20020235 Ver 1_COMPLETE FILE_20020215

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Michael F. Easley
Governor
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D., Acting Director
Division of Water Quality
March 13, 2002
DWQ# 02-0235
Mecklenburg County
Don Caldwell
P.O. Box 410672
Charlotte, NC, 28241
APPROVAL of 401 Water Quality Certification
Dear Mr. Caldwell:
You have our approval, in accordance with the attached conditions, to place fill in 40 linear feet and flood 160 linear
feet of intermittent streams in order to construct a pond on your property in Mecklenburg County, as described in your
application received by the Division of Water Quality on February 15, 2002. After reviewing your application, we have
determined that this fill is covered by General Water Quality Certification Number 3287, which can be downloaded from our
web site at httpl/h 2o.enr.state.nc.Lts . This Certification allows you to use Nationwide Permit Number 39 when it is issued
by the U.S. Army Corps of Engineers. In addition, you should get any other federal, state or local permits before you go
ahead with your project including (but not limited to) Sediment and Erosion Control, Non-Discharge and Water Supply
Watershed regulations. You should send an application to the Division of Land Resources for their review of your project
under dam safety rules as well as erosion and sediment control. Also this approval will expire when the accompanying 404
permit expires unless otherwise specified in the General Certification.
This approval is only valid for the purpose and design that you described in your application. If you change your
project, you must notify us in writing and you may be required to send us a new application for a new certification. If the
property is sold, the new owner must be given a copy of the Certification and approval letter and is thereby responsible for
complying with all conditions. If total wetland fills for this project (now or in the future) exceed one acre, compensatory
mitigation may be required as described in 15A NCAC 2H .0506 (h). For this approval to be valid, you must follow the
conditions listed in the attached certification.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must act
within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition which conforms to
Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, P.O. Box 27447, Raleigh,
N.C. 27611-7447. This certification and its conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If you have
any questions, please telephone Pete Colwell in our Mooresville Regional Office at 704-663-1699 or Cyndi Karoly in Raleigh
at 919-733-1786.
Sincerely,
rr? Gregory J. Thorpe, Ph.D.,
/l
Attachments
cc: Corps of Engineers Asheville Regulatory Field Office
Mooresville DWQ Regional Office
Central Files
File Copy
020235
North Carolina Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
-.,- -1
MEMORANDUM
TO: John Dorney Regional Contact: Michael L Parker-
Non-Discharge Branch WQ Supervisor: Bex Gleason
Date:
SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS
Facility Name Donald Caldwell
Project Number 02 0235
Recvd From APP
Received Date 2/15/02 Recvd By Region 2/20/2002
Project Type residential access along with recreational pond
County Mecklenburg
County2
Region Mooresville
Certificates Stream Stream Impacts (ft.)
Permit Wetland Wetland Wetland Stream Class Acres Feet
Type Type Impact Score Index Prim. Supp. Basin Req. Req. ME
P _Y -@)N N 11-134 F c 30,834. 200.00 F- 200.00
Mitigation Wetland
MitigationType Type Acres Feet
Is Wetland Rating Sheet Attached? 0 Y 0 N Did you request more info? 0 Y 0 N
Have Project Changes/Conditions Been Discussed With Applicant? 0 Y 0 N
Is Mitigation required? 0 Y pQ N Recommendation: W Issue 0 Issue/Cond 0 Deny
Provided by Region: Latitude (ddmmss) 350445 Longitude (ddmmss) 810045
cc: Regional Office
Central Office Page Number 1
Date: I ? p--
To: CiRRO
?FRO
Steve W shell
Ken AveriLLe
?WaRO Deb-crah Sawyer
?WiRO Joanne Steenhuis
CWSRO Jennifer Frye
Triage Check List
Cal J ui e
Project Name
DWQ Project Number
CountyMe -
?Ii
L ARO Mike Parke-
VM Yhed -3
From: The file a besinc ;ocrrard to you for your evaluation.
assista-ce.
Telephone 919) 733- (>664
Please call if you need
Stream ler',ccu-, imp:a=teed
Stream de ir:an
C WeUand deter ,k-;a _ad csstance to blue-line surface waters on USGW topo maps

