20011539 Ver 1_COMPLETE FILE_20011019

MEMORANDUM
TO: John Dorney Regional Contact: .I. Steenhuis
Non-Discharge Branch WO Supervisor: B Shiver
Date:
SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS
Facility Name Joseph N. Honeycutt County PENDER
Project Number 01 1539 County2
Recvd From APP Region Wilmington
Received Date 10/19/01 Recvd By Region
Project Type
Certificates Stream Stream Impacts (ft.)
Permit Wetland Wetland Wetland Stream Class Acres Feet
Type Type Impact Score Index Prim. Supp. Basin Req. Req. ME

Mitigation Wetland
MitigationType Type Acres Feet
F_ F- F_
F
Is Wetland Rating Sheet Attached? Q Y O N Did you request more info? Q Y Q N
Have Project Changes/Conditions Been Discussed With Applicant? Q Y Q N
Is Mitigation required? Q Y Q N Recommendation: Q Issue 0 Issue/Cond O Deny
Provided by Region: Latitude (ddmmss) Longitude (ddmmss)
Comments:
This office has no objections to the project as proposed but conditions it to have a deep notification
placed on remaining wetlands on site. 401 written 12/14101.
cc: Regional Office
Central Office Page Number 1
John:
While in Wilmington I talked with Joanne about the Honeycutt application and talked with Mickey Suggs
with the Corps of Engineers.
The Corps authorized for 0.25 acre for a pond and 0.25 acre of fill under NW 39 and walked Mr. Honeycutt
through the application.
Also, Joanne has been out at the site and knew the project. I gave her a copy of the application and she is
going to handle the 401 Certification this week.
danny

R
Office Use Only:
USACE Action ID No.
Form Version April 2001
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.
H.
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: IN
y
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:
Mailing Address:
i elepnone Number;_ Fax Number:
E-mail Address: l11 c?r?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:
Company Affiliation: r?
Mailing Address:
Telephone Number:
E-mail Address:
Page 3 of 12
Fax Number:
PA Y110 r ,,.I I
R1 C'FIVED

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: ? E
2. T.I.P. Project Number (NCDOT Only): A4_1_
3. Property Identification Number (Tax PIN): P 121 D ?7?
4. Locati on
County: Nearest Town: of e?
Subdivision name (include phase/lot number): //9
Directions to site (include road numbe s, landmarks, etc.): ' .21Z) J 2-
/a/1a r I IN Y ,7- /6 We r
,5-e& 19 7 Y,=1 r- /7 - e /I r! chi /J .
5. Site coordinates, if available (UTM or Lat/Long):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing ]an use or condition of the site at th ti me of this application:
4r• ss
7. Property size (acres): Ji S c„}.? 3
I?'
8. Nearest body of water (stream/river/sound/ocean/lake):_l?e7y,,.-;5"D h 1_,*`,f- ede
9
River Basin: 4:f O'De" G' ?Oy. ; f a /,-) e )cc a )-
(Note - this must be one of North Carolina's seventeen designated major river basins.
River Basin map is available at htt)://h2o.enr.state.nc.us/admin/maps/.)
The
Page 4 of 12

10. Describe the purpose of the proposed work:
/ L r e 'r . ?`n
_
/ i? a J L r

yJF, / 11
List the t
e of e
i
b K
.
yp
qu
pment to
e,used to construct th
• e project: ?I ?l ?r 7 Tr Gr
;
,f
,
r -f
12. Describe the land use in the vicinity of this projecLt: CU r r?. T,
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.
,~ C l j f 1 f Ave
?
V. Future Project Plans

Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justificatio for the exclusion of this work from the current
applicatpn: ;- f
i. a ?. (a
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
I. 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***

i

* TAqt each i--f rofAly -4 ;A--,: A, ? e... _.. _.. _.:
- --- r°- ...... -.,- 1-1,11y .a.-pUlal y unpacuS, impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately lis t 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 ServiceCenterat 1-800-358-9616,or
online at htip://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 w Hands on the property:
Total area of wetland impact proposed: 4r a f
wo? ?
" r 4? r
W1104 I??ca'i` ?/ C?c? 1 r ri 't 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)

r

" T of n n{, of ..y
et.
A :J_ : c.. c
y
?? F S„t,ara an u j„onmy temporary impacts. impacts include, but are not limited to: culverts and associated 6p-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. Ifa 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.usus.gov. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
ww•w.mapquest com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:. N& 11 e
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.

VA
/

VII.
-- - --?---- --r-----•, -••- •°_••••-, •-•••r?..? ,,,,?,u..w. alut/¢l.W 111UMUe, out are not um,tea to: tiii, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation PY e k t v 1'* 1. ?/ ?>•!?7 h U Y", : ,F'1 >h,,- (a I??t' n'I l1 i "t d-? 'Nt . t }1E r<'Y5
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream wetlands
Describe the method of construction (e.g., dam/embankment, excavation installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond ?e.g., livestock atering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): $ h ?p ?71
Size of watershed draining to pond: r'1 G1 j? re' expected pond surface area: Y'' -
Impact Justification (Avoidance and Minimization)
-17 D ° 7 Q
N 's
?i !
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 do-reduce impacts.
S 117
06
S-' 7
7! ?7
LVI -44
1 r. I t- A f : l ??
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, nitigation 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://h2 o. enr. state. n c.us/ncwef ands/strni.L?d e.htmi.
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
J
?'r1 T
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/Wedands 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 .httn://h2o.enr aatc nc t»/wm/index htni 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):
TX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ? No rV
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 F1
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 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
(Meuse), 15A NCAC 213 .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
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
I 3
2 1.5
Total
cone i extends out ju 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.
Xffl. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No N
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).
-
Applict4&AgenV Signature 0 ate
(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 Cabanas 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 Cunituck 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
es
i1nuW ngton Regulatory Fi
OIffli Anson Duplin Onslow
US Army Corps Of Engine Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
)
Wilmington, NC 28402-18 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fat [phone] Cumberland New Hanover Scotland
1 ce
Pa ge 1 I of 12

