20011221 Ver 1_COMPLETE FILE_20010814

TslA e.
CF W ATF9 Michael F. Easley =
A QG Governor
William G. Ross, Jr., Secretary
] r Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D.
Acting Director
Division of Water Quality
DWQ Project N I c-9 County: __T? e. 9 Q 1 I
Applicant: C V"
Project Name: oc ar e`
s-o b?f'l a0O
Date of Issuance of 401 Water Quality Certification:
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.
App cant's `Certification
1, U\1%1, .. EANV-,D "`S O `'`- , 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 pl s, and othey supporting materials.
Signature: f Aw cw Date: / a D "a DO (
Agent's Certification
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
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
N DENR
Division of Water Quality 1650 Mail Service Center Raleigh, NC 27699-1650
Wetlands/401 Unit: [phone]
Fax: [phone]
O?O? W AT ?9QG
o -c
Michael F. Easley; Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D.
Acting Director
Division of Water Quality
October 2, 2001
DWQ# 01-1221
Iredell County
Chuck Edmonson
833 River Hwy
Morresville, NC 281.11
APPROVAL of 401 Water Quality Certification and Authorization Certificate per the Catawba River Buffer Protection Rules (15A
NCAC 2B.0243)
Dear Mr. Bush:
You have our approval, in accordance with the attached conditions, to place fill material in 896 square feet of waters for the purpose
of stabilizing the shoreline on Lot 22 Beacon Pointe subdivision Iredell county as described in your application dated September 14, 2001.
After reviewing your application, we have decided that this fill is covered by General Water Quality Certification Number 3280, which can
be downloaded from our web site at http://h2o.enr.state.nc.us/ncwetiands. This Certification allows you to use Regional Permit Number
198200030 when the US Army Corps of Engineers (USACE) issues it. This letter shall also act as your approved Authorization Certificate
for impacts to the protected riparian buffers as required under 15A NCAC 2B .0243(8). 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, Non-Discharge and
Water Supply Watershed regulations. Also this approval will expire when the accompanying 404 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 in writing and you may be required to send us a new application for a new certification. If the property is sold, the new owner
must be given a copy of the 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 and those listed below.
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, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its
conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If you have any
questions, please telephone Pete Colwell in the DWQ Mooresville Regional Office at 704-663-1699 or Todd St. John in Raleigh at 919-
733-1786.
Attachment
cc: US Army Corps of Engineers Asheville Regulatory.Field Office
Mooresville DWQ Regional Office
Central Files
File Copy
N. C. Division of Water Quality 1650 Mail Service Center Raleigh, NC 27699-1650 [phone]
;inc.er ly,
g ry Thorpe, Ph.D. n D' ector
01-1221
NMENR
Customer Service
1 800 623-7748

