20020381 Ver 1_Complete File_20020313

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor William G. Ross, Jr., Secretary
Alan W. Klimek, P.E., Director
July 30, 2004
Bruce and Karen Solomon
P.O. Box 1238
Pinehurst, NC, 28370
Subject Property: Solomon Residential Property
DWQ Project # 02-0381
Montgomery County
Approval of 401 Water Quality Certification with Additional Conditions
Dear Mr. and Mrs. Solomon:
You have our approval, in accordance with the attached conditions and those listed below, to
place fill within or otherwise impact 0.02 acres of wetlandsfor the purpose of shoreline
stabilization at the subject property, as described within your application received by the N.C.
Division of Water Quality (DWQ) on June 16, 2004. After reviewing your application, we have
decided that the impacts are covered by General Water Quality Certification Number(s) 3373
(GC3373). The Certification(s) allows you to use General Permit(s) 30 when issued by the US
Army Corps of Engineers (USACE). In addition, you should obtain or otherwise comply with
any other required federal, state or local permits before you go ahead with your project including
(but not limited to) Erosion and Sediment Control, Non-discharge, and other regulations. Also,
this approval to proceed with your proposed impacts or to conduct impacts to waters as
depicted in your application shall expire upon expiration of the 404 or CAMA Permit.
This approval is for the purpose and design that you described in your application. If you change
your project, you must notify us and you may be required to send us a new application. If the
property is sold, the new owner must be given a copy of this Certification and approval letter and
is thereby responsible for complying with all conditions. If total fills for this project (now or in
the future) exceed one acre of wetland or 150 linear feet of stream, compensatory mitigation may
be required as described in 15A NCAC 2H.0506 (h). This approval requires you to follow the
conditions listed in the attached certification and any additional conditions listed below.
1 401 Wetlands Certification Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650 One
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604 NorthCarohna
°hone: 919-733-1786 / FAX [phone] / Internet: http://h2o.enr.state.nc.us/ncwetlands Natunal/m
Bruce and Karen Solomon:
Page 2 of 4
July 30, 2004:
The Additional Conditions of the Certification are:
1. Impacts Approved
The following impacts are hereby approved as long as all of the other specific and
general conditions of this Certification (or Isolated Wetland Permit) are met. No other
impacts are approved including incidental impacts:
Amount Approved
(Units) Plan Location or Reference
Stream N/A (feet)
404/LAMA Wetlands N/A (acres)
Waters 0.02 (acres)
Buffers N/A (square ft.)
2. Erosion & Sediment Control Practices
Erosion and sediment control practices must be in full compliance with all specifications
governing the proper design, installation and operation and maintenance of such Best
Management Practices in order to protect surface waters standards:
a. The erosion and sediment control measures for the project must be designed,
installed, operated, and maintained in accordance with the most recent version of the
North Carolina Sediment and Erosion Control Planning and Design Manual.
b. The design, installation, operation, and maintenance of the sediment and erosion
control measures must be such that they equal, or exceed, the requirements specified
in the most recent version of the North Carolina Sediment and Erosion Control
Manual. The devices shall be maintained on all construction sites, borrow sites, and
waste pile (spoil) projects, including contractor-owned or leased borrow pits
associated with the project.
c. For borrow pit sites, the erosion and sediment control measures must be designed,
installed, operated, and maintained in accordance with the most recent version of the
North Carolina Surface Mining Manual.
d. The reclamation measures and implementation must comply with the reclamation in
accordance with the requirements of the Sedimentation Pollution Control Act.
3. No Waste, Spoil, Solids, or Fill of Any Kind
No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or riparian areas
beyond the footprint of the impacts depicted in the Pre-Construction Notification. All
construction activities, including the design, installation, operation, and maintenance of
sediment and erosion control Best Management Practices, shall be performed so that no
violations of state water quality standards, statutes, or rules occur.
I.
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
July 30, 2004
Bruce and Karen Solomon
P.O. Box 1238
Pinehurst, NC, 28370
Subject Property: Solomon Residential Property
William G. Ross, Jr., Secretary
Alan W. Klimek, P.E., Director
DWQ Project # 02-0381
Montgomery County
Approval of 401 Water Quality Certification with Additional Conditions
Dear Mr. and Mrs. Solomon:

You have our approval, in accordance with the attached conditions and those listed below, to
place fill within or otherwise impact 0.02 acres of wetlands`,for the purpose of shoreline
stabilization at the subject property, as described within your application received by the N.C.
Division of Water Quality (DWQ) on June 16, 2004. After reviewing your application, we have
decided that the impacts are covered by General Water Quality Certification Number(s) 3373
(GC3373). The Certification(s) allows you to use General Permit(s) 30 when issued by the US
Army Corps of Engineers (USACE). In addition, you should obtain or otherwise comply with
any other required federal, state or local permits before you go ahead with your project including
(but not limited to) Erosion and Sediment Control, Non-discharge, and other regulations. Also,
this approval to proceed with your proposed impacts or to conduct impacts to waters as
depicted in your application shall expire upon expiration of the 404 or CAMA Permit.
This approval is for the purpose and design that you described in your application. If you change
your project, you must notify us and you may be required to send us a new application. If the
property is sold, the new owner must be given a copy of this Certification and approval letter and
is thereby responsible for complying with all conditions. If total fills for this project (now or in
the future) exceed one acre of wetland or 150 linear feet of stream, compensatory mitigation may
be required as described in 15A NCAC 211.0506 (h). This approval requires you to follow the
conditions listed in the attached certification and any additional conditions listed below.
401 Wetlands Certification Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650.. One 7
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604 NOfthCarohna
Ohone: 919-733-1786/ FAX [phone]/ Internet: http://h2o.enr.state.nc.us/ncwetlands Naturctlltl
J
Bruce and Karen Solomon:
Page 3 of 4
July 30, 2004:
4. • No Sediment & Erosion Control Measures w/n Wetlands or Waters
Sediment and erosion control measures shall not be placed in wetlands or waters to the
maximum extent practicable. If placement of sediment and erosion control devices in
wetlands and waters is unavoidable, they shall be removed and the natural grade restored
within six months of the date that the Division of Land Resources has released the
project.
5. Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or
applicable Buffer Rules, and any subsequent modifications, the applicant is required to
return the attached certificate of completion to the 401/Wetlands Unit, North Carolina
Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650.
6. This project is for the installation of a treated wood bulkhead to prevent further erosion of the
property due to
wave action. The use of mechanical equipment on the beach must be minimized;
7. Equipment and materials may be offloaded to the beach at the bulkhead site, but steps must
be taken to keep all equipment out.of the reservoir.
Violations of any condition herein set forth may result in revocation of this Certification and may
result in criminal and/or civil penalties. The authorization to proceed with your proposed
impacts or to conduct impacts to waters as depicted in your application and as authorized by this
Certification, shall expire upon expiration of the 404 or CAMA Permit.
If you. do not accept any of the conditions of this Certification (associated with the approved
wetland or stream impacts), you may ask for an adjudicatory hearing. You must act within 60
days of the date that you receive this letter. To ask for a hearing, send a written petition, which
conforms to Chapter 150B of the North Carolina General Statutes to the Office of Administrative
Hearings, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its
conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean
Water Act. If you have any questions, please telephone Cyndi Karoly in the Central Office in
Raleigh at 919-733-9721 or Ken Averitte in the DWQ Fayetteville Regional Office at 910-486-
1541.
Sincerely,
arg Afe
Alan W. Klimek, P.E.
AWKlcbk
Bruce and Karen Solomon:
Page 4 of 4
July 30, 2004:
Enclosures: GC 3373
Certificate of Completion
cc: USACE Wilmington Regulatory Field Office
DWQ Fayetteville Regional Office
DLR Fayetteville Regional Office
File Copy
Central Files
Filename: 0203 81 S olomon (Montgomery)401 REN
t
t s