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 Pivers Island
Raleigh, NC 27636-3726 Asheville, NC 28801 Beaufort, NC 28516
Telephone: [phone] Telephone: [phone] Telephone: [phone]
•GS
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
CAMA and NC Coastal Counties
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
Telephone: [phone]
Fax: [phone]
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild 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
Page 12 of 12

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DEPARTMENT OF THE ARMY
WILMINGTON DISTRICT, CORPS OF ENGINEERS
P.O. BOX 1890
WILMINGTON. NORTH CAROLINA 28402-1890
REPLY TO
ATTENTION 01'-
September 6, 2001
Regulatory Division
Action ID. 200101045
Mr. Joseph Honeycutt, Sr.
122 Broadview Lane
Hampstead, North Carolina 28443
2 i 2001
DI\/ISION OF
COASTAL NiAIN',AGET?illtEi,;T
Dear Mr. Honeycutt, Sr.:
This letter serves to confirm my August 22, 2001 follow-up inspection, regarding your
restoration efforts for the unauthorized discharge of excavated material into Section 404 wetlands
on your property. The property is located on the northwest corner of NC Highway 210 and
Leacrest Lane intersection, in the headwaters of Harrisons Creek, in Hampstead, Pender County,
North Carolina. Additionally, please reference my July 23, 2001 correspondence.
Based on the follow-up inspection, it has been determined that your restoration efforts
have been satisfactorily completed. Accordingly, no further action will be taken in this matter
and our file will be closed as of the date of this letter.
It is noted that the perimeter berm surrounding the pond was properly stabilized with
erosion control measures. However, at the time on my inspection, the restored area had not
been stabilized. It is strongly recommended that a variety of annual ground cover (no fescue) be
cast over the area to prevent erosion. This will provide a temporary cover prior to the volunteer
reestablishment of native vegetation.
Please be cautioned that any future unauthorized work of similar nature in Section 404
wetlands or waters would be considered a willful and intentional violation of Federal law and
may result in immediate referral of the matter to the U.S. Attorney with recommendation for
civil prosecution.
If it is your intentions to develop or sell any portion of the 60-acre tract, it is strongly
recommended that all waters and wetlands be identified, delineated, and surveyed. This mapped
survey will help in your planning of the property and prevent any unintentional violations of
Federal law. The wetland survey should be sent to our office for verification.
Thank you for your time and cooperation in resolving this matter. If youU
questions or comments, please contact me at [phone], Wilmington District,
Copies Furnished:
/Ms. Joanne Steenhuis
Division of Water Quality
North Carolina Department of
Environment and Natural Resources
127 Cardinal Drive Extension
Wilmington, North Carolina 28405-3845
Ms. Janet Paith
Land Quality Section
North Carolina Department of
Environment and Natural Resources
127 Cardinal Drive Extension
Wilmington, North Carolina 28405-3845
Mr. Mike Wylie
U.S. Environmental Protection Agency
Wetlands Protection Section- Region IV
Atlanta Federal Center
61 Forsyth Street
Atlanta, Georgia 30303
Sincerely,
Mickey Sugg, Project Manager
Wilmington Regulatory Field Office
I'l
U. S. Attorney
Eastern District of North Carolina
310 New Bern Avenue
Suite 800, Federal Building
Raleigh, North Carolina 27611
Mr. John Ellis
U.S. Fish and Wildlife Service
Post Office Box 33726
Raleigh, North Carolina 27636-3726
2

`,J

Office Use Only:
Form Version April 2001
USACE Action ID No. DWQ No 01 1539
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1.
H.
Processing
1. Check all of the approval(s) requested for this project:
Section 404 Permit
? Section 10 Permit
401 Water Quality Certification
F,7] Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: (A/ #-,, j 2'
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:
Mailing Address_
Z!?

1 clcpnone 1Vumger:
1 r- Fax Number:
E-mail Address: /Vo,,-j,
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: j
Telephone Number:
E-mail Address:
Fax Number:
F>?? V? "I-
V/, 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: IJ61 C(l ,.', ,;? 7- 7
2. T.I.P. Project Number (NCDOT Only):.
3. Property Identification Number (Tax PIN): p 13 1 D ??
4. Locati on
County: Pe oq Nearest Town:
?If e
Subdivision name (include phase/lot number): liq
Directions to site (include road numbe s, landmarks, etc.): .21U I/V E'SA'
lrle S T a W PI 7`
'see, i9trclch eel Ma D.
5. Site coordinates, if available (UTM or Lat/Long):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing lan use or condition of the site at th time of this application: C L° c7 t??,
9 ra s .s .
7. Property size (acres): 5 A e r ? S ? 'c r lf>- Y 3? 4C
8. Nearest body of water (stream/6ver/sound/ocean/lake):1j?ey?"
9
River Basin: 4:f ape /,_ 4n: t (/V. ,G, CfC? 1,2 - /rte y.
(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:_ /o L Y e- r_i Z
L 1,
11. List the type of equipment to be used to construct the project: J L ?/ r 7- 7 ' ?? k c
IV.
12. Describe the land use in the vicinity of this project:_ /Co r-
5 '
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.

