20020475 Ver 1_COMPLETE FILE_20020328 (2)

F W A J-F Michael F. Easley, Governor
\O?O 9QG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
7 Gregory J. Thorpe, Ph.D.
> Acting Director
O Division of Water Quality
April 29, 2002
County Hyde
DWQ Project # 02-0475
APPROVAL of 401 Water Quality Certification
Showell Blades
142 Oakland Avenue, Suite C
P. O. Box 10671
Rock Hill, SC 29731
Dear Mr. Blades:
You have our approval, in accordance with the attached conditions, to place fill material in 0.05 acres of wetlands or
waters for the purpose of constructing a home as you described in your application dated March 24, 2002 and supplemented
on April 24, 2002. After reviewing your application we have decided, this fill is covered by General Water Quality
Certification Number 3362. This Certification allows you to use Nationwide Permit Number 18 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 or CAMA permit expires unless otherwise
specified in the General Certification.
This approval is only valid for the purpose and design that you described in your application. If you change your
project, you must notify us and send us a new application. If the property is sold, the new owner must be given a copy of this
Certification and approval letter and is thereby responsible for complying with all conditions. This approval shall expire
when the corresponding Nationwide Permit expires or as otherwise provided in the General Certification. If total wetland
fills for this project (now or in the future) exceed one acre, compensatory mitigation may be required as described in 15A
NCAC 2H .0506 (h). For this approval to be valid, you must follow the conditions listed in the attached certification.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must act
within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition, which conforms to
Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, P.O. Box 27447, Raleigh,
N.C. 276 1 1-7447. 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 John Dorney at 919-733-1786 or Deborah Sawyer at our Washington Regional Office at
252-946-6481.
Sincerely.
Attachment
cc: Corps of Engineers Washington Field Office
Washington DWQ Regional Office
File Copy
Central Files
Marlene Mathews, Southwind Realty (Fax# [phone])
DE
N. C. 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)
[phone] (phone), 919-733-6893 (fax), (http://h2o.enr.state.nc.us/ncwetlands
oVIA rFRQ?
O `C
Michael F. Easley
Governor
William G. Rcss,Jr.Secretary
Department of Environment and Natural Resources
Kerr T. Stevens
Division of Water Quality
DiyiEon of Water Quality
DepartrEnt of Enonmental and Natural Resources
- Wd-J"ands1401 Unit
Location: 2321 Crabtree r"oulevarc; Suite 250 Raleigh, NC 27604-2260
Mailina AddrEs 16601'4t? Senfic_= Center Raleigh, NC 27699-1650
Contact Info€mation: Ga ieral °19-733-1786 Fax: [phone]
Fax To: ????S Fax Number:
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19:48 FAX
11:25a Marlene Mathews
LAC-WCn-uuua
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HYDE COUNTY HEALTH DEPARTMENT SITE
SHOVVELL BLADES, IV
PERMIT #41702-3

20.00 feet
1:240
LOT #9
lt. U font
PLAN
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UPLAND TRENT S/D

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19:48 FAX igjuj
HYDE COUNTY HEALTH DEPARTMENT
1151 Main 5t[ee[ a P.O. Box 100 w Swan Quarter, N.C. 27885 Linda MaW
Telephone [phone] Neakil Di a =r
IMPROVEMENT PERMIT
114M AL INSTALLA"ON: XXX PANSION:
Permit No: 42702-3 , 2002
poll tee: L showen Blades,
Address: P.O. Wm 10671, Rode Hill, SC 29731
Phone No.: (25x) 928-6037
Property 1.000 rr. Lot" upland Trent SID, Oaaooke
Facilities to be served: 3 bedroom house
wat o :supply: cornnwnity
Wast awateir Flow GPD: 360 gpd
Wastewater Sysb un Type: M-c, gravity fill, rock bed
Wasbew~ System Repair : NA
Long Terns Acceptance Rabe: 1.0 gpd/sq.ft.
Ahaorptgn Aril: 540 sq.fL
Sepft Tank Capacity: 1000 gallons with finer
Pump Tank Capadty: NA
Total Bed/Tranch Length: 45' 1Midth: 12'
Bed/Trench Spacing: Ton center
rnycl?W/Trwtch Batmm Depth: 4" abvtie the noWraliy occurring soil surface
19: 4 8 FAX Lgj U4
11:258 Marlene Mathews 252-020-0051 p•3
4ENT PERMIT
BLADES, IV
PAGE 2
COIND 90-r
1. Installation of the wasor^W ' system shall be In strict aowidance with the
approved sita plan and all .IN! -s that are a part of this permit.
2. Maintain a 10'setbodk from all parts of the wastaevraes:r system to the wager
line.
3. Clear a 34'x 67' acres whom the dra inflaid is to be boated as shown an the
site plan. Re"KNO all vegetation and root mat and restore to the original
elew Bann with dean sand. Add an add' ' 6° of dean send to cover the
basal area of the mound (22'x 55').
4. Contact the Health Department for an inspection at this point prior to
installing the system.
5. An Audwxizatlon to Construct will be Issued upon final approval of the InltW
sift modifications.

This Impna?mment Permit shall be valid:
Without 03Wkation
upon a showing ends acb, r V to the Hyde County Health Depsi bs nt twat the sloe
and soil conditions are unalb rwd_ tfurl' Hha fawint+r_ .a.K:nn &-mw m.rA
Apr c3 02 02:33p Marlene Mathews 252-920-6051 p.l
SOUTHWIND REALTY
MARLENE MATHEWS
252-928-6037
FAX: [phone]
NO. OF PAGES : 14
TO: y o r,r, ?o r2?1 e
FROM: ? SVOL, 11 ??a? S
P j- ?-e n -e
RE:
?h? e_ F? C. (-N (1 .1?
L ock ?Ave_

Hpr 23 02 02:34p Marlene Mathews 252-928-6051 p•2
State of North Carolina
Department of Environment, FIA
Health and Natural Resources 4 FA
Division of Coastal Management r
James B. Hunt, Jr„ Governor C
Jonathan B. Howes, Secretory G
Roger N. Schecter, Director
Ms. Marty Vonne DeHoney
40 Macopin Avenue
Upper Montclair, New Jersey
Dear Ms. DeHoney:
This letter is in reference to a I November 1995 inspection of your property known as Lots 9 and
10, Upland Trent Subdivision off SR 1356 (Sarah Eden Street) on Ocracoke Island in Hyde County, North
Carolina. The purpose of the inspection was to determine if the Division of Coastal Management has any
jurisdiction/regulatory authority based upon the statutory requirements of the Coastal Area Management
Act and the State of North Carolina Dredge and Fill Law.
Based on my inspection, and to the best of my ability without the lots being staked or flagged, I
have determined that the area known as Lot 9 does not fall within the definition of Coastal Wetlands as
described in Subchapter 7H.0205 of the North Carolina Administrative Code. Furthermore, due to the
proximity of Lot 9 to Estuarine Waters, there are n4 designated Areas of Environr glta cern (AEC)
under the re ulatory authori of this Division on this property. Therefo no nermit?equired froWas
sion for development on Lot 9 Lot 10 has a small area of Coastal t etlands, a ate
desen e-d nu chapter o the North Carolina Administrative Code, located in the southeast, front
corner. In addition, a portion of Lot 10 falls within the Estuarine Shoreline AEC. Based upon these
findings, permits are required by the Division for development onsite Lot 10 The exact permit
requirements depend upon what type of project is proposed. Please be advised that Hyde County/Ocracoke
Island has adopted a Land Use Plan that has been approved by the Coastal Resources Commission, and any
proposed development must be consistent with this plan. If you desire to have the line delineated, please
contact me.
I encourage you to contact the U.S. Army Corps of Engineers at [phone] regarding the
possibility of 404 wetlands on these lots. I appreciate your concern and effort to comply with the pennit
requirements of this Division and encourage you to continue to consult representatives of this Division for
future questions regarding CAMA jurisdiction. Thank you for your time and concern in these matters and
if you have any questions, please call me at [phone], extension 299.
Loo- 4-`1 f-) } Ve qs ? Sincerely,
10 0,
v a?rtZ ?? eA^A? -Jeffrey R. Schaffer
Field Representative
cc: Terry Moore - District Manager, Washington Regional Office, DCM
David Lekson - U.S. Army Corps of Engineers
1424 Carolina Avenue, Washington, North Carolina 27889 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employor &)%recycled/1016 poi corti:urnnr paper
Apr' 23 02 02:34p Marlene Mathews
State of North Carolina
Department of Environment
and Natural Resources
Division of Coastal Management
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Roger N. Schecter, Director
28 October 1997
Ms. Patricia Dancy
40 Hill and Dale Lane
St. Louis, Missouri 63132
252-928-6051
REFERENCE: ACTION ID 199810149
Nationwide Permit for an
Activity Located in Hyde
County, North Carolina
Dear Me. Dancy:
P.3
The North Carolina Division of Coastal Management has reviewed the above
referenced application for a Nationwide Permit dated 10 October 1997 pursuant to
Section 307 of the Coastal Zone Management Act of 1972 as amended. Based upon
our review, we have determined that the proposed activity is consistent with the
North Carolina Coastal Management Program provided the, following conditions are
met.
1. The activity described in the above application qualifies to receive
one of the Nationwide Permits described in 33 CRF Part 330 with the
exception of Numbers 17, 21, 24 and 34 which were found inconsistent
with the North Carolina Coastal Management Program.
2. A 401 Water Quality Certification is received, w ere?requi , from
the North Carolina Division of Environmental Management.
This letter does not relieve you of the responsibility to ensure that all
other State authorization and/or permit requirements are met prior to
implementation of the project. Please feel free to contact me at [phone]
if you have any questions or need further assistance.
Sincerely,
T-0?4r W/Y2?
Terry E. Moore
District Manager
Division of Coastal Management
Washington Regional office
cc: Steve Benton - Federal Consistency Coordinator, DCM, Raleigh
John Dorney - Water Quality Section, DEM. Raleigh
„Sharon Miller - Sharon Miller Realty
Wilmington District Engineer
ATTN: CESAW-CO-E