Michael F. Easley _
Governor
William G. Ross,Jr.Secretary
Department of Environment and Natural Resources
Kerr T. Stevens
Division of Water Quality
I PN e- L C 20001
aunty
DWQ Project # (9 I - I 'a a
APPROVAL of 401 Water Quality Certification and Neex-River Buffer Rules
?}rsnres??ll? NC_ 2`8 Gl ( 5 U
Dear Mr. ??ryl ?titi5r?1
Yo have our /apoval, in accordance with the attached onditions, o ???A in
of wegemdds-or waters for the pu ose of - as you
described in your pplication dated 1q Zoe. Aft r reviewing your ap lication, we have
decided that this fill is covered by Ge ral Water 6ua-rity Ce cation Number 5 D
This Certification allows you to use Permit Number ( O when the Corps
of Engineers i s approval is also valid for the Nz&e River buffer rules
n 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. This approval shall expire when the corresponding Nationwide Permit
expires or as otherwise provided in the General Certification. 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.
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 Q 1' under Se hon 401 of the Clean _
- - y _ _
p&aterecl If have any questi
ie se telephone bus ?? at our Mme-s V i )? _ Regional Office at
Sincerely,
Kerr T. Stevens
Attachment
cc:
ko s of ineers Jyb ski 'e- Field Office
tV DWQ Regional Office
File Copy
AM Central Files
NE W®
Division of Water Quality 1650 Mail Service Center Raleigh, NC 27699-1650
Wetlands/401 Unit: [phone]
Fax: [phone]
SENT BY: CAROLINA TRACTOR; 7049211674; 8EP-14-01 9:05AM; PAGE 2/5
Micnaer r. easiey, uovernor
a:, r
am ossr Jr., s,aeeralary
North Carolina Departmental, Environment and Natural Resourae6
r3r egory d. Thorpe, Ph.D.
AclIng 'fiPck ector
Division of Water OualKy
August 29, 2001
DWQ# 011221
Iredell County
CERTIFIED MAI
Chuck Edmonso
833 River Hwy
Mooresville, NO 11
Dear Mr.
RECEIPT REQUESTED
'On August 11 4, 2001, the Division of Water Quality (DWQ) was notified by receipt of you applications
regarding you pia 11. ? to Impact 112 feet of shoreline on Lake Norman at Lot 22, Phase I, Beacon Pointe s/d for
the purpose of st *t ilizing the shoreline of your lot in Iredell County. Approval from DWQ if required to impact
these waters. PI a provide seven copies of the following information and refer to the DWQ number listed
above in your rep
1. Also the wba River buffer rules become effective on June 30, 2001 and allow shoreline stabilization
measures in the protected buffers along Lake Norman. We are concerned that construction of these
shoreline s a ilization measures will result in excessive impact to the protected buffers. Please provide
details on you plan to install these shoreline stabilization measures, what measures you will take to
minimize i ct to the buffers and then how and when you p to replant the unavoidably impacted
portions of h se buffers.
gtq?c4
Please tel one Bob Zalrzeeki [phone], Todd St John 919 733-9 or me at 919-733-9646 if
you have any qu ons or would require copies of our ru as or prose ura ma na his project will remain on
hold as incomple in accordance with 15A NCAC 2H .0505(c). The processing time for this application will
begin when this I f rmation is received. If we do not hear from you by writing within three (3) weeks we will
assume you no to er want to pursue the project and will consider it withdrawn.
Si rely Yours,
PnDo
cc: Mooresville C
Asheville Co,
Central Files
File Copy
Regional Office
of Engineers
N. C, ow an of water tla4ity 1617 Mail 5ervlce Center Ralsigh, NO 27688.1617 (e•ra) 733-7015
. 4%
cumomsr service
1 800 X7748
,SENT BY: CAROLINA TRACTOR;
7049211674; SEP-14-01 9:06AM; PAGE 315
r.Ir.?r i?r1._ q
Water impacts, including Lakcs, bonds, l stuaries. Sounds, Atlantic Ocean and any
Water of the IJ.S.
Upcn Watvr Itnpr?c t Area oI
Site Mu ber Type of Itnp1100 Itnpacl.
igdlCatC.D .InB sscrcs
List eac impact Separately and identify ternporttry imPac
fiful linty. rainas e, bulkheads, etc.
4.
VII.
Nat-tic of Waterbody
(if applicable)
Htap;cts irMlude} but arc riot
Type of Watcrbody
e, pond, estuary, sound,
to: fill, excavation,
Pond Creation
If construction of a pond is proposed, associated wetland and stream itnpavto 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 aapppsiccatian• vuetlands
Pond to be creates! in (check all that apply): [3 uplands
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:.
Justification (Avoidance and Minimization)
;ifically describe measures taken to avoid the proposed impacts. It may be useful to provide
M ation related to site con5traintt4 such as topography, building ordinances, accessibility, and
acial viability of the project. The applicant may attach drawings of alternative, lower-impact
layouts, and explain why 6ese design options were not feasible. Also discuss how impacts
G minimized once the desired site plan was developed. If applicable, discuss Construction
Piques to be followed during constructions to reduce impacts.
rte CX
f o vt ?i _ ? 1 1?_ _..
1

