20020600 Ver 1_Complete File_20020418

A0&UaTlW ArF'1 G
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D.
Acting Director
Division of Water Quality
May 31, 2002
Stanley County
DWQ Project #: 02-0600
APPROVAL OF 401Quality Certification with ADDITIONAL CONDITIONS
Jeanette Coble
128 Industrial Park Drive
Rockingham, NC 28379
Dear Ms. Coble:
You have our approval, in accordance with the attached conditions, to impact 0.02 acres of
wetlands or waters for the purpose of dredging at Bobby Gardner Development on Lake Tillery as you
described in your application dated April 18, 2002. After reviewing your application, we have decided
that this fill is covered by General Water Quality Certification Number 3376, which may be viewed on
our website at http://h2o.enr.state.nc.us/ncwetlands. This certification allows you to use General Permit
Number 30 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. 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
except as modified below. If you change your project, you must notify us and you may be required to
send us a new application. If the property is sold, the new owner must be given a copy of this
Certification and approval letter and is thereby responsible for complying with all conditions. If total
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) (6) and (7). This approval shall expire when the
corresponding Nationwide Permit expires or as otherwise provided in the General Certification. For this
approval to be valid, you must follow the conditions listed in the attached certification and any
additional conditions listed below.
1. Upon completion of the project, the applicant shall complete and return the enclosed
"Certification of Completion Form" to notify DWQ that all the work included in the 401
Certification has been completed. The responsible party shall complete the attached form and
return it to the 401/Wetlands Unit of the Division of Water Quality.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory
hearing. You must act within 60 days of the date that you receive this letter. To ask for a hearing, send
a written petition, which conforms to Chapter 150B of the North Carolina General Statutes to the
Office of Administrative Hearings, P.O. Box 27447, Raleigh, N.C. 27611-7447. This certification and
its conditions are final and binding unless you ask for a hearing.
N EIS
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), (hftp://h2o.enr.state.nc.us/ncwetiands
, Office Use Only: -'-?-_ -?-_ -.-------- Form Version April 2001
aUSACE Action ID No. DWQ No. 2 O (r
fffeny particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
lea VifigIthe spaceblank.
V Nom..
L Processing
1. Check all of the approval(s) requested for this project: APR I y
Section 404 Permit ?U(1
? Section 10 Permit
401 Water Quality Certification
frys?C
Riparian or Watershed Buffer Rules nC,`
2. Nationwide, Regional or General Permit Number(s) Requested:_
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
IL, Applicant, Information
1.- Owner/Applicant Information
Name: 0-e,o n AA-c_ h\e..
Mailing Address., 19'8
Z4 3`l C1
Telephone Number: °1 \l?) ?lq r1- rl r) g Fax Number G
(? - ??? ?? ??
E-mail Address: ,Y.C-c"o,e e?\ -c_4 © ; n? c c, e 4 . n? t
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name 1S 1 A
Company Affiliation:
Mailing Address:
-Telephone Number: Fax Number:
E-mailAddress:
Page 5 of 13
III. Project Information
Attach a vicinity map clearly showing the location of' the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings 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: L_ Q V) e H e
2.T.I.P. Project Number (NCDOT Only):
3,Property Identification Number (Tax PIN):
,+.i,ocarnon
County: 9 Nearest Town: VAOywo? t?(C
Subdivision name (incl de phase/lot number): _l)k
Directions to site (include road numbers, landmarks, etc.):
5.Site coordinates, if available (UTM or Lat/Long):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody. )
6.Describe the existing land use or condition of the site at the time of this application:
t ci R-0-16 0,n \
7.Property size (acres): ? ose,?
8.Nearest body of water (stream/river/sound/ocean/lake):...
Q
9.River Basin: c 1c' ,,`,
(Note - this gust be one of North Carolina's seventeen designated major river basins.
River Basin map is available at http://h2o.enr.state.nc.us/admin/mans/.)
The
Page 6 of 13
10.
11.
12.
,'IV
Describe the purpose of the proposed
??c', s . av?_ (it, "?
Cpl c? ? ? ? o ? ?( .,-(
List the type of equipment to be used to construct the project:
00.?
Describe the land use in the vicinity of this project:_ k q_C A -1.10!0 U l
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 des
tribe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
sta.; ,
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application:
VL 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
Sa ?
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
.pian.:,AlI ;wetlands and waters, and all streams (intermitt
ent and perennial) must be shown on a
s Sdelineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation sand , delineation forms should be included as appropriate. Photographs may be
J?.{mcluded at,,,, the applicant's discretion. If this proposed impact is strictly for wetland or stream
z mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 13
p u 9 U e 1. Wetland Impacts
Wetland
Impact
Site Number