)a'
943 Washington Square Mall, Washington, North Carolina 27889 Telephone [phone] FAX [phone]
An Equal Opportunity AMrmative Action Employer
Apr' 23 02 02:34p Marlene Mathews 252-928-6051 p.4
Hyde `0 TV
f?y
County
Inspections
1712
Department
P. O. Box 66 - Swan Quarter, N.C. 27885
Tel. [phone]
Fax: [phone]
Leon Mooney
Fire Marshal
Building Inspector MEMORANDUM
DATE: October 21, 1997
SU3JECT: Building on Lot Number 9 Upland Trent Subdivision
TO: WHOM IT MAY CONCERN
FROM: Leon Mooney, Hyde County Building Inspector
On October 15, 1997 I visited lot 9 upland Trent Subdivision to determine if the lot was suitable
for building a residence on.
I inspected the lot and the plot plan entitled survey for Patricia D. Dancy, lot 9, Upland Trent
Subdivision, Ocracoke, NC, and found that the lot meets the requirements set forth in the
Ocracoke Development Ordinance for lot size and setbacks for a residential dwelling.
The Hyde County Health Department will have to check the lot, if it has not been check already,
to see if it is suitable for a septic system. A septic tank permit will be required before a building
permit could be issued. W -e- h ? e- Sl. +. c- r-e.?VV%6+-
A letter or permit from the Army Corps of Engineers (giving permission to build in the 404
wetlands area of the lot would have to be obtained. A copy of the permit or letter would have to
be submitted to the Inspection Department with the building permit application.
We h.Rtre x.11 ? ele rn ?-
Take Pride in Hyde

ti Mo?
Office Use Only: Form Version February 2002
USACE Action ID Nb.
DWQ No. If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
I. Processing
I. Che 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: ?
H. Applicant Information
Owner/Applic nt I formation
Name: L
Mailir
Telephone Number:
E-mail Address:
Fax Number:
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory auth rity for the owner/applicant.)
Name:__ h P8
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 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 fiill-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: I L01 19 V COW tw /O
!PM ferwy t coon * 1448'IO M (a act Hereto
2. T.I.P. Project Number or State Project Number (NCDOT Only): h a
3. Property Identification Number (Tax PIN): ,c
4. Location
County: gyve Nearest Town: Oe rae c K e-
Subdivision name (include phase/lot number): f q
Directions to site (include road numbers la dmarks, etc.): O
_car& h r; 11eh St • r; N COO 13? i., U r/ah?roh t .
5. Site coordinates, if available (UTM or Lat/Long): n f a
(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 t e existing land use or condition of the site at the time of this appplic?
/'Ifi81 !0l . 6t Ym;'l?;M9 ?i 11 aamvlef.." o L d69w,
7. Property size (acres): 13
3. Nearest body of water (stream/river/sound,ocean/lake): 6am];co Sounder
9. River Basin: Ta r'- K2Ift I C 0
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.6-tate.ne.us/admin/maps/.)
,S la„
Page 6 of 12
10. Describe the purpose of the proposed work: 611 area iwteJ em Q Q
U rVC r fie. 14- A, 4.r,
u c?i
11. List the of equipment to be used to cons ict the project: / - C
K
m** t mWWki e Trr? rio,?eor dAd !5
M Z'`
12. Describe the land use in the vicinity of this project:
_?g??e?6AZ?/?8?
IV.
V.
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.
Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for he exclusion of this work from the cugent application. ,
A _ /. _ __.t L _ _ , .1. ... V.
19 9
of.
V1.
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 V[[ 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 12
a brief written description of the proposed impacts:,
2. Individually list wetland impacts below:
Wetland Impact
Site Number
(indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Streamm I
linear feet)
Type of Wetland***
• s a f

* List each im act se aratel and 'd 1'
p p y t entr y temporary impacts, impacts rncludc, but are not limited to: mechanized clearing, grading, Jill.
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
100-fear floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMAapproved local tloodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online athtt2:.'4ww.fema. X.
"** List a wetland type that best describes wetland to be impacted (e.g., freshwaterisaltwater marsh, forested wetland, beaver pond.
Carolina Bay, bog, etc.)
List the total acreage (estimated) of all existing wetlands on the property: 0.-0 S a c res
Total area of wetland impact proposed: &0 ae rp c
3. Individually list all intermittent and perennial stream impacts below:
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)

?_..'?..., ....N„?. acy=mmy anu iocrtnry remporary impacts. impacts include, but are not limited to: culverts and associated rip-nip.
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, ditchingistraightening, etc. If stream relocation is
proposed, plans and profiles showing th a 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 us ,ov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.:onozonc co m.
www.manyu ct om, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: A I a
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number
indicate on ma
n
Type of Impact* Area of
Impact
(acres)
Name of Waterbody
(if applicable) Type of Wate-rbody

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

List each mDact se parate an i ntirv tMn.v.?s rv ,,.,...,... ?....._,.....__?..._ ?.-- - - ... ,
flooding, drainage, bulkheads, etc.
••r-w ???¦???, but ans not tttnttea to: r1n, excavation, dredging,
5. Pond Creation r1a
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:
VIL 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 f llowed during construction tc-i reduce impact
v ' ol V"
w canoe tke qOt a4l4od s exa* ss
to ; •
w+ , ? sss.Lk .
VIII. Mitigation 11ta
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.
Page 9 of 12
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
httn:/,`h2o.enr.st,dte.nc. us/ncu etiands/strmp,ide.htmi.
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
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 htto:/!h2o.enr.state,nc.us,,wro/index.hirn 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):
Page 10 of 12
DC Environmental Documentation (DWQ Only) A/a.
Does the project involve an expenditure of public (federal/:state) funds or the use of public
(federal/state) 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 919) 733-5083 to review current thresholds for environmental documentation.
Yes d 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 ? Nd ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only) A 14
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 V1I above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ? If you answered "yes", provide the following information:
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 uarc fcct Multiplier Required
Mitigation
1 3
2 1.5
Total
Zone l extends out 30 feet perpendicular from near bank of channel. Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 1 I of 12
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.
X1. Stormwater (DWQ Only) M I A
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
X11. Sewage Disposal (DWQ Only) AAA
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.
XTH. Violations (DWQ Only) N fa
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No ?
Is this an after-the-fact permit application?
Yes ? No ?
XIV. Other Circumstances (Optional): n l A
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).
h/
Applicant/Agent's Signature Date
(Agent's signature is valid only i an authorization letter from the applicant is provided.)
?. S. 61aes ?
Page 12 of 12
r? It. 10.1997 141 17 p.e2
U.S. ARMY CORPS OF ENG EERS
WILMIN$PT6NDISTRICT
16 ?e)j -.')
Action Id. 4
1 F County 14:1 de-
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property owner 1'ei`f r i c i
Address 40 14J I n c Qa l r. Lal 0:f-_ -
L a k ; 5k I''! v 313 7,.
Telephone No. 31`1 -1:21 ` 4 q G 1?
Size and Location of project (water body, road name/number, town, etc.) I T100 /91 (Jor .`lam
Description of Activity
Applicable Law: -''Rection 404 (Clean Water Act, 33 U.S.C. 1344).
(check all that apply) Section 10 (River and Harbor Act of 1899).
Authorization: Regional General Permit Number.
f g Nationwide Permit Number.
Your work is authorized by this Regional General (ROP) or Nationwide Permit (NWP) provided it is accomplished
in strict accordance with the attached conditions and your submitted plans. 1f your activity is subject to Section
404 (if Section 404 block above is checked), before beginning work you must also receive a Section 401 water
quality certification from the N.C. Division of Environmental Management, telephone [phone]. For any
activity within the twenty coastal counties, before beginning work you must contact the N.C. Division of Coastal
Management, telephone [phone].
Please read and carefully comply with the attached conditions of the RGP or NWP. Any violation of the conditions
of the ROP or the NWP referenced above may subject the permittee to a stop work order, a restoration order, and/or
appropriate legal action.
This Department of the Army RGP or NWP verification does not relieve the permittee of the responsibility to obtain
any other required Federal, State, or local approvals/perm[ts. The permittee may need to contact appropriate State
and local agencies before beginning work.
If there arc any questions regarding this authorization or any of the conditions of the General Permit or Nationwide
Per?11 it, pleaso contact the Corps Regulatory official specified below.
Tv M• Qa 11C. 011 ef -Q7'S" -.lG I6 K x.`(
Date t i /t b A ?-
Corps Regulatory OMciaLAL
Expiration Date of Verification
No. flq-13 5-1616
r
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT PLANS, ETC., MUST
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L. SHOWELL BLADES IV, P.A.
ATTORNEY AT LAW
142 OAKLAND AVENUE, SUITE C
L. SHOWELL BLADES IV POST OFFICE BOX 10671 OF COUNSEL:
(Admitted SC & NC) ROCK HILL, SOUTH CAROLINA 29731 W. RYAN HOVIS
TELEPHONE [phone]
FAX [phone]
EMAIL: blades®rock hilllaw.com
1