WETLANDS/ 401 GROUP
JUN f'6 2004 /
0 WATER QUAI,ITYSECiION
LIZ
?,ww

PA?MEn?r
RECEIVED 401 ISSUED
2

0--..
o? W A rEq WETLANDS / 409 GROUP Michael F. Easley
Governor
p QG William G. Ross, Jr., Secretary
Department of Environment and (Natural Resources
JUN 1"•6.2004
> -i Gregory J. Thorpe, Ph.D.
{p C Division of Water Quality
WATER
March 20, 2002
DWQ# 02-0381
Montgomery County
Bruce and Karen Solomon
P.O. Box 1238
Pinehurst, NC, 28370
APPROVAL of 401 Water Quality Certification with Additional Conditions
Dear Mr. and Mrs. Solomon:
You have our approval, in accordance with the attached conditions, to place fill in 0.02 acre of waters in order to
stabilize the shoreline on your property on Lake Tillery in Montgomery County, as you described in your application receiver
by the Division of Water Quality on March 13, 2002. After reviewing your application, we have decided that this fill is
covered by General Water Quality Certification Number 3373, which can be viewed on our web site at
http:l(h2o.enr.state.ne.us/ncwetiands . This Certification allows you to use Regional Permit Number 198200030 when the
Corps of Engineers issues it. In addition, you should get any other federal, state or local permits before you go ahead with
your project including (but not limited to) Sediment and Erosion Control, Coastal Stormwater, Non-Discharge and Water
Supply Watershed regulations. Also this approval will expire when the accompanying 404 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 fitls 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. This project is for the installation of a treated wood bulkhead to prevent further erosion of the property due to wave action. The use
mechanical equipment on the beach must be minimized;
2. Equipment and materials may be offloaded to the beach at the bulkhead site, but steps must be taken to keep all equipment out of
the reservoir.
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 hai
any questions, please telephone Ken Averitte in DWQ's Fayetteville Regional Office at 910-486-1541 or Cyndi Karoly in
Raleigh at 919-733-9721.
Sincerely,
J
Gregory J. Thorpe, Ph. .
Attachments
cc: Corps of Engineers Wilmington Regulatory Field Office
Fayetteville DWQ Regional Office
Central Files
File Copy 020381
ht-t, r.,. H- M46- of Water duality. 401 Wetlands Certification Unit,
MAY-19-2004 11:21 FROM:DWO-WETLANDS 9197336893
TO:89102959590 P:1/4
The following is an abbreviated application form for these applying for a 401 Water
Quality Certification to impact FERC (Federal Energy Regidstary Commission)
regulated lake shore or bottom under the U.S. Army Corps of Engineers Permit
GP30. This Application cannot be used for wetland or stream impacts. please
provide`?eveu (7) copies of this application and supporting information as well as a
non-refundable .application fee to the Divislou of Water Quality of $200.00 ter
impacts of to lake bottom of less than 1 acre and $475.00 for Impacts to lake bottom
of greater or equal to 1 acre.
Applications should be sent to:
Division of Water Quality Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
WETLANDS 1401 GROUP
JUN 1.6 2004
WATER QUALITY SECTION
L
Applicant Information
1. Owner/Applicant information
'telephone Number: CJ % actS---r-( O Fax Number:
E-mail Address:
2. Agent Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the ownerlapplicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number, Fax Number:
E-twil Address:
-
IL Project Information
Attach a vicinity snap clearly showing the location of the property with respect to
local landmarks such as towns, riven, and roads. Also provide a detailed site
playa showing property boundaries and development plaits in relation to
surrounding properties. Your may use the diagram below to make a hand sketch of
MA,Y-19-2004 11:21 FROM:DWQ-WETLANDS 9197336893
TO:89102959590 P:2/4
Your project. Also, see the example below for guidance. Both the vicinity map and
site plan must include a scale and north atmw. The footprints of all buildings,
impervious surfaces, or outer facilities must be included.
1. Location
county: (u rn-_.--c? Nearest Town: "+. L2,11-Cad
Subdivision name or gi a address (itidfude pphasellot numnber):
Directions to site please include road numbers, landmarks, eta. (This i not
necessary if an adequate vicinity map is included): )20 i S-4
?ivv?rz',
vi
2. Describe the existing land use or condition of the site at the time of this
application: Seca cAc11.. 25f" &?C- nr?roc