(indicate on
ma

Type of
Impact*
Area
of
Impact

(acres)
Located within
100-year
Floodplain**

(yes/no)
Distance to
Nearest
Stream

(linear feet)

ype of Wetland***

Lief P.arh imnar4 er+ noru4sh. 0«,7
____r___, ___i __, •,•• ,,,,, , ,,, ,,,,,, , ,,,,, we „?? millumu w: mccnanlzea cicanng, gntuing, '311,
excavation, flot#dittg, tlitching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
,100-Year-#l6466 are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
,(F")j or FWMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at 1lwtvw.fema. ov.
List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property:
Total area of wetland impact proposed:
o 5 3 2. Stream Impacts, including all intermittent and perennial streams
L T
?.I.nsi each ,tmpact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure,and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization' activities (cement wail, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
x proposed, plans'and profiles showing the linear footprint for both the original and relocated streams must be included.
Site= 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
"iyww:usa§.eov. Several internet sites also allow direct download and printing of USGS . maps (e.g., www.topozone.com,
:V Affikomsteora, etc.).
Stream Impact,
Site Number ''
(indicate on
map)
Type of
Impact* Length of
Impact
(linear
feet)

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

Page 8 of 13
-.
Cumulative impacts (linear distance in feet) to all streams on site:
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water
?: ?-Impact

Site Number
(indicate on
ma

ype of Impact*
Area
of

Impact

(acres)

Name of Waterbody

(if applicable) -------

Type of Waterbody
(lake, pond, estuary,
i

sound, bay, ocean, etc.)
??o r, .oa eke r 1C

-List, Webl.inwad se 1]9nielV An[1 f/lP.n}tfv 4mm?nro ra. a 7 _t_.?_
... •, bulkheads, etc. r----- --r__ • ••, .... w. uvffiwuaf w. im, excavation, dreaglllg,
ge,
4. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also the proposed
pond should
be described here and illustrated on any maps included with this a lication.
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-d6wdvalve or spillway, etc.):_J,? I CN
'
'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 followed during construction to reduce impacts..
. _ 111 Q
Page 9 of 13
VM. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USAGE.,- In accordance with the Final Notice of Issuance and Modification of Nationwide
Permitspublished 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
hgp://h2o.enr.state.nc.us/ncwetlands/stnngide.httnl.
r
1 Provide' abrief 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.
14 I(A

N
Page 10 of 13
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401./Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP; check the NCWRP website at
http://h2o.enr.state. naus/wrp/index htm. If use of the NCWRP is proposed, please check the
appropriate box on page three and provide the following information:

Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ? No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: -; - If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
V, L Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It+is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
,and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ,K If you answered "yes", provide the following information:
Page 11 of 13
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):
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
?Lmlly , nxtcilus uuL w reef perpenaictuar rrom near bank of channel; zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 213.0242 or. 0260.
_TLI?
X: Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss.. stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
XL Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
• , 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
Page 12 of 13
XIL Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction. dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
2
plicantlAgent ignature Date
Agent's signature is valid only if an authorization letter from the applicant is provided.)

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OF V4AT- Michael F. Easley, Governor
Q William G. Ross Jr., Secretary
- North Carolina Department of Environment and Natural Resources
>` Gregory J. Thorpe, Ph.D.
O Acting Director
Division of Water Quality
April 26, 2002
DWQ # 02-0600
Stanley County
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
Jeanette Coble
128 Industrial Park Drive
Rockingham, NC 28379
Dear Ms. Coble:
On April 18, 2002 the Division of Water Quality (DWQ) was notified by receipt of your
application regarding your plan to fill wetlands for the purpose of dredging in Stanley County.
Approval from DWQ is required to disturb these waters. 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 214.0500.
1. Please provide a plot plan of the property with the dredge area boundaries clearly identified.
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.
on_Program
cc: Mooresville DWQ Regional Office
Asheville Corps of Engineers
Central Files
File Copy
l?"R
North Carolina Division of Water Quality, Wetlands/401 Certification Unit Nt;aE
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/
Sincerely,
Enclosed is a plot plan of property located on Lake Tillery. My DWQ# is 02-0600
Stanley County. There is an original plus seven copies of the specific area.
Sincerely,
Jeanette Coble
128 Industrial Park Drive
Rockingham, NC 28379