March 24, 2002 E
?8Z2>bW
Division of Water Quality
401/Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699- 1650
Re: Lot 9 Upland Trent Subdivision
Ocracoke, NC
Lemuel Showel l Blades IV 21.•? ? I ,,1`'h• -15
Dear Sirs :
Enclosed please find the original completed application for my Section 404
permit, along with seven copies, and my check for $200. Please contact me if
anything is missing or if you have any questions. Unless I hear from you, I will
assume that my application is complete and sufficient.
Thank you for your assistance with this matter. I look forward to hear-thp
from you soon.
Si rely,
*e& Aw???
L.S. Blades IV
CC: Washington Regulatory Field Office
US Army Corps of Engineers
P.O. Box 1000
Washington, NC 27889-1000
W A 7FRQG
D
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Departm:.;, of Environment and Natural Resources
Gregory J. Thorpe, Ph.D.
Acting Director
Division of Water Quality
April 12, 2002
DWQ # 02-0475
Hyde County
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
Lemuel Showell Blades, IV
759 Myrtle Drive
Rock Hill, SC 29730
Dear Mr. Blades:
On March 28, 2002 the Division of Water Quality (DWQ) was notified by receipt of your application
regarding your plan to fill wetlands for the purpose of residential fill in Hyde County. Approval from DWQ is
required to disturb these areas. Please provide 7 copies of the following information and refer to the DWQ #
listed above in your reply. In particular as described in 15A NCAC 213 .0502, we will require you to locate all
streams and ponds on the property. Please show these on maps of suitable scale (for instance 1" = 100 feet) so
we can begin to determine your projects' compliance with 15A NCAC 2H.0500.
1. Provide a site plan for the proposed fill area including specific measurements.
2. Are there any surface waters on the site (such as streams or CA-NL? wetlands) which would be
subject to the buffer rules
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.
cc: Washington DWQ Regional Office
Washington Corps of Engineers
Central Files
File Copy
incerely,
hn Dorney
ater Quality C ifi tion Program
06EN-R
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], http://h2o.enr.state.nc.us/ncwetlands/

MR 2 ?! ! I,
Office Use Only: Form Version Febmary 2002
(f§Ac ";A l'rt`i6if I'D 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. Che 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: ?
II. Applicant Information
1
Owner/Applicant Information
Name:
Mailing
Telephone Number:
E-mail Address:
Fax Number: 503-
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory auth rity for the owner/applicant.)
Name: A ?8
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 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 pin 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: j C p ?( fP
CHI Perrw t Action * I "flo 149 a ac a Hereto
2. T.I.P. Project Number or State Project Number (NCDOT Only):_ h a1
3. Property Identification Number (Tax PIN): ,c
4. Location
County: H Y D E Nearest Town: O c rac o Ke
Subdivision name (include phase/lot number): f q d,Treh
Directions to site (includS road numbers landmarks, etc.): 11,001
5. Site coordinates, if available (UTM or Lat/Long): h I a
(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 a existing land use or condition of the site at the time of this applic?
Res! nfial W . a roai ;?rq .4,11 coxw/ot;ovi & c aw,
7. Property size (acres): 13
8. Nearest body of water (stream/river/sound/ocean/lake): d ico so t.Ad Qr
9. River Basin: 7a r- K20L ( (Co
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at htt)://h2o.enr.state.nc.us/admin/maus/.)
Page 6 of 12
10. Describe the
the
of the proposed work:_ ?? Q 121 ivto
of equipment to be used to

k 4_E& 4, 04
7Yr6?S ?C- j,
ek c.
Lyk%Awe,-e
12. Describe the land use in the vicinity of this project:_RESM04*491
IV.
V.
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.
Future Project Plans
Are any future perniit requests anticipated for this project? If so, describe the anticipated work,
n"A MM^IAA. i„cf: ?i.,nh:..w r-- .1.,.......1.. _: _.. _&U!- ---- .t_ P .. ..
a f
of.
V1.
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 V11I below. If additional space is needed for
listing or description, please attach a separate sheet:
Page 7 of 12
Proposed Impacts to Waters of the United States/Waters of the State
Wetland Impact
Site Number
(indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream i
linear feet)
Type of Wetland***
Yes a f lamd

* List each im act sc aretcl d 'd 1'
p p yen t ene y 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.
100-1 ear floodphtins are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA -approved local floodplain maps. Maps are avnilable through the FEMA Map Service Center at 1-800-358-9616, or
online at httn:i,'www.fema.uov.
*** List a %wtland 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 all existing wetlands on the property: O? O,S Q e res
Total area of wetland impact proposed: &o .' ae rp c
3. Individually list all intermittent and perennial stream impacts below:
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)

us eac uUp= separately and idennfy temporary impacts. Lnpacts include, but are not limited to: culverts and associated rip -rip.
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, ditchingistraightening, etc. If stream relocation is
proposed, plans and profiles showing th a 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.u%v%_gov. Several internet sites also allow direct download and printing of USGS maps (e.g., wwa•.wnozo w coill,
www.manaucst.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: h. Q
Page 8 of 12
2. Individually fist wetland impacts below:
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number