El Buffer Rcdes (,'?1r^r,T??an?7co, C----tawba, Randleman)
C Pond fill.
(`- Mitigation,F?a?ss
Ditching
[i Are the st e :, -=73:j or w mfffca'9on sites available and viable?
C Check dramires for acar--g _
? Is the appica i c-css`a wfifi pre-application meetings?
Cumulatr? iTr.?a.,s --?-= _

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Pre-Construction Notification (PCN) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act an&or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
http://w?Ltiy.Saw.usace.ami?-.mil/wetlands/Perm app htm.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at httti://www.saw.usace.armv.mil/wetlands/reatour.litm. or contact one of the. field
offices listed at the end of this application. The website also lists the responsible project manager for
each county in North Carolina and provides additional information regarding the identification and
regulation of wetlands and waters of the U.S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's,. 401/Wetlands Unit website at
http://h2o.enr.state.nc.us/ncwetlands to read about; purrent requirements for the 401 Water Quality
Certification Program and to determine whether )oar not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for some General Certifications is not required,
provided that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet
should contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is also required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on the last page of this application).
Page l of 12

CAMA Coordination - If the project occurs in any of North Carolina's twenty coastal counties (listed on
the last page of this application) the applicant should also contact the North Carolina Division of Coastal
Management (DCM) at [phone]. DCM will determine whether or not the project involves a
designated Area of Environmental Concern, in which case DCM will act as the lead permitting agency.
In such cases, DCM will require a Coastal Area Management Act (CAMA) Permit and will coordinate
the 404/401 Permits.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office (addresses are listed at the end of this
application). Upon receipt of an application, the USACE will determine if the application is complete as
soon as possible, not to exceed 30 days. This PCN form is designed for the convenience of the applicant
to address information needs for all USACE Nationwide, Regional or General permits, as well as
information required for State authorizations, certifications, and coordination. Fully providing the
information requested on this form will result in a complete application for any of the USACE
Nationwide, Regional or General permits. To review the minimum amount of information that must be
provided for a complete PCN for each USACE Nationwide permit. see Condition 13, 65 Fed.Reg. 12893
(March 9, 2000), available at http://w,,vw.saw.usace.armv.mil/wetlands/mvotin al FedRe2.pdt".
Processing times vary by permit and begin once the application has been determined to be complete.
Please contact the appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
-- as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than. 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at http://h2o.ehnr.state.nc.us/ncwetIands/fees.htm1. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 12
Office Use Only: Form Version April 2001
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing A tv1 Vol' ?,EO'A ?N At-- O? T? ?' S? ? R C N E
?n
?. ctl? ?K ?? T?FW? A rvy
1. Check all of the approval(s) requested for this project: so Q Section 404 Permit
SeI Water PeQuality rmit
Certification ??? CIS 11-G u1W?
© Riparian or Watershed Buffer Rules (L
2. Nationwide, Regional or General Permit Number(s) Requested: I
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ? Al-A
4: If payment into the North Carolina Wetlands Restoration Program (NCWR.P) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ? /C/ A .
II. Applicant Information
1. Owner/Applicant Information
Name: 1,') 0Al C A LD WE Z L- .
Mailing Address: P O A 4/ O G 7 2
G RL_ OTT E
Th?eC7 l-M 8) hq- 6 0 ?, 0
G b h (L Ldr E
Telephone Number:--70(4 .50 ?L-
E-mail Address:da,,. c a.D1,., p PPI
r?Z?l
uob -it -D
?G 2.77 R
Fax Number:
IaL.C.ovn
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: Al/ A
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
Pase 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: T)00 C ALDWS-( C_ & RA G.IN6- /I 1vD P(7/VD Co m pZFIJOJ l
2. T.I.P. Project Number (NCDOT Only): IVA
217- 0 2 l? (14' It 21 1-- 02. 7
3. Property Identification Number (Tax PIN): 2 J 7 01- 1 16
4. Location
County: Mkr, KZ_ E N 13 LA R G- Nearest Town: C R L 0 ?
Subdivision name (include phase/lot number): IVA
Directions to site (include road numbers, landmarks, etc.): ©CGr S. O ?V 16 1 W
vigr? VQ . 70 41 OT A V006 &-,("00 2 Z-A plu p- Tv
?-
f?C--Ac,ffi'KIG 1DUSTE..R AQ I R b6G U LLB Ohl uww Stavn RD
fpcL, ow 1. 2, MC ro /5630 yyyr,,60C-a D car- X16 -JT, AvGc, uw A&pAALT- b"V,v
TO Hous& -
5. Site coordinates, if available (UTM or Lat/Long): OT 4 V q,?,
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time c( s application:
C'c 14 hTOA)- 0 ?S, I ` o () ? Al pe (Lv STAtN--0
TQ CL&ntL 11r ORtU- : ATV V(LP :t1Nq
7. Property size (acres): 2 2 2 G
,?' ? ? r? n N 13 ? Nc?
8. Nearest body of water stre=,/river/sound/ocean/lake): 1_14 KC 47h ?• 2 M71,C S
??w t??nm 01f Ex,Y,T' AV pAl h ad Pv?Ty
R i T:m pn is a ?? n-v R y
9. River Basin: C Art 1b,6
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
Page 4 of 12
y0KAUL 12' LgWk 011-ML W1cMf 1 0 15A X
01 V(Late -,T +. 7M w iu- RkRd? t ti?l ?
ONL-9 AccEsS. /J,IuL lw BiLlO /jpfs,
i 115 M,,\;SXTFHn (i U\ tv R%N W1 ?-L
10. Describe the purpose of the proposed work:L- ukMJ'* BtA CIO Y L& POND S 11E
f 14koTe u LO A r)-, S oQ 4 ? 4 Ta?- o kTL- NJ d'?A
ML o d A 9, (L C d 0 O lU
11. List the type of equipment to be used to construct the project: '1 M E?p ,9SS4 1 CQA?? n-
SouC? como? Kc JFC ? TAWDLM T 9"'A Stew
IV.
12. Describe the land use in the vicinity of this ro'ect:? -L 3 A C T 2 t` c,?s S 1 ly (, S
RAC dl ?? i r n ??. ^ (, usL n`F 70 ILST
Prior Project History
V.
VI.
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.
AI-
Future Project Plans
Are any additional permit requests anticipated for. this project in the future? If so, describe the
anticipated work, and provide 'u tifcation for he exclusion of this work from the current
application: O-r AT 1?
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.
Pace 5 of 12
1. Wetland Impacts /V -A
Wetland Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floo plain**
(es o) Distance to
Nearest Stream
(linear feet)
Type of Wetland***