Page7af12
SENT BY: CAROLINA TRACTOR; 7040211674; SEP-14-01 0:06AM; PAGE 4/5
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,SENT BY: CAROLINA TRACTOR; 7049211674; SEP-14-01 9:06AM; PAGE 515
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SENT BY: CAROLINA TRACTOR; 70492ii674; REP-14-01 9:05AM; PAGE 1
Y lina -Traitor ` .4
9000 S'ta# We,Road DATE: pp ?-
Charlotte, NC ,28269-7642 7'OrC?Ol + ?t 1?
P. 0 Box 095, 28201-1095
Telephon [phone] COMPANY
(800J 277-1212
'FAX #: q ?. `'1 ' 3 • Cg-
SALES [phone] ,F.ROM.-
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FAX T17ANS'MISSION

Gregory J. Thorpe, Ph.D.
Acting Director
Division of Water Quality
August 29, 2001
DWQ# 011221
Iredell County
CERTIFIED MAIL-REQUEST RECEIPT REQUESTED
Chuck Edmonson
833 River Hwy
Mooresville, NC 28111
Dear Mr. Edmonson:
On August 14, 2001, the Division of Water Quality (DWQ) was notified by receipt of you applications
regarding you plans to impact 112 feet of shoreline on Lake Norman at Lot 22, Phase I, Beacon Pointe s/d for
the purpose of stabilizing the shoreline of your lot in Iredell County. Approval from DWQ if required to impact
these waters. Please provide seven copies of the following information and refer to the DWQ number listed
above in your reply.
Also the Catawba River buffer rules become effective on June 30, 2001 and allow shoreline stabilization
measures within the protected buffers along Lake Norman. 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.
Please telephone Bob Zarzecki [phone], Todd St John [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.
Si rely Yours,
PnDoM('yv
cc: Mooresville DWQ Regional Office
Asheville Corps of Engineers
Central Files
File Copy
ivision of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone]
micnaei r. tasiey, vovernor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
3-?
MOW
Customer Service
1 800 623-7748
k ? ?-
Michael F. Easley
Governor
William G. Ross, Jr. Secretary
Department of Environment and Natural Resources
Kerr T. Stevens
Division of Water Quality
CERTIFIED MAIL - RETURN RECEIPT REQUESTED1
rvwo # 01- tZ2,1
County
?u? ?m0 w1s &\
LP,
aSe r n
PC-
Dear Dear
?4
On 5? 1, the Division of Water Quality (DWQ) as notified by receipt of your applications regarding
your plans to impac _ feet of shoreline on Lake afhn? at for the purpose of stabilizing the shoreline
of your lot in rg County. Approval from WQ 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.
The location of the proposed shoreline stabilization measures must be shown on a map.
Also the Catawba River buffer rules became effective on June 30, 2001 and allow shoreline stabilization
measures within the protected buffers along Lake James. 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.
Please call Todd St. John, Bob Zarzecki or me at 733-1786 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
within three (3) weeks of the receipt of this letter, we will assume that you no longer want to pursue this project and will
consider it withdrawn.
Sincerely yours,
John Dorney
Mooresville DWQ Regional Office
Asheville Field Office Corps of Engineers
File copy
Central files
Division of Water Quality 1650 Mail Service Center Raleigh, NC 27699-1650 [phone]

011221
DUKE POWER DIRECTIONS BY ROAD FORM
Lake Use Permit Applicants and Contractors: Ease of locating the proposed project site can have a big
impact on permit processing time. Please complete this form and return it along with your completed
permit application to:
DUKE POWER
C/O LAKE MANAGEMENT - EC 12 Q
PO BOX 1006 -- -w
CHARLOTTE, NC 28201-1006 `
1-800-443-5193
Applicant's Name: Y? C?W?ov?S o v? Type of Permit.Req. ested
VIA "C`iccle":
Street Address (at lake):
1 \ ' Private Facility
Lake Name: I?o.K-e. Commercial Facility
c7R \ - . E?
Subdivision Name: -C-Ckco ? 1 dr ej. I Stabilizatio RIP RKQ
? Conveyance
Property Section:S 2 Lot # C -01 Miscellaneous Uses
City: Moo+`eSV County: ?recte\?
State: Coot-oIZip: a$ IN 'I
Telephone:( oq) ?ULk- yQ a 3
Directions (from major road or highway):
'`l'`I -c ? 3 (A ( taw y t So> ? 1--
4p Q
G 4-o ?21' h tt ?' ?00. S
Descriptive Structure on Property (i.e. brick garage, white fence, mobil home, etc):
1(1 > Y\ --- I l o ?- 1r? G-S Jt???-- b ??v, C\ ? ar e
'Note: Please use the back of this form if desired to draw us a map to the sites
GPALA,AKEMGMTA-MPPM/D[RECnONS.DOC
EtTective Datc• IM 5199