indicate on tna
Type of Impact' Area of
Impact

(acres)
Name of Waterbody
(ifappltcable) Type of Wat?'rbody

(lake, pond, estuary, sound,
bay. oceanetc.)
n

• List each znpact se parate y an i ntif tem ra i I s
m
Y po ry unpac
flooding, drainage, bulkheads, etc. acts include, but am not limited to: fill, excavation, dredging,
.
5. Pond Creation rl a
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 ? wetland,
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:
VIL 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 f flowed during construction t reduce impact .
V - GaAt o e toe qot "fl"ds az* s S
0% Jft #SS.' l k .
VIII. Mitigation h` GS.
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.
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http:/.,'h2o.enr.state.n.c.us/nc,A,etlands/strm,gide.htTni.
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.
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 woiild 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 htto:4%h2o.em•.state.nc.us/wm/index.htm if
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX. Environmental Documentation (DWQ Only) A/4-
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) 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 ? Nd ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only) A14
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 Vll above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ? If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 3
2 1.5
Total
Zone t extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 1 l of 12
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.
M. Stormwater (DWQ Only) 141 A
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
X11. Sewage Disposal (DWQ Only) v?{ A
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 I a
X111. Violations (DWQ Only
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No ?
Is this an after-the- fact permit application?
Yes ? No ?
XIV. Other Circumstances (Optional): n l ot
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,/
Applicant/Agent's Signature I Date
(Agent's signature is valid only i an authorization letter from the applicant is provided.)
L. S . 61a es
Page 12 of 12
r? 11.10.1997 141 17 p,e2
U.S. ARMY CORPS OF ENGMEERS
WILMINFlOk DISTRICT
Action Id. 111Y10141 , County GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICt1lde
ATION
Property owner
Address HD b1111 a accl 10-1t, Ln ft:r--- _ _-
Telephone No, 31 Ll -'I9
Size and Location of project (water body, road name/number, town, etc.) s_-!-r
ad:
Description of Activity
Applicable Law: .erection 404 (Clean Water Act, 33 U.S.C. 1344).
(check all that apply) Section 10 (River and Harbor Act of 1899).
Authorization: Regional General Permit Number.
Nationwide Permit Number.
Your work is authorized by this Regional General (RGP) or Nationwide Permit (NWP) provided it is accomplished
in strict accordance with the attached conditions and your submitted plans. If your activity is subject to Section
404 (if Section 404 block above is checked), before beginning work you must also receive a Section 401 water
quality certification from the N.C. Division of Environmental Management, telephone [phone]. For any
activity within the twenty coastal counties, before beginning work you must contact the N.C. Division of Coastal
Management, telephone [phone].
Please read and carefully comply with the attached conditions of the RGP or NWP. Any violation of the conditions
of the ROP or the NWP referenced above may subject the permittee to a stop work order, a restoration order, and/or
appropriate legal action.
Thls Department of the Army POP or NWP verification does not relieve the permittee of the responsibility to obtain
any other required Federal, State, or local approvalstpermits. The permitter may need to contact appropriate State
and local agencies before beginning work.
If there are any questions regarding this authorization or any of the conditions of the General Permit or Nationwide
PerlrIto plans* contact the Corps Regulatory Ofl;cial specked below.
v--+ tok!m{-- a `tik -??s ?.lGf'6 ><2`(
Date t t /1 v /k -?- ,.
Corps Regulatory Official. 1E6&&!1.''W • s' &2 . Y.W . 5 . Telephone No.
Expiration Date of Verification _ 111/0 11%
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT PLANS, ETC., MUST
1"r3a?
r v n1u0 vv nUnu111 uuL uuirur?rvvvr •.vv?
HYDE COUNTY HEAL'T'H DEPAR'T'MENT
P.O. Box 100 * Swan Quacter, N.C. 27885 Linda Mayo
Telephone 9i9/926-3561 H1Akk Dbwder
D4 IIdPROvEml' PRIMIT SITE PLAN
WAV-? A6&W-A1/G PEMIT N ?d
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Office Use Only: Form Version FebmaTy 2002
USACE Action ID No. DWQ No. 020475
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
H.
?r
1. Cher all of the approval(s) requested for this project:
Section 404 Permit MM 2 8
? Section 10 Permitz
? 401 Water Quality Certification
? Riparian or Watershed Buffer Rules 6erUU`'
(ill;",LITY SEGII?;
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 (NC WRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
Applicant Information
1. Owner/Applicant information
Name:
Mai lip
Telephone Number:
E-mail Address:
Fax Number: 909-
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory auth rity for the owner/applicant.)
Name: A Y8
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 12
III. Project Information
2.
4.
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads ?Iso 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 II 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.
Name of project: Neslmwia j 7 G p w-W IO
fill Perrw t lion * I Mto I49 a ac a hemto
T.I.P. Project Number or State Project Number (NCDOT Only): ?? a
3. Property Identification Number (Tax PIN):
Location
County: N Y V E
Subdivision name (include phase/lot number
Directions to site (include road numbers. lane
5. Site coordinates, if available (UTM or Lat/Long): Ala
(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 t e existing land use or condition of the site at the time of this application:
Residential lof , 6t";Vx9 .';11 eoxwlei;oA z do9w1r),am&nt
7. Property size (acres): 13
8. Nearest body of water (stream/river/sound/ocean/lake): Pamkle 5o ahd e r
9. River Basin: '-AY=P7Nf. t6C0
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at httv://h2o.enr.state.nc.us/admin/maps/.)
/ON
Page 6 of 12
Nearest Town: ('G ratio K'e
10. Describe the purpose of the proposed work: ict ama AwW Qh 6 ck44
me- A
uYVe
Y so
6 u G?i ph
11. List the type of equipment to be used to constr ict the project: pt Yk C
K k h Z'`
12. Describe the land use in the vicinity of this project: r1?fGt6aZ?%o''?
IV.
V.
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.
Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for he exclusion of this work from the cuirrent application. .!
?.?li6,_rtf has can l:?rwet wi fA Ae&v ?i iOw.!°?Lrae<e ,ire D?l?l? .rnd
d.
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 Vll 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 fonns 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 Vlll below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
Wetland Impact
Site Number
(indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet)
Type of Wetland***
es o f

-- - -- •...y- , F-V ty WIU tuctl,ry temporary impacts. impacts mctude, 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-fear 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 1-300-358-9616, or
online athttn:%iwww.fema.20v.
List a Nwdand 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 all existing wetlands on the property: O, o5 a c res
Total area of wetland impact proposed:_ 0, ,0 az ne y
3. Individually list all intermittent and perennial stream impacts below:
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'?
leases eci ')

-3L U<RJ„ mipact sepandwy and ioennry 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 liSUS 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 b800-358-9616, or online at
www.usgs.=. Several internet sites also allow direct download and printing of USGS [naps (e.g., ?tlvw Q2onc.cont,
www.maoaucst.cotn etc.).
Cumulative impacts (linear distance in feet) to all streams on site: Y1I Q
Page 8 of 12
2. Individually list wetland impacts below:
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number
(indicate on ma #
Type of lmpact Area of
Impact
(acres Name of Waterbody

(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.)
n
1 -a
.

List -h ?.
-- - ---,..-..- k, .1 - .s..ZZ Y aw liY01air uupaus. unpacts induce, out are not umtted to: till, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. Pond Creation n /a
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 f llowed during construction t reduce impact
v q GRk fe tk a K0t "N*d s ekcr* s s
O i K o, i IK
a?ss?Lk .
VIII. Mitigation ill r1k.
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.
Page 9 of 12
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 detennining 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 applicanil may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http:/.'h2o.enr.sUite.ne. us/ncwetl,ndti/strmgide.h tm 1.
Provide a brief description of the proposed mitigation plan. The description should provide
as much infonnation 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.
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 htto:;%h2o.enr.sinte.nc.us,%wm/index.htm If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following infonnation:
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):
Page 10 of 12
IX. Environmental Documentation (DWQ Only) A /a.
Does the project involve an expenditure of public (federal; state) funds or the use of public
(federal/state) land?
Yes F1 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 ? N8 ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only) A/A
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 V11 above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify_ )?
Yes ? No ? If you answered "yes", provide the following information:
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
Miti ration
1 3
2 1.5
Total
Zone 1 extends out 30 feet perpendicular from near bank of channel: Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B.0242 or.0260.
XI. Stormwater (DWQ Only) 111 A
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
XIi. Sewage Disposal (DWQ Only) 111 A
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.
XIH. Violations (DWQ Only) N I of
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No ?
Is this an after-the- fact permit application?
Yes ? No ?
XIV. Other Circumstances (Optional): h I A
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).
. 3/1749 2---
Applicant/Agent's Signature Date
(Agent's signature is valid only i an authorization letter from the applicant is provided.)
1, s . 61 a es -1y
Page 12 of 12
Action Id. 41
,N
U.S. ARMY CORPS OF ENGINEERS
11.10.1997 14117
P.02
WILMINCT6N DISTRICT
county
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property owner _???tY-l' cJe4?a K t ?r
Address HO ?.{ o K,,l (,?s r_ ?.? ?,•f?------- ---
Telephone No, 314 - 211 q G 9
Size and Location of project (water body, road name/number, town, etc.) I '? U _ s o 't 601
ad:
Description of Activity
uut?S
Applicable Law: .----gection 404 (Clean Water Act, 33 U.S.C. 1344).
(check all that apply) Section 10 (River and Harbor Act of 1899).
Authorization:.. Regional General Permit Number.
Nationwide Permit Number.
Your work is authorized by this Regional General (RGP) or Nationwide Permit (NWP) provided it is accomplished
in strict accordance with the attached conditions and your submitted plans. Tf your activity is subject to Section
404 (if Section 404 block above is checked), before beginning work you must also receive a Section 401 water
quality certification from the N.C. Division of Environmental Management, telephone [phone]. For any
activity within the twenty coastal counties, before beginning work you must contact the N.C. Division of Coastal
Management, telephone [phone].
Please read and carefully comply with the attached conditions of the RGP or NWP. Any violation of the conditions
of the ROP or the NWP referenced above may subject the permittee to a stop work order, a restoration order, and/or
appropriate legal action.
This Department of the Army POP or NWP verification does not relieve the permittee of the responsibility to obtain
any other required Federal, State, or local approvals/permitR. The permittee may need to contact appropriate State
and local agencies before beginning work.
If there are any questions regarding this authorization or any of the conditions of the General Permit or Nationwide
Peruit, please contact the Corps Regulatory Official specified below.
v-% tokil({ - e e?k s5 /GAG ?1z?(
Date i 1 /r v A -+ - -
Corps Regulatory Official ?GUl1Qit??.I'W • !., , Telephone No. R iq-19 S"16
Expiration Date of Verification 11 / 10 12-1-
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT PLANS, ETC., MUST
T1'] ?TR\1 f\tiT*1 TA MY?w ??w? - w.?? iw?? r.? ?ww?? w??---? ??_? _ __ __-___- _- _ _ -_-_
0
1'?= 3
U MUG UV HUM uvi IG<r 1LJL7LOJlUL r, uu4
HYDE COUNTY HEAL'T'H DEPAR'T'MENT
P.O, Box 100 • Swan Quacter, N.C. 27885 Linda Mayo
Telephone [phone] Hlakb DbwIcr
=MPROVXMZiaT PRIKIT 8IT8 PLAN
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' ?' [] CONCRFTE MONUMENT SET THE SURVEYOR MAKES NO CERTIFICATION
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Mm 9
Office se Form Version Febnmry 2002
VI ,.,^i ID No. DWQ No. "Y
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. Che 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 (NC WRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
IL Applicant Information
1. Owner/Applicant Information
Name:
Mailing Address: rigg
Telephone Number;
E-mail Address:
Fax Number:
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory auth ity for the owner/applicant.)
Name: h ?8
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 12
M. Project Information
4.
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roa&'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.
project: NCSIAWK21
F=4 M, I Z GOlG1R'd (v
'rrw t Action * I "T IO 149 (a ac a Hereto
?ject Ntunber or State Project Number (NCDOT Only): Y1 A
1. Name
fIM
2. T.I.P.
3. Property Identification Number (Tax PIN): g
Location ? ? D E
County:
Subdivision name (include phase/lot number):,
Directions to site (include road numbers, laude
5. Site coordinates, if available (UTM or Lat/Long): n 1 $
(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 t e existing land use or condition of the site at the time of this application:
ResWP f#a! lof . a(pia;1E';N4 -411 noxwkt;aA JL dl?r?we. nt
7. Property size (acres):
8. Nearest body of water (stream/river/sound,%oceanilake): &)" );co so u.Ad e r
9. River Basin: Tar- E2NL t'%C0
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at httt)://h2o.enr.b-tate.nc.us/admin/maus/.)
Page 6 of 12
Nearest Town: Qc ralc0 Ke
10. Describe the purpose of the proposed work:
c7i ,
11. List the type of equipment to be used to
area loot
iject:.
12. Describe the land use in the vicinity of this project:_Res1defttal
IV.
V.
V1.
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.
Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work.
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 Vll 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 V11I below. If additional space is needed for
listing or description, please attach a separate sheet:
e
he
Page 7 of 12
Proposed Impacts to Waters of the United States/Waters of the State
written description of the proposed
2. Individually list wetland impacts below:
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet) i
Type of Wetland***
s a f