C
V.
Future Project Plans
Are any additional permit requests anticipated for this project in the future?
anticipated work, and provide justificatio for the exclusion of this work
applicafipn:-Alo -2 .,.:.? a
J i :.J fti' r Nti t ,.
If so, describe the
from the current

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

feet)
Type of Wetland***

* T.ictrnchimn?nrc oral .,e.,.4 ;.4--.:A,
- - --- r- -r° ° -v -•••••y ..., p-l y Iuipacu. 1111pacr5 Incluae, out are not tlmlted to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately Iis t impacts due to both structure and flooding.
* * 100-Year flood pIains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local flood pIain maps. Maps area vai I ab I c through the FEMA Map Service Center at I -KG-358-9616, or
online at htip://www.rcma.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 existi g wetlands on the property
Total area of wetland impact proposed: osle
/ jJI
W014I Ae
2. Stream Impacts, including all intermittent and perennial streams
?/C' ? Sri 71 FiIli MY
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?
lease s ecify)
-

s
Y

rNUJ- Y a•,d j d c iiti y tcrnpurary Impacts. impacts Include, but are not limited to: culverts and associated rip-tap,
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.topozone.com,
www.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:- N U l11 2'
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.

V 17

T --..1..
--•-• ---•• • r_- -r°•?•? ., - .. ,,....v , N any "'Pa-'. iinNacis inciuue, out are not limited to: till, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation ?r? ?tv Ic S1 ?/ f?li7h ??? i`',i r'y f 5 ?r'rr11/ C?jw D- ejvr?y111?'Y,;
If construction of a pond is .
p oposed, 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., darn/embankment, excavation installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond e.g., ivestock atering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): $ Fb nIT `
Size of watershed draining to pond: /kJ r-'rExpected pond surface area: 4 Y
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. j'
a 4-
„? -
? ? jt'C'? C"',7t L. k1 ice../^7' ?.. 'C_ ?:,.? ? N' ?: i.I ? ,% !? ?. '.J r '•.?5. ? N l d 1? ? ? t"? ?
O'VI'17 Z!F 17J -N
_tr VII/

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/ncwetiands/stmi.6de.htmi.
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. t
gel j y Vl fn 1 E'? S d s , fle) yre` v f? ?"7" Se r2--
r 4
o tI ?. ?-
9 /?f???I L fii'? !' )"h I$ /, `'t " l7'l t7 C 1`s }' S `r a "'+a? 42" `?'L
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/Wedands 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 _httn://h2o enr .tate nc us/wM/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/stateAocal)
land?
Yes ? No V
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 must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify ?9
Yes ? 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
I 3
2 1.5
Total
i-one t extenas out su teet perpenaicular 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.
XH. 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.
XII L 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 'M No ?
Page 10of 12
e
X TV. 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).
4 - - t-1
Applic Agen ' Signature 1 5ate
(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 Suny
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
Wiln?ngton egulatory Field Offi Anson Duplin Onslow
rps Of Engine ers Bladen Harnett Pender
ox 1890 Bnrnswick Hoke Riclunond
L
C 28402-1890 Carteret Montgomery Robeson
10) 251-4511 Columbus Moore Sampson
-4025 Cumberland New Hanover Scotland
I aq
Pa ge I I of 12
US F
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
ish and Wildlife Service / National A
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
Zarine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivers Island
Beaufort, NC 28516
Telephone: [phone]
CGS
I j?qq 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 Resources
1650 Mail Service Center 1619 Mail Service Center 4617 Mail Service Center
Raleigh, NC 27699-1650 Raleigh, NC 27699-1619 Raleigh, NC 27699-4617
Telephone: [phone] Telephone: [phone] Telephone: [phone]
Fax: [phone] Far: [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 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates 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 Suny
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
Far: [phone] Haywood McDowell Yancey
Page 12 of 12

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Office Use Only:
Form Version April 2001
USACE Action ID No.5 3 9
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.
Processing
1.
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:--N IA/ #
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
H.
1. Owner/Applicant Information
Name: < /9 /7 Af • 7
t?
Mailing Address. t eo
T 1 1
1 Cicpnone rqumoer: zz,?, - Fax Number: /: ?'-> F
E-mail Address:_ Al c.,,,)
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:_ f)
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 fWl-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: HQ 1? ;.,
2. T.I.P. Project Number (NCDOT Only):?A
3. Property Identification Number (Tax PIN): / 2 Q 6 (
4. Location J
County: ?e n t:% j' Nearest Town: d-7
Subdivision name (include phase/lot number): /X
Directions to site (include road numbe s, landmarks, etc.): t r,2 /U W E
M;2 e l/(/e.S 7- 4 r- L e 4 r ef.5 7-
.5-e5le /9 It r1l e_ At r^ e M a D.
9
5. Site coordinates, if available (UTM or Lat/Long):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing lan use or condition y of the site at th time of tliis application:
Y? S S'.
7. Property size (acres): le ? Y3 ?JGy Z) eoll
8. Nearest body of water (stream/6ver/sound/ocean/lake):1 e y!^ sp &
River Basin: c-oa p ?•1 , 'Ica ? -
(Note - this must be one of North Carolina's seventeen designated major river basins.
River Basin map is available at hqp://h2o.enr.state.nc.us/adniin/inaps/.)
The
Page 4 of 12
10. Describe the purpose of the proposed work: 76
L I :J 7 ;
J L { r ? r ' 1 ?? tl f •a
'ZI
UI-01 a?G?JY•x C•? , .??•,, J C , kr J- 1 / E• ? F M /
a ` ' ` ?' ( r i- M 1f ?•? ^) !i'( ' it ?'
,-.? J .???
11. List the type o?equipment to be used to construct the prolYect.??L JY ? T r L-r
12. Describe the land use in the vicinity of axis project: YU r .2:F 5
W. 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. ?r
77
V. Future Project Plans
til
Are any additional permit requests anticipated for this project in the fixture? If so, describe the
anticipated work, and provide justificatio?x for the exclusion of this work from the current
applicatipri: A16. a t.
-4
VI. Proposed Impacts to Waters of the United Stites/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***
t