or
DUKE POWER LAKE MANAGEMENT, EC12-Q
P O BOX 1006 011221
CHARIATTE, NC 28201-1006
704-382-1567 or TOLL FREE 1-800-443-5193
APPLICATION FOR PERMIT TO STABILIZE THE SHORELINE IN NORTH CAROLINA
Please type or print and fill in all blanks. If information is not applicable, so indicate by placing N/A in
blank. PLEASE SUBMIT APPLICATION AND APPROPRIATE DUKE POWER FILING FEE,
PAYABLE TO DUKE POWER, TO ABOVE ADDRESS.
L Applicant Information
A. Name rimavas O Vl.
B. Mailing Address 3 3 :T i V" e. r- "W
lfl? 00r-cS \r 1 U -el ( , G•
C. Telephone: l `l Oti4 ) lot oaf -
IL Location of Proposed Project
A. Lake Y f- VIA A V1
B. Street Address
C. County:;;? r e 2
D. City, town, community or landmark fY? o t- Q S `f +
E. Section-)s =Lot g @L'.1- Subdivision n o ` P
F. Directions to property byroad 'Pg t4-fin 1ZooA A-b Pe 1r\ A? i 11
A L.. ?-- 1
G. Latitude and longitude for the project site rvl aJ? aX-t-o-c3ne cx
Please submit a map showing the coordinates or a detailed map (USGS quad map, city
map, etc.) showing the exact location of the project site. (NOTE: Latitude/ longitude
coordinates can be found on internet site, www.mapblast.cotn)
lia x s ?+ =?
III. Description of Project
A. Length of wall o
B. Material
C. Distance from property line/shoreline
IV. Intended Use of Project Area
A. Private_ \No W? eS \-?2
B. Commercial l
V. Applicant Signature:_ Date g " -
PLEASE NOTE THE FOLLOWING:
• A COPY OF THE COMPLETED APPLICATION WITH A ROAD MAP SHOWING LOCATION OF
THE PROPERTY MUST BE SUBMITTED TO: USARMT CORPS OFENGINEERS, 151
PATTONAVE. -ROOM 208, ASHEVILLE, NC 28801-5006
A COPY OF THE "DUKE POWER APPLICATION FOR PERMIT TO STABILIZE THE SHORELINE
IN NORTH CAROLINA" AND SEVEN (7) COPIES OF THE COMPLETED "NC DIVISION OF
WATER QUALITY PRE-CONSTRUCTION NOTIFICATION APPLICATION" MUST BE
SUBMITTED WITH THE DIVISION OF WATER QUALITY APPLICATION FEE TO:
NC DIVISION OF WATER QUALITY
ATTENTION: JOHN DORNEY
16$bMAIL SERVICE CENTER
RALEIGH, NC 27699-168'D
919-733-1786
1/10/00ssb

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R. S. Hol meld 1o d IsuMvIsionplannigg •o D! - p,O.E-1036 Trouhnan,NC28166
file: bua?ne phone [phone] - f (704,1871-2777 - -U.' ho(iraW.-Wind
Lot 23
Lot 21
IX ASN
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e Lake
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Boundary And Physical Survey
0.866 Acre
Lot 22 BEACONPOINTE,14Iap,, sheet,
Fallstown Towship Iredell County, NC
Tar PIN 4639-13-4682 -D. B. 1092-1006 - P. B, 24-I53, 154, I5S
property of Charles E4lnumson and Mindy Edmonson
Office Use Only: 0112 2 Trm 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.
1. Processing
Check all of the approval(s) requested for this project:
? Section 404 Permit
? S on 10 Permit
401 Water Quality Certification
? Riparian or Watershed Buffer Rules
^ ?
2. Nationwide, Regional or General Permit Number(s) Requested: 'Q -I S Q o0o s o
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
1. Owner/Applicant Information IN
Name: 0- S
Mailing Address: 8 3 2k i