3. Property size (acres): __ (`) , a s 4
4. Nearest body of water (stream/river/soundlocearAake):
5. Describe the purpose of the.
b. I
V ?-
7. Amount of impact (including. all excavation, backfill, rip rap, retaining walls,
etc.) below the normal pool lake level in square feet or acre ; O (ac b..&_
8. a. Amount of impact (including aU clearing, back fill, excavation, rip rap,
retaining walls, etc.) above the normal pool lake level and 5o feet land-ward in
square feet or acres:
b. Please describe vegetation above the normal pool lakq level and 50 feet land-
ward to be impacted (number of trees for instance): i1r4-
LtAenrs Signature Daze
signature is valid only if = authorization letter fzom the applicant is provided.)
,MAY-19-2004 11:21 FROM:DWQ-WETLANDS 9197336893 70:89102959590 P:3/4
.h„
?U
P km Oppoidmdely oh the foftwm'g enumOm an a w- p1m
(Oftne p Idn nsiom for each go* oudi as W It. x Joe ft):
1) AN proposed vogdoiflon dewbW (proWde
.2) LocOm d p Fop or fill to be planed at the PaM sle,?ati@n
Leo awm- of rip rap orini to be Pled below the l eie n
4) The bcaflart of any prepond sus h as ildlns, r n
waft. doff ub?,
i) The 1k Cun of eMMOM or *WgkV belw!fie Pug Pend
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ov
Z VV E ERALD SHORES ROAD
Michael F. Easley
Governor
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D.
Division of Water Quality
March 20, 2002
DWQ# 02-0381
Montgomery County
Bruce and Karen Solomon
P.O. Box 1238
Pinehurst, NC, 28370
APPROVAL of 401 Water Quality Certification with Additional Conditions
Dear Mr. and Mrs. Solomon:
You have our approval, in accordance with the attached conditions, to place fill in 0.02 acre of waters in order to
stabilize the shoreline on your property on Lake Tillery in Montgomery County, as you described in your application received
by the Division of Water Quality on March 13, 2002. After reviewing your application, we have decided that this fill is
covered by General Water Quality Certification Number 3373, which can be viewed on our web site at
http://h2o.enr.state.nc.us/ncwetlands . This Certification allows you to use Regional Permit Number 198200030 when the
Corps of Engineers issues it. In addition, you should get any other federal, state or local permits before you go ahead with
your project including (but not limited to) Sediment and Erosion Control, Coastal Stormwater, Non-Discharge and Water
Supply Watershed regulations. Also this approval will expire when the accompanying 404 permit expires unless otherwise
specified in the General Certification.
This approval is only valid for the purpose and design that you described in your application. If you change your
project, you must notify us in writing and you may be required to send us a new application for a new certification. If the
property is sold, the new owner must be given a copy of the Certification and approval letter and is thereby responsible for
complying with all conditions. If total wetland fills for this project (now or in the future) exceed one acre, compensatory
mitigation may be required as described in 15A NCAC 2H .0506 (h). For this approval to be valid, you must follow the
conditions listed in the attached certification and the additional conditions listed below:
1. This project is for the installation of a treated wood bulkhead to prevent further erosion of the property due to wave action. The use of
mechanical equipment on the beach must be minimized;
2. Equipment and materials may be offloaded to the beach at the bulkhead site, but steps must be taken to keep all equipment out of
the reservoir.
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 Ken Averitte in DWQ's Fayetteville Regional Office at 910-486-1541 or Cyndi Karoly in
Raleigh at 919-733-9721.
Sincerely,
J
Gregory J. Thorpe, Ph. .
Attachments
cc: Corps of Engineers Wilmington Regulatory Field Office
Fayetteville DWQ Regional Office
Central Files
File Copy
020381
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!\'f'J•J -on /..1+......\ hlfl 7J7 CO!\•J /t....l Mw..•//4./1.. ..... .. .. .. r... .... /.......,.I.....J..%
L)
Office Use Only: Form Version April 2001
USACE Action ID No. DWQ No. 2 O 3 8 I
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
L Processing
1. Check all of the approval(s) requested for this project:
Section 404 Permit
? Section 10 Permit
401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested:
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: ?
IL Applicant Information
1. Owner/Appli
ant Information
Name: 2 u G iV E?/ SOLD l?Y1 D ??
Mailing Address: 0 U
r _ I. i of 0 ? ^7 n
Telephone Number: - J_ Fax Number:
E-mail Address:
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authopty for the owner/applicant.)
Name: N hlyl
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
Page 5 of 13
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 r ther than a sequential sheet version of the full-size plans. If full-size plans are
r W d do all 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:
2.T.I.P. Project Number (NCDOT Only):`
3.Property identification Number (Tax PIN):
41ocation 11 //yy
County: /I A D /4 Nearest Town: IV Subdivision name (include phase/ of number): p s/
Directions to site (include road numbers, landmarls, etc.):
N
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 thg existing land use or condition of the site at the time of this application:
7.Property size (acres): a 7 7irL?/1 ?S ,A/?i S Ly i4 ?L
8.Nearest body of water (stream/river/sound/ocean/lake): L?'i'?' 7?`-LPL y
9.River Basin: V Z/Y
(Note - this 4nust 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/mg.p .)
Page 6 of 13