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Office Use Only: Form Version April 2001
.0 0
'USACE Action ID No. DWQ No. 0206'
4f any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving-the space blank.
Processing
L Check all of the approval(s) requested for this project:
® Section 404 Permit
? Section 10 Permit
?C] 401 Water Quality Certification t 1820
!
? Riparian or Watershed Buffer Rules i
WETLANDS GROUP
2. Nationwide, Regional or General Permit Number(s) Requested: ` ?•WATER ou?1 Irv SECTION
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII - Mitigation), check here: ?
IL - Applicant Information
L Owner/Applicant Information
Mailing Address: 1 8 ,dam t '?a < 'V- "a) "z" . J e. N C
Zed 31 q
Telephone Number: 1A k t - c?q rl - rl r) Fax Number: ?`t t n - ?l c1 2L-..r) q 13
E-mail Address: ,-y-\c- e e_1, c_:;r © e A ,
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name; Pt
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
r E-mail' Address:
Page 5 of 13
IIL , Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site;plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1.Name of project: a v) ,g Col?
2.T.I.P. Project Number (NCDOT Only):
3.,Property Identification Number (Tax PIN): ?o'er ?4 3
4.Location
County: _ Nearest Town:- VAO-(wo? NC-
Subdivision name (incl de phase/lot number): lAk L? Ry r_i?c\j
Directions to site (include road numbers, landmarks, etc.):
5. Site coordinates, if available (UTM or Lat/Long): i-
(Note - If project is linear, such as a road or utility lme, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6.Describe the existing land use or condition of the site at the time of this application:
7.Property size (acres):- I os_x
8.Nearest body of water (stream/river/sound/ocean/lake):_ AaV-,
9.River BasinA O d \C,
(Note this ust be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
Page 6 of 13

Describe the purpose of the proposed work:
J- J
List the type of equipment to be used to construct the project:
Describe the land use in the vicinity of this prc ject:_(o-C v o (k -4 -; z, n,, 1
{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
t 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,
1ist;.and;describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
V. - Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application:
1?\`A
-x
VL 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
piam r1A11,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
ev
iy aluation , and , delineation forms should.be included as appropriate. Photographs may be
.,,included at: the applicant's discretion.' If this 'proposed ` impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 13
N 5„ e 1. Wetland Impacts
tip/ . f ?? a-y
Wetland
Num
Site e Number
?--(indicate on
map)°
Type of
*
Impact* Area
of

Impact
(acres) Located within
100-year
**
Floodplain
(yes/no) Distance to
Nearest

Stream
(linear feet)

Type of Wetland***

"t.icl -h
---,, -.- --.?-----> ......j.. J •+..Y.avW.. ,a F-W "1WUUG, VUL Mr, UVL IUIIneU LO. mecnanizea clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
.?z .=100-Year4lbodplains:are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM); or F approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
oiiline at L 0., Tema. ov.
List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
- List the total acreage (estimated) of existing wetlands on the property:
Total area of wetland impact proposed:
a z a 2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
'' `
Slt Number
(indicate on
map)

Type of
Impact* Length of

Impact
(linear
feet)

Stream Name** Average
Width of
Stream

Before
Impact
Perennial or
Intermittent?