* T of t, ..?.. ..?e i. -A
-_ - .. .... F- . scpaia,..?r and 1uo11dLy Lanputary impacts. impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately lis t 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), 6r FEMA-approved local floodplain maps. Maps arc available through the FEMA Map ServiceCenterat1-800-358-9616,or
online at htip://ww-w.fcma.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 properly:
Total area of wetland impact proposed
:/Gr
2. Stream Impacts, including all intermittent and perennial streams
a? e
614 r;,4
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)

""pa-ocpa,amly and idcnuty temporary impacts. impacts include, but are not limited to: culverts and associated rip-tap,
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. Ifa 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.usas.Kov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
wW11v.mapauest.eom, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:-N &, h e
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.

T;nfs nt. ..f .. ._1.. .. ..J J_ C--.
VII.
---- ------ -..-r--- --r...... I _••° •??•••••? -"F"." -.F. ia. -'Paces MuMuc, out are not iimitea to: till, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation
fir r° r r? S If t t/ C? v-? ?r 11?''?.
If construction of a pond is p oposed, 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, exca.__ vation installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond ?e.g., ]rvestock atering, irrigation, aestheti_c, trout pond,
local stormwater requirement, etc.):- 15 h F'p nI _
Size of watershed draining to pond: .. -'5'f © A M te:gExpected pond surface area: 4 fi6 Y- L
Impact Justification (Avoidance and Minimization)
7"L -7
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.
17
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, nitigation 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/ncwet]ands/stmi.iti de.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 (acreageAinear 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.
f7 .? • ? c' -D l d ?" ? /art f c? ? ?ry_ ?. f._?,
O'q
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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/Wedands 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 httn://h2o.enr.tate nc us/wM/index htni 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):
TX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ? No [j
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 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
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
I 3
2 1.5
Total
Gone t extends out 3u teet perpendicular trom near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone I.
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.
XH. 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 N
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).

w d
Applic Agen' Signature ate
(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 Cabanas 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 Suny
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 Cun-ituck 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 Offi 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
Far. [phone] Cumberland New Hanover Scotland
I C49 !
Pa ge 1 I of 12

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 Pivers Island
Raleigh, NC 27636-3726 Asheville, NC 28801 Beaufort, NC 28516
Telephone: [phone] Telephone: [phone] Telephone: [phone]
CGS
North Carolina State Agencies
11vision of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
CAMA and NC Coastal Counties
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
Telephone: [phone]
Fax: [phone]
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator
3855 Idlewild Road
Kernersville, NC 27284-9180
Telephone: [phone]
Mountain Region Coordinator
20830 Great Smoky Mtn. Expressway
Waynesville, NC 28786
Telephone: [phone]
Fax: [phone]
Alleghany Caldwell Watauga
Ashe Mitchell Wilkes
Avery Stokes .
Burke Surry
Buncombe Henderson Polk
Cherokee Jackson Rutherford
Clay Macon Swain
Graham Madison Transylvania
Haywood McDowell Yancey
Page 12 of 12

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Office Use Only:
USACE Action ID No.
Form Version April 2001
DWQ No. 1 1,539
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
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
H.
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
Owner/Applicant Information
Name:
Mailing Address:_
Telephone Number: Fax Number: r ,? '
.? ?, .. 1.
E-mail Address: JU o ,,j zt-'
2
Agent Information (A signed and dated copy of the Agent Authorization
attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation: /
Mailing Address: j
Telephone Number:
E-mail Address:
letter must be
Fax Number:
PAYM, -Nl
RECF1V[-D
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: ,6?Q /)C6/?
2. T.I.P. Project Number (NCDOT Only): AA
3. Property Identification Number (Tax PIN): P121 0,56
Subdivision name (include phase(lot number): 1/61L
Directions to site (include road numbe s, landmarks, etc.): Q,.2 /
4. Locati on
N?
County:_ Re f f Lam' r Nearest Town:[] f??)
5. Site coordinates, if available (UTM or Lat/Long):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a disti nct waterbody.)
6. Describe the existing Ian use or condition of the site at th time of this application:
ras
7. Property size (acres):_ 5,,4e r C-"s , c y c ?;5rt ,,? e.. ` '•c:t Y,3Ae
8. Nearest body of water (stream/river/sound/ocean/lake):eyl^
9
River Basin: 4:f ap , "4_eat(N15 Z-a l-?e i"C 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:
1 Y., G: S C. t''. , J I S
4 J t I ? '}
}l it J• r1
I ? q
el L! ? ?G-l ? I'1 ' „J • i?, j t?' ' , ' a ?- a ?"
11. List the type of equipment to be used to construct the project:L ?->l r 7 T r 12. Describe the land use in the vicinity of this project: kU r f :5
e /
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 * ificatio for the exclusion of this work from the current
applicatiPn: L:. `,..
r'p _ I _ •., ..e
01 f
71
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
17 /- ? ?? +?"" ? G? / eftr i. 1 • ?` ,. ? ? ?`_ i?l }' r"? !'? 1 ?/ vc_': -t i . ? .?" ... r _ .-
G
Pei
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***
1 "? ? l © ? o CaS/mar ?