* t.1¢1'.?At!}t
---' --?.• .-Jr- -r-., _. -j,11] Icllrpuriuy impacts. impacts include, but are not limited to: meChani'Led clearing, grading, fill,
excavation, flooding, ditching/drainage. etc. For dams, separately list impacts due to both structure and flooding.
100-fear floodphains 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 athttn:!,www.fema. oM.
».« List a Nietland type that best describes wetland to be impacted (e.g.. freshwatcrisaitwater marsh, forested wetland, beaver pond.
Carolina Bay, bog, etc.)
List the total acreage (estimated) of all existing wetlands on the property: 0.-05 a c roes
Total area of wetland impact proposed:_ D, D ." QG tg s
3. Individually list all intermittent and perennial stream impacts below:
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?
leases eci )

va?u u11NuL1 a."ra cry and iucnnry• Temporary impacts, impacts include, but are not limited to: culverts and associated rip-mp.
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, ere.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing th a 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.=muov. Several internet sites also allow direct download and printing of USES maps (e.g., wvw.ts ozone m,
www.mapclucst.com etc.).
Cumulative impacts (linear distance in feet) to all streams on site: h I Q
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number

indicate on ma
Type of Impact* Area of
Impact

(acres)
Name of Waterbody
(if applicable) Type of WateKbody

(lake, pond, estuary, sound,
bay. oceanetc.)
n

• List each mnact se narate v an it ?„li lv r ............ ... : ?.....- e.____... _
-- - -- --- -- --- --_J .?...,....o.? ....L.o..w. aaurw.u ,u?iuuc, but am noL amiLea to: rill, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. Pond Creation rl /a.
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:
VIL Impact Justifleation (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 f llowed during construction Wr;, ce impact .
TM Ae ;at v ' fe M tk e qOt wtfl"ds ewomms
IN i IN
VIII. Mitigation ht r#.
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 nerennial
streams.
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http:/.,'h2o.enr.st,ate.ne.us/newetiands/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.
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 htto:,'.,h2o.enr.scate.nc.usiwro/index.han 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):
Page 10 of 12
UC Environmental Documentation (DWQ Only) A/4L
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) 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/SEQA document is required, call the SEPA
coordinator at 919) 733-5083 to review current thresholds for environmental documentation.
Yes n 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 ? Nd ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only) A A
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 VU above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ? If you answered "yes", provide the following information:
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
Lone t extends out 30 feet perpendicular from near bank of channel. Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page I 1 of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (DWQ Only) M I A
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
XII. Sewage Disposal (DWQ Only) AAA
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.
XJIL Violations (DWQ Only) N a
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No ?
Is this an after-the- fact permit application?
Yes ? No ?
XIV. Other Circumstances (Optional): h l ot
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).
/? 31191o 2-
--Applicant/Agent's Signature
(Agent's signature is valid only i an authorization letter from the applicant is provided.)
?.. S. 61a es
Page 12 of 12
,r11.10.1997 141 17 P.02
U.S. ARMY CORPS OF ENGWEERS
WILMINFTbN DISTRICT
/6 if
Action Id. 4 1 ?- , County - /,
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property owner 1,-ct r i-4,
Size and Location of project (water body, road
town, etc.)_ - b 0 L, S( I g 't for -7)
Description ription of Activity 1 01 0-5--a g v >r y o =?fj c T/ o"'1 ( w e r la u 41
L" /' Y' 9i a3 l?'1 ? i ?t J cr y 00 A leyrl,n k T C
Applicable Law: .-/'S'ection 404 (Clean Water Act, 33 U.S.C. 1344).
(check all that apply) Section 10 (River and Harbor Act of 1899).
Authorization: Regional General Permit Number.
Nationwide Permit Number.
Your work is authorized by this Regional General (RCiP) or Nationwide Permit (NWP) provided it is accomplished
in strict accordance with the attached conditions and your submitted plans. If your activity is subject to Section
404 (if Section 404 block above is checked), before beginning work you must also receive a Section 401 water
quality certification from the N.C. Division of Environmental Management, telephone [phone]. For any
activity within the twenty coastal counties, before beginning work you must contact the N.C. Division of Coastal
Management, telephone (919)•733-2293.
Please read and carefully comply with the attached conditions of the RGP or NWP. Any violation of the conditions
of the ROP or the NWP referenced above may subject the permittee to a stop work order, a restoration order, and/or
appropriate legal action.
This Department of the Army RGP or NWP verification does not relieve the permittee of the responsibility to obtain'
any other required Federal, State, or local approvaWpermits. The permittee may need to contact appropriate State
and local agencies before beginning work.
If there are any questions regarding this authorization or any of the conditions of the General Permit or Nationwide
Pert it, please contact the Corps Regulatory Official specified below.
0 -% a `lief Y VI
Date
Corps Regulatory Official.
Explmdon Date of Verification
No. R1g-1;Y-1614
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT PLANS, ETC., MUST
Address HD , l I a w? ?o r_ L 1 ft:fd
Telephone No, IN - 411 1
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,JV uiJU VV nunu,u uui l ,VV•\.V 1I.VVr v. ,, V-
HYDE couNTY HEALTH DEPARTMENT
P.O. Box 100 9 Swan Quactrr, N.C. 27885 Linda Mayo
Telephone [phone] HwMb Dlwc?a.
???? %Wltovnm w P=KXT BITE PLAIN

SARA# eez ry Doe.
Qh Watson
Snviran ntal Health specialist
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MAR 2 8 2001
„ n?y• Form Version Febmary 2002
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
I. Processing
1. Che 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: ?
H. Applicant Information
1. Owner/Applicant Information
Name:
Mailing Address: rIgg
Telephone Number:
E-mail Address:
Fax Number:
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory auth n for the owner/applicant.)
Name: h ?8
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 12
11:1. Project Information
4
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: USIAMlial LD1 -, yiou?lv cow-Ma FIR Perot Action * I Q'Q IMI (a act Hereto
2. T.I.P. Project Number or State Project Number (NCDOT Only): YI la
3. Property Identification Number (Tax PIN): A
Location 1 Y D E
County: A
Subdivision name (include phase/lot numN
Directions to site (include road numbers. la
Nearest Town:
Oc raco Xe
S. Site coordinates, if available (UTM or Lat/Long): h 1 a
(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 a existing land use or condition of the site at the time of this application:
Resi nV.#1 lol . a um;- ; is -4;11 cow/??;er, dQUQ/ve.??n-1?
7. Property size (acres):
8. Nearest body of water (stream/river/sound/ocean/lake): PAIN iieo so uAd e r
9. River Basin: 7-2 Y,-
(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/mai)s/.)
Page 6 of 12
10. Describe the
11. List the
of the proposed
of equipment to be used to construct the
rea Awt

12. Describe the land use in the vicinity of this project:_&%-7C1 dh*t9/
IV.
V.
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.
Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for he exclusion of this work from the cuVent application.
?iojrr f he; rda tract & MA Dwv A# , oweha`e .lre DG?`?i..r?d

G
h-t
d.
V1.
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 V[[ 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 Vlll below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
a brief written description of the proposed impacts:,
2. Individually list wetland impacts below:
Wetland Impact
Site Number
(indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream !
linear feet)
Type of Wetland***
Yes aggir. 12o
f