rt
Office Use Only: Form Version April 2001
USACE Action ID No. DWQ No. 020381
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:
M Section 404 Permit
? Section 10 Permit
Nr401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: &Y), OcO30-
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/Ap ant Information
Name:. g U 6 F iV k g1V ZePL.l> M O 1%)
Mailing Address: O U
Telephone Number: - .? Fax Number:
E-mail Address:
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authol;itx for the owner/applicant.)
vnma N / 14-
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 13
10. pe cri a the purpose of the proposefl. work: ?? /? S??r? ???,?i j?,?
11. List the type of equipment to be used to construct the project:
np
12. Describe the land use in the vicinity of this project: ?c°5,'?j'g? yyl?Ao?12?
IV.
V.
VI.
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.
4J 14--
Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion .of this work from the current
application:.. iv flies nJ no A P
Proposed Impacts to Waters of the United StatesAVaters of the State .
It is the applicant's (or agent's) responsibility to determine; delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. ' If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. 'If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 13
1. Wetland Impacts
N /f?_
ti
Wetland
Impact
Site Number
(indicate on
ma
Type of
Impact* Area
of
Impact
(acres) Located within
100-year
Floodplain**
(yes/no) Distance to
Nearest
Stream
(linear feet)
,?**
Type of Wetland***

{ List eacn impact separately and identity temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://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!. JI,!
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
(indicate on
map)
Type of
Impact* Length of
Impact
(linear
feet

Stream Name** Average
Width of
Stream
Before
Impact t
Perennial or
Intermittent?
(please specify)

- List eacn impact separately and identity temporary impacts. impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
* * Stream names can be found on USGS topographic maps. If a stream has 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.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.tgpozone.com,
www.mapguest.com, etc.).
10. a cri a the purpose of the proposed work: ?.? Sys u??T ?d??'J?i ?,?
11. List the. type of equipment to be used to construct the project:
,np
12. Describe the land use in the vicinity of this project__?e5,'?/??j'g? ,? /1 `yl?77DA2?
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn.' Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and, describe permits issued for prior segments -of the -same T.I.P. project, along with
construction schedules.
V. Future Project Plans -
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application: .?V 12W nJ h U A P
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine; delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. ` If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 13
Cumulative impacts (linear distance in feet) to all streams on site:
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water
Impact
Site Number

(indicate on

ma

Type of hnPact* Area

of

Impact
(acres)

Name of?Waterbody

(if applicable)
Type of Waterbody

(lake, pond, estuary,

-sound, bay, ocean, etc.),
L L a _ 485 J?