* T.ict ra rh i rf a o/e l.. .,...t :ate.. ?:A,
r° ° w °" . en ify -inpuiau y impacts. impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately lis t 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 ServiceCenteratl-800-358-9616,or
online at http://www.fema.szov.
* * * 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:k j/
i 1'4441
2. Stream Impacts, including all intermittent and perennial streams

ex I'm ,
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?
lease s ecify)

T 11
?- u.. 'I"Fac, paiatc?y anu iuonuly 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 strearn.reloeation 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. Ifa 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
wwNv.usus.eov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.lopo7.one.com,
ww y.mapquest eom, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: Nv)I
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 Waterbod
(if applicable) y Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.

-° r°?• r.....-J -1- - ...,.,.r a ,,,pv,a,y ,n,pacis. impacts inciuae, out are not umitea to: till, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation 11,1 E er S
If construction of a pond is 4prosed, 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., Jivestock atering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): I $ h f9t, r/
Size of watershed draining to pond: ,S% 0 R,' te''Expected pond surface area: -4 r^ e
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 constructipri tjo.reduce impacts.
Y A 't- t,
i ) ?'. ,emu i.f Yr 4
4 S 7 !.,?/ )'r?l ed I':°?t? a:_: ?, 1 tF
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
Pennits, published in the Federal Register on March 9, 2000, nitigation 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.ne.us/ncNveflands/stmi.itide.htrni.
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
I
j 1 'epn T
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/Wedands 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 httn://h2o enr .tate nc us/wm/itidex htni 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 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 213 .0259 (Tar-Pamlico), 15A NCAC 213 .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
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
I 3
2 1.5
Total
Gone t 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.
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.
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 'N No ?
Page l0 of 12
.e
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).

k,zz, X??
4 &z2l' _ "
- I/ I _ _a.
Applic Agen ' Signature ate
(Agent's signature is valid only if an authorization letter from the applicant is prov ided.)
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office
US Army Corps of Engineers
151 Patton Avenue
Room 208 Alexander
Avery
Buncombe
Burke Cherokee
Clay
Cleveland
Gaston Iredell
Jackson
Lincoln
Macon Mitchell
Polk
Rowan
Rutherford Union
Watauga
Yancey
Asheville, NC 28801-5006
Telephone: [phone] Cabarrus
Caldwell Graham
Haywood Madison
McDowell Stanley
Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham Wilson
US Army Corps Of Engineers
6508 Falls of the Neuse Road
Suite 120 Alleghany
Ashe
Caswell Edgecombe
Franklin
Forsyth Lee
Nash
Northampton Stokes
Surry
Vance Yadkin
Raleigh, NC 27615
Telephone: [phone] Chatham
Davidson Granville
Guilford Orange
Person Wake
Warren
Fax: [phone] Davie Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers
Post Office Box 1000
Washington, NC 27889-1000
Telephone: [phone] Berne
Camden
Carteret*
Chowan Dare
Gates
Green
Hertford Lenoir
Martin
Pamlico
Pasquotank Tyrrell
Washington
Wayne
Fax: [phone] Craven Hyde Perquimans *Croatan National Forest Only
Wilmington Regulatory Field Offi 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
I COY
Pa ge I I of 12
1.
US F
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
ish and Wildlife Service / National A
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
Zarine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivers Island
Beaufort, NC 28516
Telephone: [phone]
•G S
,, North Carolina State Agencies
'Iivision of Water Quality Division of Water Quality State Historic Preservation Office
401 Wetlands Unit Wetlands Restoration Program Department Of Cultural Resources
1650 Mail Service Center 1619 Mail Service Center 4617 Mail Service Center
Raleigh, NC 27699-1650 Raleigh, NC 27699-1619 Raleigh, NC 27699-4617
Telephone: [phone] Telephone: [phone] 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 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Tr out 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 Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
I clephone: [phone] Graham Madison Transylvania
Far: [phone] Haywood McDowell Yancey
Page 12 of 12

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Office Use Only:
USACE Action ID No.
n C3 Form Version April 2001
?J 9
D W Q No t"' 1
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:
[Y Section 404 Permit
? Section 10 Permit
401 Water Quality Certification
Riparian or Watershed Buffer Rules
H.
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
Owner/Applicant Information
Name:
Mailing Address:_
Telephone Number:_ a? , Fax Number:
E-mail Address: &©yj ;
2
Agent Information (A signed and dated copy of the Agent
attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Authorization letter must be
Fax Number:

Page 3 of 12
A
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: H6
2. T.I.P. Project Number (NCDOT Only):_ V_
3. Property Identification Number (Tax PIN): P 12 ? D '5?0
4. Locati on
County: Pe n e r Nearest Town: /? G IYI l1S
Subdivision name (include phase/lot number): /X
Directions to site (include road numbe s, landmarks, etc.): i .,2 /!J j ?-

5. Site coordinates, if available (UTM or Lat/Long):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing lan use or condition of the site at M
time of this application:
/lL' a rl GPI' S? u'M
r4 S S.,
7. Property size (acres): 5 Gr 3 Ae
8. Nearest body of water (stream/river/sound/oceanAake):_ )V ,5,yl" /.S`p iz
9. River Basin: 4:faplefl Z? 1' 6V.Z-,'
4?,a '? e /Cca r
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http:i2o.enr.state.nc.us/admin/maps/.)
Page 4 of 12
10. Describe the purpose of the proposed work.-26 L i- e 7
IV
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11. List the type ofequipment to be used to construct the project: /L1 ?r Gr e',
1 r/ *=i Its t i ?' .1`
12. Describe the land use in the vicinity 1 ?of this project:- ko r ? a w
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 justificatio for the exclusion of this work from the current
applicatrPn: i t 1
F A

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***

s

* TACT-1, 1 of se a uts lr nr.4 :A :r.,
_.__ ___......,.__. _r_ , , ,,,,,r --p--3, ?111p1VLJ. impacts inciuae, out are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately lis t 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 ServiceCenteratl-800358-9616,or
online at htip://w\vw.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 exi
Total area of wetland impact proposed
the
x/
c j V stet'
eak , ri ' C,C
WO 4;
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)

" L' t h
is eac in pact separately and Wentify 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.usus.¢ov. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.ma2guest com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: NL> h L'
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.