Telephone Number:
E-mail Address: (
Fax Number: Vto4 ) 4i'M -
An .'TM - .1-ne- _ P n M
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: n 1A
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Page 3 of 12
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 maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: C _k0,i_d 1 eS ?CJlW1?Y?5C? V?
2. T.I.P. Project Number (NCDOT Only):
lc - Q, -- DS
3. Property Identification Number (Tax PIN):
4. Location
County:_ = - e 4,e.1 k Nearest Town: M ?, n Q_c y i P
Subdivision name (include phase/lot number): 2•e ac_er
Directions to site (include road numbers, landmarks, etc.):_ _o
?+ xi+ stn t:1?w' tSo? 150 :kk,4- 4b 4e+-?h tZoad? 7'1R.
Go - o t-p_r-r? AA II 1l 200. d . 71 L Ca n •-4-r, TRU? it -U. e
5. Site coordinates, if available (UTM or Lat/Long): Lo,. A-- 3S. US 135 Lon - ft gpu6S
(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:
7. Property size (acres): a 1Ci -'E-ob pl e?
8. Nearest body of water (stream/river/sound/ocean/lake): L 2 P o a yyko.vv
9. River Basin:
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/ma-os/.)
Page 4 of 12
10. Describe the purpose of the proposed work: -?-n C-P-A j-, c.. Choi- `ih e
IV.
11. List the type of equipment to be used to construct the project.-T i-o?c-k Lockc(Q-r-o
12. Describe the land use in the vicinity of this project: 22S i ckky 't-i OA ?OUSIh°,
?QV?.?n Dew?2 ?? .
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.
y-N 1A
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe.the
anticipated work, and rvide justification for the exclusion of this work from the current .
.. . . % A .. n 1 1? 1
r
t-
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 fisted 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 5 of 12
1. Wetland Impacts
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
es/no) Distance to
Nearest Stream
linear feet
Type of Wetland***
r? n 1.4 r\ A- ,4 n +

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at htto://www.fema.eov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
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
aO
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)

List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
• www.usgs.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.tonozone.com,
, www.manauest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
Page 6 of 12
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* Area of
Impact
acres Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ean, etc.

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
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): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): to 1A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): h /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.
r\ o -A-
Page 7 of 12
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 proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/strmgide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offske), 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 8 of 12
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.ne.us/YU/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):
IX. 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 ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicants (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 E] No ? If you answered "yes", provide the.following information:
Page 9 of 12
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
"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 (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (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.
XIII. 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 ?
Page 10 of 12
.
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).