,.bt WWI 1111PUUL bVVd1aw1y MW MUMIry temporary impacts. impacts mctuae, out are not lurmea to: tin, 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/embankm t, excavation; installation of
draw-down valve or spillway, etc.): A 1,A,
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
Page 9 of 13
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
hqp://h2o.enr.state.nc.us/ncw6t!auds/strmgide.htmi.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite),.affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a 'plan view,
preservation mechanism . (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is-needed.
Page 10 of 13
. 4

Cumulative impacts (linear distance in feet) to all streams on site:
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U. S.
Open Water
Impact

Site Number

(indicate on
ma

ype of Impact*
Area

of
Impact
(acres)

ame of Waterbody
(if applicable)

Type of Waterbody

(lake, pond, estuary,
sound, bay, ocean, etc.)
elk

.. ,_
"-"' ••••Y••"• vvYw..av+) u.au +uviawy wuiFwiaiy uUJJ"Lb. aLUJJU% b LUUmuG, ou[ ere um umllea to: Im, excavauon, areagmg,
flooding, drainage, bulkheads, etc.
4. Pond Creation
If construction of a pond is proposed, associated Vvetland 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/embankan t, excavation, installation of
draw-down valve or spillway, etc.): 04 11A,
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, Trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: . Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
<."//- S'C,e P'kN
Page 9 of 13
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 4014tlands' Unit if payment. into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check ahe NCWRP website ' at
http://h2o.enr.state.nc.us/wry/indek.htin. If use of the NCWRP is proposed, please check the
appropriate box on page three and provide the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
• Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or" the use of public (federal/state/local)
land?
Yes ? No []
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environnleintal 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 appro?jal letter.
Yes ? No ? /
IX. 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 Requir ments), or other (please identify )?
Yes ? No [ ] If you answered "yes", provide the following information:
Page 11 of 13
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
W "Lone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or. 0260.
X. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property. J n
XI. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewa;er generated from the proposed project, or available capacity of the subject facility.
• Violations (DWQ Only)
Is this site in violation of WQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact pe 't application?
Yes ? No
Page 12 of 13

2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy, mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands,Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at
http://h2o.enr. state. nc.us/wrp/index.htm. If use of the NCWRP is proposed, please check the
appropriate box on page three and provide the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
• Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ? No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental 'Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is, required, call the SEPA
coordinator at [phone] to reviepy 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 appro?jal letter.
Yes ? No ?
W
IX. 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 v `] If you answered "yes", provide the following information:
Page 11 of 13
MIL Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of.desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues 'outside of the applicant's control).
Z o? 2._-
App-licant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 13 of 13
77
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be4lGj,ef-` SOLOM01V

Survey. for
DR. BRUCE SOLOMAN &.. WIFE,
KAREN SOLOMAN-
Lot No. 17, Map -B, Section 5 of_t o
EMERALD ? u?ubdivlsion a on Lake Tillery.
Pee ee Township, Montgomery County, or Carolina
Deed Reference Book 420 Page 254
Surveyed by Thomas J. Fields, PLS7-,2906; on August 29, 2001
TOTAL AREA 0.29 Acre t
by coordinates
40 0 40
r p P2 ` -cl
0 7-? /'7
?Jry?rA?c) Siva
Scale is in Feet Found: 5/8"
1 „_ 40'
Iron Rod
411 /0
From the office of
WRIGHT & FIELDS LAND SURVEYING ,? tit 0
303 WEST SPRING STREET TROY, N.C. 27371 A,,p
Found: 5/8"
Iron Reber
0
N 49'34'44" W
20.00 FT
Found: 5/8"
MAGNETIC
NORTH
August 2001