VII.
1111P \. 3 nic,uuc, out arc not nmiteo to: Im, excavation* dredging
flooding, drainage, bulkheads, etc.
4. Pond Creation e rt I ?lE' ers
If construction of a pond is pfoposed, 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, exca+ va`n, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond ?e.g., ivestock ater
local stormwater requirement, ing, irrigation, aesthetic, trout pond,
?? /?
Size of watershed draining to pond: !S'? 0 /krefExpected pond surface area: Y
Impact Justification (Avoidance and Minimization)
!r t
:=?Y1. CV /7 L"/"/ c? L- `'?' )' rl /!?): .!v •i- C ?'. ?.!' L '`; ?? !_ / /
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.
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.ne.us/ncNveflands/stmi,i?de.htrni.
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 an d 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

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/Wedands 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 htt.p://h2o enr .tate nc t»/wrp/index htni 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):
TX. 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 [:J Non
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 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
(Meuse), 15A NCAC 213 .0259 (Tar-Pamlico), 15A NCAC 213 .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
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
cone i extends out su teet perpendicular tram 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 N
Is this an after-the-fact permit application?
Yes P No ?
Page l0 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).
--
Applico&AgentgSignature 0 ate
(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 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabanas 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 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
'Wilnngton Regulatory Field
US Army Corps Of Engineers
Post Office Box 1890
Wilmington, NC 28402-1890
Telephone: [phone]
Fax [phone] /
Offi Anson Duplin Onslow
Bladen Harnett Pender
Brunswick Hoke Richmond
Carteret Montgomery Robeson
Columbus Moore Sampson
Cumberland New Hanover Scotland

Pa ge I I of 12
Pitt
Tyrrell
Washington
Wayne
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 33726 160 Zillicoa Street Pivers Island
Raleigh, NC 27636-3726 Asheville, NC 28801 Beaufort, NC 28516
Telephone: [phone] Telephone: [phone] Telephone: [phone]
jr114S
. North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone] i
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
Telephone: [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 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell
3855 Idlewild Road Ashe Mitchell
Kemersville, NC 27284-9180 Avery Stokes .
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson
20830 Great Smoky Mtn. Expressway Cherokee Jackson
Waynesville, NC 28786 Clay Macon
Telephone: [phone] Graham Madison
Fax: [phone] Haywood McDowell
Watauga
Wilkes
Polk
Rutherford
Swain
Transylvania
Yancey
Page 12 of 12

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Office Use Only:
Form version April 2001
011539
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.
H.
Processing
1. Check all of the approval(s) requested for this project:
[2 Section 404 Permit
? Section 10 Permit
® 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested.N (A/
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:
Mailing Address:_
Telephone Number: F r ;; Fax Number:
E-mail Address: c,yl ?r
z_'
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/a0plicant.)
Name:
Company Affiliation:
Mailing Address: j
Telephone Number:
E-mail Address:
Fax Number:
Vn,gr ,
Page 3 of 12 ?, rV l (' PV
RF ? f ?VL-

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: D ?? c i 'r '7" ° =~ ``
2. T.I.P. Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): p 13 1 n -5-0
4. Location
County: Pe j( e Nearest Town: L7? p s
Subdivision name (include phase/lot number): //9
Directions to site (include road numbe s, landmarks, etc.): " .2 /!J IT M i L E lWe 17" a 01 '` %, Cc e,5 7'
5. Site coordinates, if available (UTM or Lat/Long):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing lan use or condition of the site at th? ti me of this applicati on: a -,ef ,
1
9
7. Property size (acres): r It- S C ! c'' ,e ,.3 SIC w`) eoy,?- A
8. Nearest body of water (stream/river/sound/ocean/lake): dat--45`p 1-7
9
River Basin: C ape, J'(N.1 , ?a /_-) e / c a ?'
(Note - this must be one of North Carolina's seventeen designated major river basins
River Basin map is available at h_ ://h2o.enr.state.nc.us/adniin/inaps/.)
The
Page 4 of 12
10. Describe the purpose of the proposed work.--76 L Y
t [ r1 } r
a c 1ti t ,/., i Y', llc,7
11. List the type ofseyquipment to be used to construct the project:_ f`/,I 4
f %I' . J!V I % / :r_lr t..•. :' I ? (- P .i i.? ? f} 1i ? .w
12. Describe the land use in the vicinity ofthis project: ko r Z!F
/

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.
7 r~- 1 "? it r
6 7
V. Future Project Plans
c?
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justi1 catio for the exclusion of this work from the current
applicatipn:
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***
ri
L? O p??aS/mar

* T ;ct -6 L.., ..A ;A--.: C.. . _.`-----'--- _ -.
--•-1-•-°•• ••^r°? r° ? w ...... -y iCrlipo-av y rtnpacis. impacts inciude, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately lis t 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 ServiceCenteratl-800-358.9616,or
online at http:;/www,fema.uov.
"* * 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 w lands on the
Total area of wetland impact proposed:d Wlrxi
NOddr A,
Stream Impacts, including all intermittent and perennial streams
L 1 +? P f H y' t ?t 1 Y dJ
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)

?- V M.Pac 5cpEa.C?yaUIUJUonuiytcmporaryimpacts. 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. Ifa 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
ww%v.usas.t.!ov. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapquest_com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: NU );) 2e
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.

