20020417 Ver 1_COMPLETE FILE_20020320

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® North Carolina Wildlife Resources Commission
Charles R. Fullwood, Executive Director
MEMORANDUM
TO: Steve Chapin, Permit Coordinator
Asheville Office, U.S. Army Corps of Engineers
FROM: Ron Linville, Regional Coordinator Original Signed
by J. R. Linville
Habitat Conservation Program
DATE: March 21, 2002
SUBJECT: Review of an application for Royster Creek Crossing (commercial development),
McGill Creek, Cleveland County
The applicant is requesting a letter of concurrence from the North Carolina Wildlife
Resources Commission (NCWRC) to obtain a 404 permit from the U.S. Army Corps of
Engineers. The NCWRC has reviewed information provided by the applicant, and field
biologists on our staff are familiar with habitat values of the project area. These comments are
provided in accordance with provisions of the Clean Water Act of 1977 (33 U.S.C. 466 et. seq.)
and the Fish and Wildlife Coordination Act (48 Stat. 401, as amended; 16 U.S.C. 661-667d).
The project includes two culvert crossings for a total of 298 linear feet of perennial
stream impacts. Plans included with the application were too small to decipher. The crossings
are indicated to be necessary to access the wooded site for development.
It is not clear if the impacts are unavoidable by bridging. However, based on the
information provided by the applicant and our review of the project area, it does not appear that
this project will cause significant effects to waters providing erosion control and stormwater best
management practices are provided. Culverts 48" diameter or larger should be buried one foot
into the streambed and culverts less than 48" in diameter should be buried to a depth equal to or
greater than 20% their diameter. This should provide for aquatic life passage. As two perennial
crossings are indicted, the NC Division of Water Quality should review the proposed site and
application, as a 401 Certification and/or mitigation could be appropriate. Cumulative impacts
may be a concern.
Thank you for the opportunity to review and comment on this project. If you have any
questions regarding these comments, please contact me at 336/769-9453.
Cc: Mike Parker, DWQ-MRO
Mailing Address: Division of Inland Fisheries • 1721 Mail Service Center • Raleigh, NC 27699-1721
Telephone: [phone] ext. 281 • Fax: [phone]
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
April 30, 2002
DWQ# 02-0417
Cleveland County
Sincerely,
D.W. Royster
P.O. Box 146
Shelby, NC, 28151
APPROVAL of 401 Water Quality Certification with Additional Condition
Dear Mr. Royster:
You have our approval, in accordance with the attached conditions, to place fill in 149 linear feet of perennial streams in order to
construct a single road crossing at the Battle Forest Drive development in Cleveland County, as described in your revised application
received by the Division of Water Quality on April 4, April 12 and April 25, 2002. After reviewing your application, we have determined
that this fill is covered by General Water Quality Certification Number 3362, which can be downloaded from our web site at
http:Hh2o.enr.state.nc.us . 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, or if stream impacts exceed 150 linear feet, 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 condition listed below:
1. Deed notifications or similar mechanisms shall be placed on all lots with remaining jurisdictional wetlands and waters or areas within
50 feet of all streams and ponds. 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 format can be downloaded from the 401/Wetlands Unit web site at
http://h2o.enr.state.nc.us/ncwetiands .
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 1508 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 Samar Bou-Ghazale in our Mooresville Regional Office at 704-663-1699 or Cyndi Karoly in Raleigh at 919-
733-9721.
Attachments
I ry J. T rpe, Ph
cc: Corps of Engineers Asheville Regulatory Field Office
Mooresville DWQ Regional Office
Central Files
File Copy
Jonathan Hollifield, 152 East Main St., Forest City, NC, 28043
020417
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)
919-733-1786 (phone), 919-733-6893 (fax), http://h2o.enr.state.nc.us/ncwetiands/
MEMORANDUM
TO: John Dorney Regional Contact: Samar Bou-ghazale
Non-Discharge Branch WQ Supervisor: Rex Gleason
Date: 4/26!2002
SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS
Facility Name Battle Forest Drive (David Royster) County ;Cleveland
Project Number 02 0417 County2
Recvd From APP Region Mooresville
Received Date 3/20/02 Recvd By Region
Project Type Commercial Residential
Certificates Stream
Permit Wetland Wetland Wetland Stream Class Acres Feet
Type Type Impact. Score Index Prim. Supp. Basin Req. Req.
39 Stream O Y OO N F- l 1-135-2 F -(- -F-F36,837. F -- 298.00
F('litz FT O 1' O ?? ??F__ F__ 3n.?37.
r-F__O Y _0N F__ F_ F_F_ F_ F_ F_
Mitigation Wetland
MitigationType Type Acres Feet
Is Wetland Rating Sheet Attached? Q Y 0 N Did you request more info? o Y 0 N
Have Project Changes/Conditions Been Discussed With Applicant? O Y O N
Is Mitigation required? Q Y (0 N Recommendation: Q Issue ® Issue/fond O Deny
Provided by Region: Latitude (ddmmss)
Longitude (ddmmss)
Comments:
Per conversation with Jonathan Hollifield, Engineer with Odom & Associates, on 4/25/02, the
applicant wishes to revise the impact to the stream and delete one of the stream crossing. The total
impact to the stream is now 149 feet instead of 298 feet as per the submitted application. No 401
certification is needed at this time since the impact to the stream is less than 150 feet. Our concern
r
is that the applicant might disturb additional stream footage in the future, but circumvent the need for
a ep it by limitin tg he impact to 149 feet. Mr. Hollifield was informed by the writer that any new
impact to this stream or any other stream in the subdivision requires a 401 Certification,
cc: Regional.Off ice
Central Office Page Number 1
Thursday, April 25, 2002 327 PM Odom & Associates 828-247-4498 p•U1
Attention: Mike Horan
Company:
Fax Number: 19197336893
Voice Number:
From: Odom & Associates
Company:
Fax Number: 828-247-4498
Voice Number: 828-247-4495
Subject: DWQ #02-0417
Date: 4/25/2002
Number of Pages: 2
Comments:
Samar Bou-Ghazale with your Mooresville regional office was
review this plan (Battle Forest Drive) and noticed that in the PCN
Application we show 298 feet of stream impact. THIS IS
INCORRECT. We will only be disturbing 149 feet of stream. This
fax includes a corrected PCN application page 6. If you have any
questions please call me at 828-247-4495.
Jonathan Hollifield
Thursday, April 25, 2002 3:27 PM Odom & Associates 828-247-4498
1. Wetland Impacts
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***
N!A