S. 49'34'44" E
20.00 FT
Found:
Iron Rod 3/4" Iron
bent-over s@46oLb Pipe
?T.
?o
Lot No. 18 N
C5 lb
° x
N
Lot No. 17
20 FT Setback Zone wooden
rail fence
Lot No. 16
- nsT/1.ceC S
1ge ?s
/

Found: N 86'39'20", W 168.76 FT
/1 1/4" Iron Found: 1"
Pipe Carolina Power '& Light Company Iron Pipe
Property
NORTH
MONTGOMER
I, Thomas J. Fields; certify that this plat was
prepared from on actual survey done by me in
A14q
August 2001 and Is in. all respects correct
The
e and belief
knowled
f m
t
th
b
t
?. 9/0
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y
es
o
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o
ratio of precision as calculated by latitudes and
'
+ This plat was
departures Is 1:20.000
prepared in accordance with Board Rule .1600 SEAL
-
Witness my original signature and official stamp
this the 4th da of September 2001.
y
?2 a, v
p?
SURte,
r?
JEFPSII
SURVEYOR PLS-4906 .
No horizontal control within 2000 feet.
NOTE: This property is not located In any FEMA special flood hazard area.
Legend
o ...... denotes monuments found
or set as noted on plat.
SITE,
NTS VICINITY MAPS
Job No. 2001-203a
ne-
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Survey. for
DR. BRUCE SOLOMAN &, WIFE,
KAREN SOLOMAN-
Lot No. 17, Ma B, Section 5 of the
EMERALISSHORES Subdivision along Lake Tillery
Pee ee Township, Montgomery County, oNorth Carolina
Deed Reference Book 420 Page 254
Surveyed by Thomas J. Fields, PLS72906, on August 29, 2001.
TOTAL AREA 0.29 Acre t
by coordinates
40 0 40
Lot No. 16
SCOIe is in Feet
1 40' Found: 5/8"
A? Iron Rod
From the office of
WRIGHT & FIELDS LAND SURVEYING
303 WEST SPRING STREET N? 9
TROY, N.C. 27371 /cp.
- ?,
MAGNETIC
NORTH
August 2001

Found: 5/8"
Iron Rebar \
q
N 49'34'44" W
20.00 FT
Found: 5/8"
??oh
?•' \ S 49'34'44" E
20.00 FT
Found:
Iron Rod 3/4" Iron
bent-over ^`s?Ot6o 0? Pipe
/ or T
?o
Lot No. 18 bye` / N
~ o
cv o? / 1 -n N
LA 0.
1 01
?. / Lot No. 17
(A
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n ?T2ceC?
f.?oot??wl?
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/
fid&el5s e4-
r, 6Pe%`
l.-?rv?r?lcl S?.?

\ Found: N 86'39'20" . W 168J6 FT
/1 1/4" Iron Found: 1"
/ Pipe Iron Pi
Carolina Power & Light Company Pe lo?
Property
shoreline ,_i•'
%
NORTH CA e
o
MONTGOMER
rln?lll
I, Thomas J. Fields; certify that this plat was
prepared from an actual survey done by me In August 2001and is in, all respects correct
F?S??/? ti
to the best of my knowledge and belief.. The
ratio of precision as calculated by latitudes and ?t
departures is 1:2).000'+ . This plat was B?A? z
prepared in accordance with Board Rule .1600
Witness my original signature and official stamp i ' p CQ
this the 4th day of. September 2001. ?Q'?;d
VUR
SURVEYOR PLS-2906 _??I1???1f1+N
No horizontal control within 2000 feet.
NOTE: This property Is not located In any FEMA special flood hazard area.
1 Legend
denotes monuments found
or set as noted on plat.
h
f
SITE,
117
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VICINITY MAP
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XII. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
I-ZoU2_
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
.Page 13 of 13