* L imt each iinnart an na R+*nly nn.i :.7...w 1:, ? ......-.--..?.:_
- -'- '-"" "-"r""'?r?"'••'v ?••? "+?'+`+a7 ` uw++++y impacts. Impacts include, out 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-fear 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 1-300-358-9616, or
online athitn-,Vwww.fema.yov.
*** List a uedand 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 all existing wetlands on the property: 0,0 5 Q C res
Total area of wetland impact proposed: 4"0 az ne s
I Individually list all intermittent and perennial stream impacts below:
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)

-•,• --Fa 19+ciy eu,u 7ucnmry temporary impacts, impacts include, but are not limited to: adverts and associated rip -mp.
dams teeparately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net lossrgain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditchingistraightening, etc. If stream relocation is
proposed, plans and profiles showing th a 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
wwwy,vs.-, v. Several internet sites also allow direct download and printing of USES maps (e.g., NMw.woo mc. •n",
www.mauijucst.com etc.).
Cumulative impacts (linear distance in feet) to all streams on site: n 1lA
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
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

• List each innact se narntely an ireubf%, rn ........ ... :.. ??___...
--• - - _ ---? -v •• •-•r?•a•? •••=e•?• •?• ••.,p"ts .ucauae, out arc not limited to: riu, excavation, dredging,
flooding. drainage, bulkheads, etc.
5. Pond Creation n!a
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:
VIL 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 f (lowed during construction t reduce impact •.
v cakte tAe q0t ?vttl"d s e*r mt%j;s
VIII. Mitigation nI C%l
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.
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http:/./h2o.enr.state..ne.us/nc,A,etian&,/stnn,gide.httni.
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.
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 htto:/ h2o.cnr.state.nc.us,'wro/index.him 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):
Page 10 of 12
DC Environmental Documentation (DWQ Only) V114.
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federaUstate) 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/SEQA 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 ? Nd ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only) A 14
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 V1I above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify p
Yes ? No El If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 3
2 1.5
Total
Zone t extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
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.
X1. Stormwater (DWQ Only) N
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
X11. Sewage Disposal (DWQ Only) A
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.
X111. Violations (DWQ Only) N of
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No ?
Is this an after-the- fact permit application?
Yes ? No ?
XIV. Other Circumstances (Optional): n l A
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).

Applicant/Agent's Signature I Date
(Agent's signature is valid only i an authorization letter from the applicant is provided.)
L. S. 61aes?
Page 12 of 12
,rr 11.10.1997 141 17 P.02
U.S. ARMY CORPS OF ENGINEERS
WILMINPT6N DISTRICT
Action Id. ??_ _ ?Cl U County
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property owner ctT.r i c_ t:.u . I,)a s~ c
Address Ho N-.11 Ln.r
Telephone No, I141 - 411
Size and Location of project (water body, road name/number, town, etc.) 1100 /or
I ,q
ad:
Description of Activity
Applicable Law: --"gection 404 (Clean Water Act, 33 U.S.C. 1344).
(check all that apply) Section 10 (River and Harbor Act of 1899).
Authorization: Regional General Permit Number.
g Nationwide Permit Number.
r
Your work is authorized by this Regional General (RCIP) or Nationwide Permit (NW) provided it is accomplished
in strict accordance with the attached conditions and your submitted plans. If your activity is subject to Section
404 (if Section 404 block above is checked), before beginning work you must also receive a Section 401 water
quality certification from the N.C. Division of Environmental Management, telephone [phone]. For any
activity within the twenty coastal counties, before beginning work you must contact the N.C. Division of Coastal
Management, telephone [phone].
Please read and carefully comply with the attached conditions of the RGP or NWP. Any violation of the conditions
of the RGP or the NWP referenced above may subject the permittee to a stop work order, a restoration order, and/oc
appropriate legal action.
This Department of the Army POP or NWP verification does not relieve the permittee of the responsibility to obtain
any other required Federal, State, or local approvals/permit-q. The permittee may need to contact appropriate State
and local agencies before beginning work.
If there arc any questions regarding this authorization or any of the conditions of the General Permit or Nationwide
Pert it, please contact the Corps Regulatory official specified below.
Date
Corps Regulatory
Expiration Date of Verification
No. R??-4?5?ld1G
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT PLANS, ETC., MUST
ICU niuri vv nanuin uLri iuu «u???vvu?
HYDE COUNTY HEALTH DEPAR'T'MENT
, vv,
P.O. Box 100 • Swan Quarter, N.C. 27885 Linda Mayo
Telephone [phone] MONA Dbwmr
IMPROYXMMT PMUIT BITE PLAN
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c I#2mp1y: Form Version Febn.my 2002
-UMS. Action_W No. DWQ No. 0 2 0 4 7 5
IT`.' r;
If any particular item fs not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
1. Ches}rrall 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 (NC WRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
H. Applicant Information
1. Owner/Applicant Information
Name: . J_
Mailing Address:
Telephone Number:,
E-mail Address:
Fax Number:
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory auth rity for the owner/applicant.)
Name: A P8
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 12
III. Project Information
4.
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 pjran 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: j L01 1,8 1 GO??( (P
Rill Pey*t Action * I4M$10I49 a ac a Hereto
2. T.I.P. Project Number or State Project Number (NCDOT Only): h 3
3. Property Identification Number (Tax PIN):
Location
County: A NE
Subdivision name (include phase/lot numb4
5. Site coordinates, if available (UTM or Lat(Long): 11' a
(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 tti?e existing land use or condition of the site at the time of this
ResidexV.91 tof . a MM;'&OQ -4; /l c0rm1wi,;am -JL
7. Property size (acres):
8. Nearest body of water (stream/river/sound/ocean/lake): Pam) co so "der
9. River Basin: Tar- K20% I (co
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at httt)://h2o.enr.state.nc.us/admin/maps/.)
Page 6 of 12
Nearest Town: QG rac0 Ke-
10. Describe the purpose of the proposed work:
C71; O
IV.
V.
11. List the
of equipment to be used to construct the
Ga M A k0?

12. Describe the land use in the vicinity of this project: _Res de,%tai
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.
Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for ffie exclusion of this work from the cuVent application.
kqlfQkl1*-WF he; a tract ail-b Da&v -/-* o rrltace ,ireo??f? AAd
G
ht
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LI.
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 V[[ 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 12
a brief written description of the proposed impacts
2. Individually list wetland impacts below:
Wetland Impact
Site Number
(indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet) I
Type of Wetland***
M& QAt s aggir. 4rosW f

* List ench im--an nu.n4nlu _ . . ..
---- ---•• •I-----r-""- 7 ....,uu•7 wu,FvLa&y impm;Ui. impacts mciuuc, out are not ttmitea to: mcchmuzed clearing, grading, fill,
excavation, flooding, ditching/drtinage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-fear 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 1-300-358-9616, or
online athttn:%,wvww.fema.Vnv.
List a %%eiland 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 all existing wetlands on the property: Qi 05 a c res
Total area of wetland impact proposed:_ &0 rp c
3. Individually list all intermittent and perennial stream impacts below:
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)

..?. -F--FMjllVly anu iucntuy 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/straishtening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
•" Stream nines 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
veww.usLs_;,ov. Several internet sites also allow direct download and printing of USGS maps (e.g., vtnvw.tonozone.com,
www.maaCgucst.com etc.).
Cumulative impacts (linear distance in feet) to all streams on site: h I Q
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number

indicate on ma
Type of Impact' Area of
Impact

(acres)
Name of Watcrbody

(ifa ppltca ble) Type of Watt7body

(lake, pond, estuary, sound,
bay. ocean etc.)
n1.9

• List each inpact se parate an i ntif - l m
Y por
flooding, drainage, bulkheads, etc. ary impacts. pacts include, but are not limited to: fill, excavation, dredging,
5. Pond Creation n!a
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 ? wetland,
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:
VIL
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 f llowed during construction t reduce impact
,? cakse Oe q0t r ?l ds ex ss
VIII
Mitigation III w
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.
Page 9 of 12
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 applicanil 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
httr):/.,'h2o.enr.state.ne.us/nc,A,etlands/stringide.htrnl.
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.
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 wottld 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!wro/index.hcm 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):
Page 10 of 12
IX. Environmental Documentation (DWQ Only) A/A.
Does the project involve an expenditure of public (federalf'state) funds or the use of public
(federal/state) 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 919) 733-5083 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 ? Nd ?
K Proposed Impacts on Riparian and Watershed Buffers (DWQ Only) A /A
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 V11 above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ? If you answered "yes", provide the following information:
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
Miti >ation
1 3
2 1.5
Total
• Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (DWQ Only) Y1' A
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
X11. Sewage Disposal (DWQ Only) A I A
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'
X111. Violations (DWQ Only
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No ?
Is this an after-the- fact permit application?
Yes ? No ?
XIV. Other Circumstances (Optional): n ! A
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).