h d le 'n adin fill
* List each impact separately and identify temporary impacts. Impacts include, but are not ]rmrted to. mec antze c an g, gr g,
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 l/www.femaeov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property:
Total area of wetland impact proposed:
2. Stream impacts, including all intermittent and perennial streams
p.ul
Stream Impact
Site Number
indicate on map)
Type of Impact* Length of
Impact
(linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
lease specify)
I Culvert 149 UT to McGill Creek 3 ft. Perennial

_7.a.. L.., .. ...,t i-ZA t- d U otts Ana mgnciated rin-ran.
k List each impact separately and identify temporary rmpacW. iucpacw ,,,?.u..., °... - -- - - --
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net losegain),
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
?vww.usas.eov. Several internet sites also allow direct download and printing of USGS maps (e.g., www to g=z .com,
www.mapguest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 149
Page 6 of 12
._
All,
-Triage Check List
Date:
To: ?RRO Steve Mitchell Project Name i 'v-U r .
?FRO Ken Ave:itte DWQ Project Number
?WaRO Deborah Sawyer County_-(?, Z-O
?WRO Joanne Stee Buis
?WSRO Jennifer Frye
OARO Mike Parker
MRO 1?.e- oh-
From: c _ Telephone (919) 733-
The file a-LL=-(:hed is being forwarded to you for your evaluation. Please call if you need
assisi4c1)C.G. 1 -
?--z--
Stream Length unpact d
can de:-=. fi E5w 3ct
[i Weband d=.`mir35on and distance to blue4ine surface waters on USGW topo maps
pl?fi '-crvavoid=_r?ce issues r'e\ ty;4'
F-i Edrier Fsa es (Ne-ze-, i ar-Pamilco, Catawba, Randleman)
? Pond
?i?rig?io?n 1?.?--t?s _ _ - - - - -
A a t-•e s n a.-1d or- wetland mitigation sites available and viable?
%?Check aaw?)as fcc aca rrcy s : - - -
?? is the apph=aticn cuisstent with'p?e-application meetinas?
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Apr 12 02 01:35p Odom & Associates 828-247-4498 p.1