A

- - - ----r---- --r-----v -••° •?? ••••! •""'Y"16J .•uNaa,.a. iu•Nauw mumurz, oul are not nmitea to: Illl, 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.):
Proposed use or purpose of pond (e.g., livestock atering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):_ 5 ?c rl
Size of watershed draining to pond: , 0 fi-,, fe',Expected pond surface area: ?/ ? Y^ L
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. y
1117
Dc I ft/ ?..'Y 4 2, 7 CL i f i 1I, 1 _ "A. S
J t/ A I
L. i k)
/ham' ? ?,• _ _ ; . ,. _ - _
r ` "
Page 7 of 12
VIII. Mitigation
1
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
stream s.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, nitigation 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
h ttp://h2 o. enr. state. n c. us/ncNved ands/stmi .i?d e. 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 (acreageAinear 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.

,u ?T.
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/Wedands 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 httn://h2o.enr.tate nc us/wrp/index htni 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 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
(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
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* S Impact
feet) (square Multiplier Required
I 3
2 1.5
Total
Gone i extends out JU 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.
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.
XH. 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 N
Is this an after-the-fact permit application?
Yes No ?
Page l0of 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).
-- _
ApplicKPNAgentg Signature ate
(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 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
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes
6508 Falls of the Neuse Road Ashe Franklin Nash Suny
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 Berne 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
ilmington Regulatory Field Offi 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
Fa, [phone] Cumberland New Hanover Scotland
I CB?
I
Pa
ge I I of 12
Pitt
Tyrrell
Washington
Wayne
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 33726 160 Zillicoa Street Pivers Island
Raleigh, NC 27636-3726 Asheville, NC 28801 Beaufort, NC 28516
Telephone: [phone] Telephone: [phone] Telephone: [phone]
•GS
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
Telephone: [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 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild 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
Fix: [phone] Haywood McDowell Yancey
Page 12 of 12

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Officc Use Only:
USACE Action ID No.
Processing
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1.
H.
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.N IN #
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:
Mailing Address:
L ? ''`5 Q
Form Version April 2001
DWQ No. 01 1539
V y,
i
------------
Telephone Number:---y j ?? - k 'r "I Fax Number: / v' <`) f
E-mail Address:- /V c, yl
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: r j
Mailing Address: j f-
Telephone Number: Fax Number:
E-mail Address:
Page 3 of 12
fit ?'??1i,k D
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: 77? _'
2. T.I.P. Project Number (NCDOT Only):/"
3. Property Identification Number (Tax PIN): 13 ?6
Subdivision name (include phase/lot number): t/ _
Directions to site (include road numbers, landmarks, etc.):. 1 i? .2
4. Location
County: Pe OV/ Nearest Town:
X z? li e cl -,?rd H !A'+r' Y .x? /6 We .5 T:

5. Site coordinates, if available (UTM or Lat/Long):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing ]an use or condition of the site at th time of this application: C Z 2`'' ,a
r P ,mot
7. Property size (acres):_ fi elk er S Y,3 Ae /"
8. Nearest body of water (stream/river/sound/ocean/lake):-)?r?y!^IS.-D fz
9
RiverBasin: (&Z, Y-
(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/adniin/inaps/.)
The
Page 4 of 12
10. Describe the purpose of the proposed work: ?U L
tJcs/IBC-I/Y', ?'?;
11. List the type ot?equipment to be used to construct the pro' j ect:_ f`/L c
.
IV.
V
VI.
12. Describe the land use in the vicinity of this project: )56 1" -2tF
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.
.A 2 06! 01-
Future Project Plans
Are any additional permit requests anticipated for this project in the fixture? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
applicatiPn: L? /?{'• w
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***

t r

* T.ist each impart er nareMly ar l L Kf., s e _.:
_r-----r...... j -••- •--..,,•.v • r a y ?pacu. impauis inumue, out are not united to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately lis t 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 snaps. Maps are available through the FEMA Map ServiceCenteratl-8358-9616,or
online at httn://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:
??
Odd 14,4
2. Stream Impacts, including all intermittent and perennial streams
.#V
6 it

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)
_

" L'st t, ' t I
i eac impac separate y 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.usus.¢ov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapquest com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:_ N1.>h e
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.

I
L
- -r-------.._ .--_.....? --'--'J ....r--w. ,-P.- ."l-, uut 111e; not iimitea to: I111, excavation, dredging
flooding, drainage, bulkheads, etc.
4. Pond Creation ?}??'r:'r.
If construction of a pond is p 4posed, 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., dan-/embankment, excaio„n installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond e.g., }tvestock atering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): $ r`t t tit'
Size of watershed draining to pond: 1` u lj;_'?=` `expected pond surface area t= Y
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 durinp, construction to reduce impact. t
} r > 1 ! f/ r', 1?) l ' % } / t ?/ L'n `* c t / t l f C+l
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, nitigation 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/ncweti ands/stmzcti de.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 an d 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.