Applicant/Agent's Signature I Date
(Agent's signature is valid only i an authorization letter from the applicant is provided.)
?. S. 61a es -rp,
Page 12 of 12
11.10. 1997 141 17 P-02
U.S. ARMY CORPS OF ENGINEERS
WILMIN? T& DISTRICT
Action Id. 16 ,f m c) county
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property owner _1 Jct7.r i c. ?,
Size and Location of project (water body, road
town, etc.) 13- by f S.{ lot ? /or V
utcG?S
Applicable Law: .f'9ection 404 (Clean Water Act, 33 U.S.C. 1344).
(check all that apply) Section 10 (River and Harbor Act of 1899).
Authorization: Regional General Permit Number.
g Nationwide Permit Number.
Your work is authorized by this Regional General (ROP) or Nationwide Permit (NW) provided it is accomplished
in strict accordance with the attached conditions and your submitted plans. If your activity is subject to Section
404 (if Section 404 block above is checked), before beginning work you must also receive a Section 401 water
quality certification from the N.C. Division of Environmental Management, telephone [phone]. For any
activity within the twenty coastal counties, before beginning work you must contact the N.C. Division of Coastal
Management, telephone (919)•733-2293.
Please read and carefully comply with the attached conditions of the RGP or NWP. Any violation of the conditions
of the ROP or the NWP referenced above may subject the permittee to a stop work order, a restoration order, and/or
appropriate legal action.
This Department of the Army POP or NWP verification does not relieve the permittee of the responsibility to obtain
any other required Federal, State, or local approvals/permits. The permittee may need to contact appropriate State
and local agencies before beginning work.
If there are any questions regarding this authorization or any of the conditions of the General Permit or Nationwide
Per1 it, pleaso contact the Corps Regulatory Official specified below.
0 ?^+ W k s IC r-, a `f i ef Y7.11
Date I I
Corps Regulatory Officid
Expiration Date of Verification I
No. R iq-41 5`1614
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT PLANS, ETC., MUST
i312 AqV`P A nL7C11'r!% PMrrT Vr7r r /'..v ir+r? ".% nnnY) n.. --
Address 4 D bi ? ,? ` 10n 1 t L IQ F41.%f1d --
Telephone No, 31 H -1J 3? ` I C. Y
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?u niua vv nanuln uari iau cvc?cvvv?
HYDE couNTY HEALTH DEPARTMENT
C. VV7
P.O. Box 100 • Saran Quarter, N.C. 27885 Linda Mayo
Telephone [phone]
DD44 ??I1IPAOVmnw pmulT MITI PLANT
LKIb1/? AJ' 9W 1Ie- PBMT
93
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SA,QAN ,ALLEN Deg
qh Watson
Inviramental Health specialist

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a r.:
I PddiR nly: Form Version Febmmy 2002
E '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. Che*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: ?
H. Applicant Information
1
Owner/Applicant Information
Name:
Mai lin
Telephone Number: 10 1 - - J Fax Number:
E-mail Address: b ads 0S rwJcfi;Ulatd, enom
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory auth rity for the owner/applicant.)
Name: h ?8
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 12
M. 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 p>tan 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: ( COW
es(
'Pill ferwut Acton * MIDI ? a ace Hereto
2. T.I.P. Project Number or State Project Number (NCDOT Only): h a
3. Property Identification Number (Tax PIN): g
4. Location
County: A Y12E Nearest Town: OC ra?CO Ke
Subdivision name (include phase/lot number): t q iand T[reh
Directions to site (includS rpad numbers_ landmarks, etc.): 1 .00/ s.f. C i
5. Site coordinates, if available (UTM or Lat/Long): n 1 a
(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 t e existing land use or condition of the site at the time of this appplication:
7. Property size (acres): 13
8. Nearest body of water (stream/river/soundrocean/lake): ramlice sounder
9. River Basin: Tar'- K2^%- (ICo
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at htti)://h2o.enr.s-tate.nc.us/admin/maps/.)
idA
Page 6 of 12
10. Describe the purpose of the proposed work: area iwted Qh Q a
6l rV? ,? a c?;
11. List the type of equipment to be used to cons ct the project: day?/?- ?ydC,
AJZ
9 P.rt Q?d 1r/ftlt ?l lie //iI#, k e2 - r® yti .J1?
I -ea
12. Describe the land use in the vicinity of this project:_OLOSM6atdV/
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 future permit requests anticipated for this project? If so, describe the anticipated work,
and provide iustification for the exelminn of rhic wnAr frn.,, +hp
,1 41
d.
V1.
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 Vff 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 V11I below. If additional space is needed for
listing or description, please attach a separate sheet:
Page 7 of 12
Proposed Impacts to Waters of the United States/Waters of the State
Wetland Impact
Site Number
(indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain"
es/no Distance to
Nearest Stream I
linear feet)
Type of Wetland***
Pos- f a .?

" List each impact se parately and identify temDO aM im pacts. Impacts ineludr heir nn, -t li-it--l r..• ..•? tio..:..n.a ..? _. _ .. _ ?:_ _ .-
Ass SL null 19, 1 it I,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
100-fear 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 1-300-358-9616, or
online athttn:iiwww.fema.& .
List a «etland 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 all existing wetlands on the property: 0,0 'S a a res
Total area of wetland impact proposed: &0 5" ar- m c
3. Individually list all intermittent and perennial stream impacts below:
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)

d. . - ....r..,,..?r?•••-=r ..."u IU?«<uy wtLporary 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 th a 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 nine, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at b800-358-9616, or online at
www. tsv%.e n•. Several internet sites also allow direct download and printing of USGS maps (e.g., ',Mw.ilmozonc co m.
ww_ w.manguest.corn etc.).
Cumulative impacts (linear distance in feet) to all streams on site: Y1I A
Page 8 of 12
2. Individually fist wetland impacts below:
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number

indicate on lna
Type of Impact' Area of
Impact

(acres)
Name of Waterbody
(if applicable) Type of Wate-rbody

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

Lest each mnact se parately an idenH v t?.,,?,,.9 .,. ;,.,.,,,.... L..w-..... _1_17 L... ..__ . ••
r----? -r- WY•w.? -'o wt 4" not "m1mu 10: rill, excavation. drodging,
flooding, drainage, bulkheads, etc •. ....
.
5. Pond Creation n /a
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:
VIL 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 f !lowed during construction N44*!Fe educe impact, •.
TM " 1. L v ' acttie X104 wttld s e.ygss
-
in At dso .
r -1 VIII. Mitigation ill C#.

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.
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http:/,'h2o.enr.state.ne.us/ncwetiands/stmgide.htTni.
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.
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.cnr.stlte.nc.us,wm/indcx.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):
Page 10 of 12
DC Environmental Documentation (DWQ Only) n/OL
Does the project involve an expenditure of public (federal,/state) funds or the use of public
(federal/state) 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 ? Nd ?
X Proposed Impacts on Riparian and Watershed Buffers (DWQ Only) Ato
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 V11 above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ? If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 3
2 1.5
Total
zone 1 extends out 30 feet perpendicular from near bank of channel: Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page l 1 of 12
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.
X1. Stormwater (DWQ Only) N ! 'A
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
XH. Sewage Disposal (DWQ Only) AAA
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.
VIII. Violations (DWQ Only) N' a
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No ?
Is this an after-the- fact permit application?
Yes ? No ?
XIV. Other Circumstances (Optional): n ` q
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).

Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
L. S. 61aoes -I!!-
Page 12 of 12
11.10.1997 14117 P.92
U.S. ARMY CORPS OF ENGINEERS
WILMINCF`I~6N DISTRICT
Action Id. 111910H County GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION

Property owner 1"ATr r i c i
Address 40 N 11 a sc at --
Telephone No.31N -1:31 - 41C W. _.. _.. .
Size and Location of project (water body, road
off S,aeaL r 11{h Sr (/Ui
ad:
town, etc.) _ 1 *(Zy S? 10 't toy
Description of Activity F l O U_S _ _u c. r y o f k r; J c T/ o a w T ?uu t?S
P Y S? a? r?r r i k 1 T u e v A i_ rH ,r_ a. i t
Applicable Law: ."Section 404 (Clean Water Act, 33 U.S.C. 1344).
(check all that apply) Section 10 (River and Harbor Act of 1899).
Authorization: . Regional General Permit Number.
Q Nationwide Permit Number.
Your work is authorized by this Regional General (RGP) or Nationwide Permit (NWP) provided it is accomplished
in strict accordance with the attached conditions and your submitted plans. Yf your activity is subject to Section
404 (if Section 404 block above is checked), before beginning work you must also receive a Section 401 water
quality certification from the N.C. Division of Environmental Management, telephone [phone]. For any
activity within the twenty coastal counties, before beginning work you must contact the N.C. Division of Coastal
Management, telephone (919)•733-2293.
Please read and carefully comply with the attached conditions of the RGP or NWP. Any violation of the conditions
of the ROP or the NWP referenced above may subject the permittee to a stop work order, a restoration order, and/or
appropriate legal action.
This Department of the Army POP or NWP verification does not relieve the permittee of the responsibility to obtain
any other required Federal, State, or local approvals/permits. The permittee may need to contact appropriate State
and local agencies before beginning work.
If there arc any questions regarding this authorization or any of the conditions of the General Permit or Nationwide
Peit, pleaso contact the Corps Regulatory Official specked below.
-70 .-1 L(
Date t 1 /t b
Corps Regulatory Official 1?'la1JBJN.' W • ! . , Telephone No. R ?q j q :j'"J 6
Expiration Date of Verification 11110 / I cl
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT PLANS, ETC., MUST
v
m uc vv nanu m uar l
I?ulf.??7?vviv? I. vv?
HYDE COUNTY HEALTH DEPARTMENT
P.O. Box 100 • Swan Quarter, N.C. 2M5 Linda Mayo
Telephone [phone] N000 Da e?or
DD44 IMPROVXMMIT PERMIT SITE PLAN
C61405AM,r A G&W- 0? PERMIT r AO -