-gyp-D(
Applicant/Agent's Signature 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 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 Graham 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 Perquimans *Croatan National Forest Only
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
Page 11 of 12
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o1221
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.
I. Processing
1. Check all of the approval(s) requested for this project:
? Section 404 Permit 4
F-1 Se 1
on 10 Permit
401 Water Quality Certification
? Riparian or Watershed Buffer Rules
n ^ ?
2. Nationwide, Regional or General Permit Number(s) Requested: 1 9 S DOD S D
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
1. Owner/Applicant Information
Name:
ddres?s: qa.-? G? ?r? r`n?nSo n
8 3 3 1Z ? v 4s 1k is N_ W 0-
Mailing Address:'
YY?oor2Su 114 n . . a.$
Telephone Number: (fi o - 9$ Fax Number:
E-mail Address: C eclv?nonSon 0o."liyna-`Tmc_-.
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: r1 1A
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 3 of 12(?
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: 1-1 e s Z? . E CLV aC) Y\21-a V-\
2. T.I.P. Project Number (NCDOT Only):
to - 13 - OS
3. Property Identification Number (Tax PIN):
4. Location
County: =- e d?e. k k Nearest Town: M on n e.s V i I k e
Subdivision name (include phase/lot number): I2-ecxce%n `fit o? r`?-e Chas T 4-
Directions to site (include road numbers, landmarks, etc.): ha enka.k__ Itl +o
_ E x i+ stn t:l?w? l5 o)1' I L . -mo-V c 1 S o ?aS?- --40 4e?--1-h t2oad? !P„
Go to term 3011 Roo-d. -'IL- . t'--,n 4-o `Ru k-?1y\.8 'dL `r i R..
Site coordinates, if available (UTM or Lat/Long): Lo.A 3S. Wy 135 Lon • $p. gouLj
(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:
beep re e
7. Property size (acres): 2
/< r)
; P.; -?o?p ?? i eta
l+a-_+ xs
8. Nearest body of water (stream/river/sound/oceaMake):_ L a ? o t- OkaY.,
River Basin: l ?0,_kaLr)V)a,
(Note - this must be one of North Carolina's seventeen designated major river basins.
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
The
Page 4 of 12
10. Describe the purpose of the proposed work: -Tp_eA,L . c_k ?1no i- QA i??, e
eco? i ot^ .
11. List the type of equipment to be used to construct the project.--T -o:ck 10a,kz r-.
12. Describe the land use in the vicinity of this project: k Q-s i cLk rA o,--\ ?kou5? ra
TQV-0-\ 0 DQVOAQ V ?
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.
(N 14
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe.the
anticipated work, and rovide justification for the exclusion of this work from the current .
` A 1
annlinatinn•A n l- EAT- 'k-?iS ?r0 1 QC -V . A,V\ Tl?? DQr1 %
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 5 of 12
1. Wetland Impacts
Wetland Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(es/no Distance to
Nearest Stream
linear feet)
Type of Wetland***
n1.4 nA nA n Pr

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://www.fema.eov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
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 ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)
A- A ?A- f ? /?-

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be.found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
, www.usgs.EOy. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.tooozone.com,
, www.mat)quest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
Page 6 of 12
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* Area of
Impact
(acres) Name of Waterbody

(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.
n t)v\ e e o. ?,rY.0.? L a. k e

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
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): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): A 1/4- --- - -
Proposed use or purpose of pond (e.g., livestock 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.
1'104-
Page a? r?b
7 of 12
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 proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlands/strmfzide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
47 14-
Page 8 of 12
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.ne.us/m/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):
IX. 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 ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicants (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 9 of 12
i i
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
* 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 (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B.0242 or.0260.
XI. Stormwater (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.
XHL 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 ?
Page 10 of 12
I a . .
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules f6r lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).

?-l0-dl
Applicant/Agent's Signature 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 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 Graham 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 Perquimans *Croatan National Forest Only
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
Page 11 of 12
¦ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
¦ Print your name and address on the reverse
so that we can return the card to you.
¦ Attach this card to the back of the mailpiece,
or on the front if space permits.
Article Addressed to:
(17 L drd &f /%17
4im-? 4w'r l y
A. Received by (Please Print Clearly) I B. Date of Delivery
C.
Agent
D. I4?fellvery address different from item 1? ? Yes
If YES, enter delivery address below: ? No
3. Service Type
? Certified Mail ? Express Mail
? Registered ? Return Receipt for Merchandise
? Insured Mail ? C.O.D.
4. Restricted Delivery? (Extra Fee) ? Yes
2. Article Number (Copy (Copy from service label)
2ai7 W& &C-9-1
PS Form 3811, July 1999 Domestic Return Receipt 102595-99-M-1789
UNITED STATES POSTAL SERVICE
First-Glass_Mail
Postage. & Paid
U9PS..._....
Permit. No. G-vr-
• Sender: Please ?r nt:yo,u name, address, and ZIP+4 in -this boz • _
NC DENR
DWQ - WETLANDS/401 UNIT
1650 MAIL SERVICES CENTER
RALEIGH NC 27699-1650
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