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To: ROB RIDINGS Fax: [phone]
From: JONATHAN HOLLIFIIELD Date: 4/12/2002
Re: ROYSTER.BATTLE DRIVE Pages: 3
CC:
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Apr 12 02 01:35p Odom & Associates 828-247-4498 p.2
Attention: Michael Horan Date: 4/4/2002
Company: Number of Pages: 2
Fax Number: 19197336893
Voice Number:
From: Odom & Associates
Company:
Fax Number. 828-247-4498
Voice Number: 828.247-4495
Subject:
Comments:

Apr 12 02 01:35p
Odom & Associates
828-247-4498
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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
April 1, 2002
DWQ # 02-0417
Cleveland County
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
D. W. Royster
Post Office Box
146 COUP
Shelby, NC 28151
Dear Mr. Royster:
On March 20, 2002 the Division of Water Quality (DWQ) was notified by receipt of your
application regarding your plan to culvert McGill Creek for the purpose of providing road access on to the
site in Cleveland County. Approval from DWQ is required to disturb these stream areas. Please provide us
,v6th seven copies of the following information and refer to the DWQ# listed above in your reply. In
particular as described in 15A NCAC 2B .0502, we will require you to locate all streams and ponds on the
property. Please show these on maps of suitable scale (for instance V = 100 feet) so we can begin to
determine your projects' compliance with 15A NCAC 2H .0500.
A site plan is needed for the proposed construction and should indicate detailed
measurements.
Please telephone me at 919-733-1786 if you have any questions or would require copies of our rules
or procedural materials. This project will remain on hold as incomplete in accordance with 15A NCAC 2H
.0505(c). The processing time for this application will begin when this information is received. If we do not
hear from you by writing within three (3) weeks we will assume you no longer want to pursue the project
and will consider it withdrawn.
Program
cc: Mooresville DWQ Regional Office
Asheville Corps of Engineers
Odom & Associates
Central Files
File Copy
N"A
NCDEN7R
North Carolina Division of Water Quality, Wetlands/401 Certification Unit
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
Ph: [phone], Fax: [phone], hftp://h2o.enr.state.nc.us/ncwetiands/
' Odom
&Associates
Engineering, Inc.
REGISTERED MAIL
March 7, 2002
:41T
C
Ie
MAR 2 0 2002
--j
WETUNOS GROUP
WATER QUALITY SECTIONn_j
MAR 0 i?
0204 1 X11
Mr. Robert Ridings
Division of Water Quality
2321 Crabtree Boulevard
Parkview Building
Suite 250
Raleigh, North Carolina 27604
Dear Mr. Ridings:
RE: Royster Creek Crossing
Please find enclosed seven (7) copies of the PCN Application and design for crossing two
(2) creeks on the property in question.
Should you have any questions or comments regarding this matter, please do not hesitate
to give me a call.
Sincerely,
Jonathan F. Hollifield
152 East Main Street • Forest City, North Carolina 28043 0 [phone] • Fax [phone]

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MAR i00? . t?F
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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 and/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://www.saw.usace.a!M.mil/wetlands/Perin 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 hILtp://[e-mail]/wetlands/regtour.htm, 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 current requirements for the 401 Water Quality
Certification Program and to determine whether or 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 1 of 1
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 h=://www saw usace army mil/wetlands/nwpfmalFedReg.ndf
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 htty //h2o ehnr.state.nc.us/ncwetlands/f`ees.ht nl. 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 2
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
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: Nationwide 39
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name: D W Rooster
Mailing Address: P.O. Box 146
Shelby North Carolina. 28151
Telephone Number: [phone] Fax Number: [phone]
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 owner/applicant.)
Name:
Company Affiliation: Odom & Associates
Mailing Address: 152 East Main Street
Forest City North Carolina 28043
Telephone Number: [phone] Fax Number: [phone]
E-mail Address:
Page 3 of 3
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: Battle Forest Drive
2. T.I.P. Project Number (NCDOT Only
3. Property Identification Number (Tax PIN):
4. Location
County: Cleveland Nearest Town: King's Mountain
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.):
Property is located at intersection of Highway 161 and 74 bypass
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 land use or condition of the site at the time of this application:
Currently the land is an unused wooded area.
7. Property size (acres): 12.3 acres
8. Nearest body of water (stream/river/sound/ocean/lake): McGill Creek
9. River Basin: Catawba
(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.g /admin/maps/.)
Page 4 of 4
10. Describe the purpose of the proposed work:
To place a culvert in two separate streams to provide access to a site
11. List the type of equipment to be used to construct the project: dozer, front end loader,
compactor
12. Describe the land use in the vicinity of this project: commercial
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
N/A
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: N/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 5
1. Wetland Impacts
Wetland Impact
Site Number
(indicate on map)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
(linear feet
Type of Wetland***
N/A