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SA?Ay ,?CLEJV a?• .
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Bnvirammntal Health specialist

?!1' f`???1I?*s ? pv c ' ;'pig •• ! ? . ..
LEGEND MT
'
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Cx1STNb IRON R00 011
?, ': t. THIS SURVEY IS SUBJECT Tq• A II
dSCIbeED BY A FULL AND' ACCURA
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EXISTING PK NAN 3. F.I.R.M. ZONE: A5; OFE T '
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5 RECORDED REFERENCr: OR A%, PG 478
0 CxISnNn CON"t'k: YONUMENIJ 6. BUILDING LINES SHOWN WEREON MUST BE
CONCRETE MONUMENT SET THE SURVEYOR MAKES NO CERTFICAW
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O e Form Version Febr ary 2002
RU.S??CIE?Action ID No. DWQ No. ? 42
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. Che 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: ?
H. Applicant Information
1. Owner/Applicant Information
Name:
Mailing Address:
Telephone Number:,
E-mail Address:
Fax Number: 803-
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory auth city for the owner/applicant.)
Name: h ?8
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 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 II by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: 1 fi CO WM
FM Perow t Acton * 1"T IO M (a ac hereto
2. T.I.P. Project Number or State Project Number (NCDOT Only): h .1
3. Property Identification Number (Tax PIN): ,c
4. Location
County: R YDE Nearest Town: Oe rac0 lie
Subdivision name (include phase/lot number): f q
Directions to site (include road numbers_ landmarks, etc.): DD
5. Site coordinates, if available (UTM or Lat/Long):_ 1 $
(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 a existing land use or condition of the site at the time of this appplication:
i?esi nt4l lof . QWi ;f;xq ?i11 collwle-&oo L dQWlUDi
7. Property size (acres):_ 3
3. Nearest body of water (stream/riverlsound/ocean/lake): dam 1;co so aAd e r
9. River Basin: Tar- E20L t C 0
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http:/ih2o.enr.state.ne.us/admin/maps/.)
Page 6 of 12
10. Describe the
11. List the
of the proposed
of equipment to be used to
a121 kote?l opt a
t??
the project
12. Describe the land use in the vicinity of this project:_Aes MOO h&49 J
IV.
V.
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.
Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for ;he exclusion of this work from the cur t application.
R.?li? Est he; cope tract ar f-A Da&y Y--# ,Oarr-hace .ire o?J??? ?v+d
C?Ij i
Z`

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 Vlll below. If additional space is needed for
listing or description, please attach a separate sheet'.
Page 7 of 12
I . Provide a brief written description of the proposed
2. Individually list wetland impacts below:
Wetland Impact
Site Number
(indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to I
Nearest Stream '
linear feet)
Type of Wetland***
• s a f

---• --?•• ••--r°-• ?•'!•°•°•?v '?'? iu -ny IVII&F l6ly Impacts. impacts mcmae, out 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-fear floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA -approved local floodplain maps. Maps are avnilable through the FEMA Map Service Center at 1-800-358-9616, or
online athttn:n'www.fema.YOv.
"** List a uednnd type that best describes wetland to be impacted (e.g., freshwaterisaitwater marsh, forested wetland, beaver pond.
Carolina Bay, bog, etc.)
List the total acreage (estimated) of all existing wetlands on the property: 0,0 1S Q C res
Total area of wetland impact proposed: 4,,o .' ae IV c
3. Individually list all intermittent and perennial stream impacts below:
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)

?. -41 11 IPUi l bcJYM (cry rmu roennry 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/straishtening, etc. If stream relocation is
proposed, plans and profiles showing th a linear footprint for both the original and relocated streams must be included.
•" Stream names can be found on liSGS 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
wwwmsys.uov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.umozone.com.
www.maouucstcom etc.).
Cumulative impacts (linear distance in feet) to all streams on site: Al a
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number
indicate on ma
Type of Impact Area of
Impact
(acres) Name of Waterbody

(if applicable) Type of Wat,rbody
(lake, pond, estuary, sound,
bay, ocean etc.)
n

List each impact se ns"lely an nil'.. r ............ ...: ?.-___.._
--r--• --r--^-? ^-? ••--••••v •?,uy.na.? .uaYa- Mpnx;ts incluuc, out all; not Waited to: till, excavation, dreAging,
flooding, drainage, bulkheads, etc.
5. Pond Creation /1!a
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:
VIL 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 f llowed during construction t reduce impact,
3= v . I% ty
r caAt se ttie qot uefl d s ew, ss
i •
/H Mt ili1'e.
VIII. Mitigation „I G,.
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.
Page 9 of 12
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 wedand
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 applicanI 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
httn:/,`h2o.enr.state.ne.us/ncwetlan&, strmaide.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.
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 htto:Uh2o.enr.state.nc.usrwrrolindex.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):
Page 10 of 12
IX. Environmental Documentation (DWQ Only) 1114L
Does the project involve an expenditure of public (federal; :state) funds or the use of public
(federal/state) 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 919) 733-5083 to review current thresholds for environmental documentation.
Yes li 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 ? Nd ?
K Proposed Impacts on Riparian and Watershed Buffers (DWQ Only) A A
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 V11 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
(Neese), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ? If you answered "yes", provide the following information:
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
Miti ration
1 3
2 1.5
Total
Zone 1 extends out 30 feet perpendicular from near bank of channel: Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page l 1 of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B.0242 or.0260.
XI. Storm water (DWQ Only) 141 ok
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
XII. Sewage Disposal (DWQ Only) A I A
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
XIII. Violations (DWQ Only) N ( 0l
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No ?
Is this an after-the- fact permit application?
Yes ? No ?
XIV. Other Circumstances (Optional): n l A
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).

Applicant/Agent's Signature --paste
(Agent's signature is valid only i an authorization letter from the applicant is provided.)
?. S . 61aAes -ro
Page 12 of 12
,r 1@. 1997 14,17 P.92
U.S. ARMY CORPS OF ENCd EERS
WILMIN TAN DISTRICT
Action Id. IIIYIOL41 County GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION

Property owner I,ct`7 r L4,-
Size and Location of project (water body, road
town, etc.) 100 L Sf. I g 't for .Y
Applicable Law: ?S'ection 404 (Clean Water Act, 33 U.S.C. 1344).
(check all that apply) Section 10 (River and Harbor Act of 1899).
Authorization: Regional General Permit Number.
Nationwide Permit Number.
Your work is authorized by this Regional General (RGP) or Nationwide Permit (NW) provided it is accomplished
in strict accordance with the attached conditions and your submitted plans, if your activity is subject to Section
404 (if Section 404 block above is checked), before beginning work you must also receive a Section 401 water
quality certification from the N.C. Division of Environmental Management, telephone [phone]. For any
activity within the twenty coastal counties, before beginning work you must contact the N.C. Division of Coastal
Management, telephone [phone].
Please read and carefully comply with the attached conditions of the RGP or NWP. Any violation of the conditions
of the ROP or the NWP referenced above may subject the permittee to a stop work order, a restoration order, and/or
appropriate legal action.
This Department of the Army RGP or NWP verification does not relieve the permittee of the responsibility to obtain
any other required federal, State, or local approvals/permits. The permittee may need to contact appropriate State
and local agencies before beginning work.
If there arc any questions regarding this authorization or any of the conditions of the General Permit or Nationwide
Peit, pleaso contact the Corps Regulatory Official specified below.
.4 4 14
Date
Corps Regulatory
Expiration Date of Verification
No. Rl??q?S?1dlL
.TV Address 40 K 11 e k e L, a mk-%C _
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT PLANS, ETC., MUST
T30 A T-rAr4U1UT WN T-TVIT vet r ^111 .1- rn
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Telephone No. 3114 -1 ?t } N q L _-. r
!„s.7a,
I7u niuo vv nrinuiu uui i uu ,wr.r??.??
HYDE COUNTY HEALTH DEPART'MENT'
p.0. Box loo • Swan Quaker, N.C. 27885 un& Mayo
Telephone [phone] MONADifecAm
VAel- ,?IMP ROV>MIT PERMIT SITS PLAN
A,&W- A/c PSRWIT
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