' List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/dminage, etc. For dams, separately list impacts due to both structure and flooding.
100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616. or
online at httn://%%ww.fcmn.eov.
List a wetland type that best describes wetland to be i acted (e.g., freshwater/saltwater marsh, forested well d, beaver pond,
Carolina Bay, bog, etc.) NO ?ZS f?/O ?h?-S l WO , SOVO; htLkV4.W(,?Jb(j4W
0VTT0vw, d? R&V ?WC-? ?Q-0 ADMVV 0LA. ?2oSla iV
List the total acreage (estimated) of existing wetlands on the property:
Total area of wetland impact proposed:,+A
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
(indicate on ma)
Type of Im act*
Pk(ilr r ?QY» Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
(please seci
C[tA i;t IV (OF d-ZO ZVO k 'i- Z» - T W
E?CmATTnjl /D'D v-DAin ,
B G 70'46N6

F f
-, UPI ' w
NO wva"vN 91 4MW4814
NE?Go? .. k I?o??a? ?G?`? PuNi) PONfl1501 ?0 6 "?0 ? w?D?
List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
ww.v.uses.gov. Several intemet sites also allow direct download and printing of USGS maps (e.g., wNvw.tooozone.com,
wwNv.maoauest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: I 50-2-00,
Pate 6 of 12
Y
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S. NA
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.)