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, nil,
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 h=://www.fema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property:
Total area of wetland impact proposed:
2. 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)
1 Culvert 149 UT to McGill Creek 3 ft. Perennial
2 Culvert 149 UT to McGill Creek 3 ft. Perennial

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: cu verns ana associaiea rip-rap,
darns (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.Mozone.com,
www.mapguest.com etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 298
Page 6 of 6
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.
N/A

List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
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.
Both crossings are necessary to fully access all parts of the property
Page 7 of 7
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
hLtp://h2o.enr.state.nc.us/ncwetlands/strmgide.html.
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
N/A
Page 8 of 8
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 ho://h2o.enr.state.nc.m /mo/index.httn. 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): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
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 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify N/A )?
Yes ? No ? If you answered "yes", provide the following information:
Page 9 of 9
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
s ttare feet Multiplier Required
Mitigation
1 3
2 1.5
Total
'Lone 1 extends out 3u teet perpenaicuiar aom near Dam, of cnain,ci; i-unc a UAWILUD all
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.
N/A
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.
N/A
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.
N/A
XIH. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 211.0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
Page 10 of 10
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XIV. Other CiMUMstMen (Optional):
sufficiently in advance.of desired
It is the applicant's responsibility to submit the application- its. However, an applicant may
construction dates to allow processing time for these perm ? limits on
choose to list cotastraints associated with construction or sequenwW- My p
work schedules. (9-9, draw-awn schedules for lakes, dates. associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of ft appticofs control).
N

Appticsnt/Agent's Sigt>ttfure - lncaat is vided.)
(Agent's, signature is valid only if an authorization letter from the app Pm
US Army. Conn of Engineers Field Ofces sled CGUW CO"A
Field Office
Asheville Regulatory Akaender Cherokee

k Iredeft
Jackson Mieet+ell
Polk
US Army Corp Engineers Mi E
ievetand UMCOIn_ ROW=
151 Patton Avenue . Bwks Gaston Macon Rutherford
Room 208 Ch
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ma Madison Stanley
Asheville. NC 28801-5006 Cis
Caldwell a
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lbrmod MaD?ep Swam
71-4854
Telephone: tawba
Ca Henderson Mecklenburg Tramy'ivania
1149 4838
(828?tat-
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l4de0 Re M Field office Aberrance Durham
b. lohnswo
. Let. RocI&gltem
Smokes
US Miry Corp Of Erigitresrs Al[eghanY
A311e fi
Franklin Nash Sony
6508 Falls of the Neusa Road Caswell- Famyth dntngm
Nar hk
Suite 120 Chatha m rair W
Releigh,-NC 27615
Telephone: [phone].
Davidson
C>dntiltbrd

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Person

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WNW
Fax: (9) 9) $76-3283 Davie Ilali
ix l
washiugton Rpgulatoy Field Office
US Array coatis Of Enguwm
Post Office Bois Io00
WasM+ngton, NC 27889.1000
Teraphow: (2S2) 975w t616-
Fax: [phone]
wiimh oon Regu1>aary Fuld Office
US Army Corps Of ft1ncers
Post Office Sbx IM-
wiunketoa. NC 28402-1890
Tckphorw.-(910}25T 4Stt
Fax: [phone]
Bcaufbrt Cmrita* Jaw
Dertie Due LAMir
Camden. Ganes .. Martin
• Gtr;cn PMNW
ChowaQ. Hertford Pasquotank
Craven Hyde Perquimm
Anson Duplin Onslow-
Bledet? "MM rcadcr

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Hak. RWM=d
Carteret Montgomery Robeson
Columbus Moore upon
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union
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Yancey
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Page 11 of 11
US Fisl
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
L and Wildlife Service / National Marine Fisheries Service
US Fish and Wildlife Service National Marine Fisheries Service
Asheville Field Office Habitat Conservation Division
160 Zillicoa Street Pivers Island
Asheville, NC 28801 Beaufort, NC 28516
Telephone: [phone] Telephone: [phone]
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 276994617
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
Fax: [phone] Haywood McDowell Yancey
Page 12 of 12
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PAYMENT
RECEIVED
ODOM & ASSOCIATES ENGINEERING, INC. 2892 r
7
13272 www.checksfodess.com 800-245-5775 Order # 089665-A