Chapin Telephone No. [phone]
Expiration Date of Verification 12/31/2002
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT PLANS, ETC., MUST.
BE ATTACHED TO THE YELLOW (FILE) COPY OF THIS FORM, IF REQUIRED OR AVAILABLE.
CESAW Form 591
Revised July 1995
4'w 1, .407
s• ?• t/yd0-I?
A C1-Z mil

-nryd
s »t./y?/? .fr?ws9'?yf9 erh
?faolP. '??aafS
. .N i . -Pf .o f s`
? v a?ayy uv't?aat?bo%-I anc/y
? ?? a yet /b `u p a.t ?
?ur,, vyr /,/ ? o,ia D??b? b a?ooGll
fly/ r.•IsJ J b '7? ? ? /
'+ rf /a7 4? ?? El? OP
•1?n?y/ f 1? x.a r
10 41Y
1
1
I i
CIAO.,
r
y

1
3
n•'''?a`?.

Its

106 •??',

' - ...•--
/ ???
?-fit
',
i
? ??\` ?,
Y
' ?.
?. T•?
t
O
r s ?e--^rI?
t-l' ?I
?-
' ?`
?M'•r•••'7`? 4'
•?•?y? arm
! ? '

plo p/6 a •, L'„'.'? ? ; .._
s
w ?
•N
w
M
tr "?ai•trly
1 \? R
ra
#i-
N
.\i
N
M
M
A \
w
r,...a•' -fir('

DEPARTMENT OF THE ARMY
Wilmington District, Corps. of Engineers
Post Office Box 1890
Wilmington, North Carolina 28402-1890
General Permit No. 198200030
Name of Permittee: General Public
Effective Date: Januaiy 1, 1998
Expiration Date: December 31, 2002
DEPARTMENT OF THE ARMY
GENERAL PERMIT
A general permit to perform work in or affecting navigable waters of the United States and
waters of the United States, upon recommendation of the Chief of Engineers, pursuant to Section
10 of the Rivers and Harbors Act of March 3, 1899 (33 U.S.C. 403), and Section 404 of the
Clean Water Act (33 U.S.C. 1344), is hereby renewed and modified by authority of the Secretary
of the Army by the
District Engineer
U.S. Army Engineer District, Wilmington
Corps of Engineers
Post Office Box 1890
Wilmington, North Carolina 28402-1890
TO AUTHORIZE MAINTENANCE, REPAIR AND CONSTRUCTION ACTIVITIES IN
LAKES AND RESERVOIRS, OWNED, OPERATED AND/OR REGULATED BY
PUBLIC UTILITY COMPANIES AND THE TENNESSEE VALLEY AUTHORITY
(TVA) IN THE STATE OF NORTH CAROLINA.
These lakes and reservoirs were constructed and exist primarily for the purposes of generating
hydroelectric power and/or providing water supply. They were constructed and operated by
public utility companies or under laws and regulations administered by the Tennessee Valley
Authority (TVA). Activities within these waters are the primary concern of, and should be
regulated by, these parties. This general permit applies to all waters on or within lands owned or
under flowage easement to public utility companies and the Tennessee Valley Authority (TVA).
_ l

1
Office Use Only: 011185 Fonn Version April 2001
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
L Processing
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
2. Nationwide, Regional or General Permit Number(s) Requested: /L7 9.100030
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: ?
H. Applicant Information
1. Owner/Applicant Information
Name: WC--o2 S a^d UO/ AWF kRRSEAJ
Mailing Address:.Sd-T /RK H.D
WADES&OkO /ll. C4. o2$I'?C7
Telephone Number:-7o q -&q q - 38 44 H Fax Number: `?O /35--
E-mail Address: J AJQ SPA/ 61D VAla? A/PT
2. Agent Information (A signed and dated conv of the A „A„+ A ..`'iorization letter must be
attached if t fie Agent he,
???'?? e ,/? ?,?'?[J .,? •)
Name: N A
Company Affiliation:+ ,?
Mailing Address: ,cam
n r
Telephone Number:
E-mail Address: R! G?
fr G 4a'
A
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 Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
l.Name of project: Shore.hine 6iLi z? Fio.J b ? uSe off- R?pnan ?R Y1C o2 8 J6U/?t/YEcj bpse'j
2.T.I.P. Project Number (NCDOT Only): 1A
3.Property Identification Number (Tax PIN): N la
4.Location
County: STA N L y Nearest Town: r?ORW OWA
Subdivision name (include phase/lot number): T lle?V ,g aa? & tl, /add?itton4 kot 916
Directions to site (include road numbers, landmarks, etc.): From 14WU Sa -turd otil Pe e_
Deelave,, Oro 1, eku.e PARker Qd,Tilrnl fltAl+ot)To JRprr%J #%I{ UA]f,I See Y`#JPLIA-a
Turnl onl V,NeJAReI fo 0I_RrZ,9n1 Po ins oiP,% -. The `I AS+ ho"e onl P,5, ' TT
5. Site coordinates, if available (UTM or Lat/Long): tJ1A
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6.Describe the existing land use or condition of the site at the time of this application:
_RaS;de'N+ir?L. }ZecreAtiotiAl
3M
7.Property size (acres
8.Nearest body of water (stream/river/sound/ocean/lake): T` ll el V
9.River Basin: `I Aa HW
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at h4p://h2o.enr.state.nc.us/admin/mays/.)
Page 6 of 13

10. & Describe the purpose of the
Ave
d

11. List the type of equipment to be used to construct the project: e l:?--k hoe and
A 10 ..., n ) A., n 1/
12. Describe the land use in the vicinity of this project: ReSider -H0 Recreo&joNA I
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.
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 current
application: D T A T- TN lS TIME
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan.. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed" impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 13
J
Wetland Impacts A 11A
Wetland
Impact
Site Number
(indicate on
ma
Type of
Impact* Area
of
Impact

(acres) Located within
100-year
Floodplain**

(yes/no) Distance to
Nearest
Stream

(linear feet)

Type of Wetland***

- List each Impact separately and identity temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at bo://www.fema.gov
.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property:
Total area of wetland impact proposed:
2. jV A 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
Perennial or
Intermittent?
(please specify)

List each impact separately and identity temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has uo 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.eov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mgpguest.com, etc.).
Page 8 of 13
a
Cumulative impacts (linear distance in feet) to all streams on site:
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
ma

Type of Impact*
ofa
Impact

(acres)
Name of Waterbod
(if applicable) Y
Type of Waterbody
(lake, pond, estuary,
sound, bay, ocean, etc.)

List each unpact separately and identity temporary unpacts. impacts include, but are not limited to: fill, excavation, dredging,
flooding,, drainage, bulkheads, etc.
4. 0 Pond Creation
I construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands [stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed durinLy construction to reduce imnnntc
Page 9 of 13
VF. 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 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
hM://h2o.enr.state.nc.us/ncwetlands/strmgide.html.
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.
Page 10 of 13

l
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
http://h2o.enr.state.nc.us/wrp/index.htm. If use of the NCWRP is proposed, please check the
appropriate box on page three and provide the following information:
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):
• Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ? No ?
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
UL Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
OIN It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified. within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ? If you answered "yes", provide the following information:
Page 11 of 13
y
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 3
2 1.5
Total
T Lone i extends out su teet 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 (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B.0242 or.0260.
X. 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.
XL Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
was ?ewater generated from the proposed project, or available capacity of the subject facility.
e 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 P<
Page 12 of 13

XII. 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
. I I J, I 1 / n n r , I applicant's control).
_ .. ..,.
we- Ne&-j fo
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 13 of 13