1
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/Wedands 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 httn://h2o enr .tats nc us/wip/index htni 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):
TX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ? No rul
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 E] 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 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
(Meuse), 15A NCAC 213 .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
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
cone 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.
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.
X11. 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.
XW. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No N
Is this an after-the-fact pen-nit application?
Yes 1 No ?
Page l0of 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). 14, 4 ,/ - U

Applic Agen ' Signature ate
(Agent's signature is valid only if an authorization letter from the applicant is prov ided.)
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 Suny
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 Offi Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Bnmswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax [phone] Cumberland New Hanover Scotland
I CB??
Pa ge I I of 12
US F
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]
ish and Wildlife Service / National A
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
Zarine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivers Island
Beaufort, NC 28516
Telephone: [phone]
1cs
,a North Carolina State Agencies
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
CAMA and NC Coastal Counties
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
Telephone: [phone]
Fax: [phone]
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild 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
Page 12 of 12

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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
December 14, 2001
Joseph N. Honeycutt
122 Broadview Lane
Hampstead, NC 28443
Dear Mr. Honeycutt:
SUBJECT: Approval of 401 Water Quality and Additional
Conditions
Corner of Lea Crest Lane and Hwy 210 West
DWQ Project # 011539
Pender County
You have our approval, in accordance with the attached conditions (WQC # 3287) to conduct the following activity at
the corner of Lea Crest Lane and Hwy 210 West, in Pender County. This approval allows you to:
1) Dig a 0.25 ac pond in wetlands.
2) Fill 0.25 ac wetlands for a building site.
This approval is only valid for the purpose and design that you described in your Pre-Construction Notification (PCN)
application received by the Division of Water Quality (DWQ) dated October 17, 2001. After reviewing your application,
we have determined that General Water Quality Certification Number 3287 covers this activity. This Certification allows
you to use your 404 Permit when the Corps of Engineers issues it. Please keep in mind that there may be additional Federal,
State or Local regulations applicable to your project, such as (but not limited to) Sediment and Erosion Control, Non-
Discharge and Water Supply Watershed regulations and Coastal Stormwater. In addition, 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 PCN (For a cumulative wetland
impact on this site of 0.50 ac). If you change or modify your project, you must notify the Division (DWQ) 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 the additional conditions listed below.
1). Any remaining wetlands and waters on the property need to be placed in a deed notification or similar
mechanism to notify the state in order to assure compliance for future wetlands and/or waters impacts. These
mechanisms shall be put in place within 30 days of the date of this letter or the issuance of the 404 permit
(whichever is later). A sample deed notification can be downloaded from the 401/Wetlands Unit web site at
http://h2o.enr.state.nc.us/ncwetlands. Please provide this Office a copy of the recorded plat.
2). The attached Certificate of Completion (COC) must be submitted to the Division upon final construction
of the site.
NMEM
Ex127 Cardinal Drive t., Wilmington, NC 28405-3845 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer
Page Two
Mr. Joseph N. Honeycutt
December 14, 2001
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 conforming 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 DWQ Permit # 011539 under Section 401 of the Clean Water Act. If you have
any questions, please telephone Joanne Steenhuis or Rick Shiver at 910-395-3900.
Sincerely,
Gregory J. Thorpe, Ph.D.
Acting Director, Division of Water Quality
Attachments: GC # 3287
Certificate of Completion
cc: Corps of Engineers Wilmington Field Office - Mickey Sugg
WiRO- Joanne Steenhuis
401/Wetland Unit, Central Office - Cyndi Karoly
Central Files
s ?OF W A 1',90
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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
December 14, 2001
Joseph N. Honeycutt
122 Broadview Lane
Hampstead, NC 28443
SUBJECT: Approval of 401 Water Quality and Additional
Conditions
Corner of Lea Crest Lane and Hwy 210 West
DWQ Project # 011539
Pender County
Dear Mr. Honeycutt: "t js'?P U
You have our approval, in accordance with the attached conditions (WQC # 3287) to conduct the following activity at
the corner of Lea Crest Lane and Hwy 210 West, in Pender County. This approval allows you to:
1) Dig a 0.25 ac pond in wetlands.
2) Fill 0.25 ac wetlands for a building site.
This approval is only valid for the purpose and design that you described in your Pre-Construction Notification (PCN)
application received by the Division of Water Quality (DWQ) dated October 17, 2001. After reviewing your application,
we have determined that General Water Quality Certification Number 3287 covers this activity. This Certification allows
you to use your 404 Permit when the Corps of Engineeifs issues it. Please keep in mind that there may be additional Federal,
State or Local regulations applicable to your project, such as (but not limited to) Sediment and Erosion Control, Non-
Discharge and Water Supply Watershed regulations and Coastal Stormwater. In addition, 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 PCN (For a cumulative wetland
impact on this site of 0.50 ac). If you change or modify your project, you must notify the Division (DWQ) 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 the additional conditions listed below.
1). Any remaining wetlands and waters on the property need to be placed in a deed notification or similar
mechanism to notify the state in order to assure compliance for future wetlands and/or waters impacts. These
mechanisms shall be put in place within 30 days of the date of this letter or the issuance of the 404 permit
(whichever is later). A sample deed notification can be downloaded from the 401/Wetlands Unit web site at
http://112o.enr.state.nc.us/ncwetiands. Please provide this Office a copy of the recorded plat.
2). The attached Certificate of Completion (COC) must be submitted to the Division upon final construction
of the site. Vilm.
Ex127 Cardinal Drive t., Wilmington, NC 28405-3845 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer
Page Two
Mr. Joseph N. Honeycutt
December 14, 2001
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 conforming 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 DWQ Permit # 011539 under Section 401 of the Clean Water Act. If you have
any questions, please telephone Joanne Steenhuis or Rick Shiver at 910-395-3900.
Sincerely,
Gregory J. Thorpe, Ph.D.
Acting Director, Division of Water Quality
Attachments: GC # 3287
Certificate of Completion
cc: Corps of Engineers Wilmington Field Office - Mickey Sugg
WiRO- Joanne Steenhuis
401/Wetland Unit, Central Office - Cyndi Karoly
Central Files