FIG Td C?Arl, crn.c
- - - - -- °v _ ••r ••••F ?? F +? a wuuc, uuL auc nul 1117 UCO I0: till, excavation, dredging,
flooding, drainage, bulkheads, etc. r -
r N ??0 Cud Qcy?i.l ??l4`??S
4. Pond Creation ok I
If construction of a pond is proposed, associated etland and stream impacts should be
included above in the wetland and stream impact ections. Also, the proposed Paid should
be described here and illustrated on any maps inc ded with this appii 'tC?
Pond to be created in (check all that aPPIY)- k uplands t k e? '
? ? ? wetlands
Describe the method of construction (e.g., dam/embankment. excavation, installation f
draw-down valve or spillway, etc.): CQ.AVJ (? 'S ' 6 P GO If
9)+ihn CotiSTV_%%ror?,2N5T4K 0Ktt2 low G o01)S IFWA R kip/ d1rT ? ;gaw
Proposed use or purpose of pond (e.g., livestock wateri g, i gati , aesthetic, trout ond, ?` P ES
local stormwater requirement, etc.): ,9 C S 1 IT E- ? ? PO to STo ?, IV) ?I ?Rj?
S?P`(LZ??6 jc t, cteKA To Tdt,(,PoN1)
VII.
Size of wattrshe? diniNng t opond: l5 AG d(L CC 3S Expected pond surface
ti6w 6'ouP w? 1 t,0 6Zt-GZ t? To ??FXI STS do
Impact Justification (Avoi?anc nMinlimi?zahon)?
T b7o
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.
0 OS i S• ? ..i S 13;S T 1 u E o n ?L Lt 1z" \1 A
iv 1) ?l0
Skylp ZN 13O1T4? 4,1r RliolNre , >imoS-f aUskn n, 1.1' . Ti r

-wpm NLI I_ 1; 61 IV 1.) r 11 1 C, ?Z?v?,? E .
c, o S m u A o ,15 w)
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SS
?? y1?, ?' - - -
c?l- - Goy GC1? ?ulti? 2?cr- yC2???
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
litti)://h2o.enr.state.nc.us/ncwetIands/strmQide.litmi.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
IYQ AZ rG n TZO d
5 IV VA Sj I It CAY HL W C- %L?-- O N tJ JLO V f R \1 m? o
cl C0VVQ- '?"AWVS a- %TAP.,iL,12n tiori - v--7T A, ?LV 1&
{-&rlctr wit. (3 G1SCr -ir ?tSTUn, ?? AA,V4.S
Paee 8 of 12
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at littr)://li2o.enr.state.nc.us/wrr)/index.litrn If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information: V A
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 ' n/ h
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final ap?oval letter.
Yes F-1 No CR /V 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 213 .02 0 (Randleman Rules and
Water Supply Buffer Requi ments), or other (please identify )?
Yes [I No l N k If you answered "yes", provide the following information:
Pale 9 of 12
Identify the square feet and acreage of impact to each zone of the riparian buffers. If bu
mitigation is required calculate the required amount of mitigation by applying the bL
multipliers.
Zone* Impact
(square feet) Multiplier Required
Mitieation
1 3
2 I.5
Total
Zone I extends out 30 feet perpendicular from 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., Donai
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservatiol
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate informatiol
identified within 15A NCAC 2B .0242 or.0260.
_ &A
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the s
Discuss stormwater controls proposed in order to protect surface waters and wetla
downstream from the property.
XII. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge)
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 pe application?
Yes ? No v
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
Three ed Species, accessibility problems, or other issues outside of the applicant's control).
? U'1 •V0-•J? 4? ?
Applicant/Agent' Signature
(Agent's signature is valid only if an authorization letter from the applicant f:
02--
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 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
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
Pitt
Tyrrell
Washington
Wayne
Union
Watauga
Yancey
Wilson
Yadkin
*Croatan National Forest Only
Page I 1 of 12
US Fis
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
h and Wildlife Service / National N
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
[arine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivers Island
Beaufort, NC 28516
Telephone: [phone]
North Carolina State Agencies
Division of Water Quality
\
401 Wetlands Unit I
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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