(please specify)

* lid "rh imnarf: e. .r.u f-h «.i
_?1 _._, ...., ....l,..,?. ..,.i -W -UMU{ VUL ?UV ,LVL tLLlllLeu w: curverts and associated np-rap,
separately list impacts due to both structure ;and flooding); relocation (include linear feet before and after, and net loss/gain),
ation activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
61, plans and ptofiles showing the linear footprint fof both the original and relocated streams must be included.
:nam!es;can be found on USGS topographic maps.'117a stream has no name, list as UT (unnamed tributary) to the nearest
ream. framed, stream, into which it flows. USGS, maps are" available through the USGS at 1-800-358-9616, or online at
sks.szov:'`" Several' internet sites also allow, direct download and printing of USGS maps (e.g., www&%nzonp.com,
elm, etc:):
Page 8 of 13
Cumulative impacts (linear distance in feet) to all streams on site:
Opeh Water Impacts, including Lakes; Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U. S.
Open
tack i Water mpact separately and identify temporary impacts. Impacts include, but are not limited t fill, excavation, dredging,
r; st,
flooding; drainage, bulkheads, etc. o:
' 4. -'Pond Creation
w 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 ro sed
p po pond should
be described here and illustrated on any maps included with this a lication.
Pond to be created in (check all that apply): ? uplands [stream ? wetlands
` Drrscrilie the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): _iA ? ?
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
e,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 maybe useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
?-f nancial 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
N,were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
r
'z ?xn;Iriipact:

Site Number
;.(indicate on
Map)

Type of Impact* Area,
of

Impact

(acres)
Name of Waterbody

(if applicable)
Type of Waterbody
(lake, pond, estuary,

sound, bay, ocean, etc.)
,;r Cho n . 0 a e r

•
Page 9 of 13
VILL Mitigation
DWQ - In accordance with 15A NCAC-2H .0500, mitigation may be required by the NC
DiyisionGq zWater., Quality for projects involving greater than or equal to one acre of impacts to
freshwaterwetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
? USACE In;accordance with the Final Notice of Issuance and Modification of Nationwide
.;; Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to. ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are notAimited 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 USAGE 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' IJWQ's Draft Technical Guide fore' Stream Work in North Carolina, available at
//h2b..ear.state.nc.us/ncwetlands/Stmigide.btml.
"-1 'Provide` a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or-map; if offsite), affected stream and river basin, type and amount (acreage/linear feet)
- - of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preseriration 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.
s ss
Page 10 of 13
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
`y< you wouldaike 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
NOW is,? available as an option. For additional information regarding the application
processfor the NCWRP, check the NCWRP website at
http:i/li2o.enr.state.nc.us//index.htm. If use of the NCWRP is proposed, please check the
appropriate box on page three and provide the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
'Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
+ Environmental Documentation (DWQ Only)
_Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes ? No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
}r} `Note;: If you are not sure whether a ` NEPA/SEPA document is required, call the SEPA
°t???;.%i ,,?-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 ? No ?
M Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
(If is 'the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
_ , , and must be; clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neese), 15A NCAC 213 .0259 (Tar-Pamlico), 15A NCAC 21 .0250 (Randleman Rules and
Water Suppl Buffer Requirements), or other (please identify )?
Yes No If you answered "yes", provide the following information:
Page 11 of 13
Identify,the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation :is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 3
2 1.5
Total
V . ?Atullu, vuL Jv ieeL perpenaumar nom near yank of channel; Gone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment'into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 213.0242 or. 0260.
lslpr
X. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss : stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
XL Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
:wastewater generated from the proposed project, or available capacity of the subject facility.
• : Yiolations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes Q No
}y
Isthis an after-the-fact permit application?
Yes, ? No
Page 12 of 13
XIL Other Circumstances (Optional):
It is the,applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
Choose;to, list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
4
/ c1
pplicant/Agent's Signature Date
Algent`s"signature is valid only if an authorization letter from the applicant is provided.)

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~ NOTE: THIS SURVEY IS a' W ~ 16g~ ~ SUB,~CT w ° ^ o ' _ FACTS WHIC1i MAY ~ ANY iB,IECT TO ANY
w ~ , BE DISCI,OSEO BY A FULL ANO ACCURATE TITLE LARCH, CLOSED BY A 9EARM
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r. ~ VIA ~ ^K ~+~nLRJ o. ago ACTUAL FIELD SURVEY PERFORMED BY ME THAT ~c=rL FOUND THE RATIO OF PREgSION AS COMPUTED BY , 2000 FEET ~ SITE. RKEft 3F StTE: 1
LATITUDES ANO DEPARTURES IS 1:1000 + ` 4`{;~ `
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~ I ~ ;1: ~ ~ NOTE. THIS MAP Y OR ORAWNIC AND ANY '4 ~ ~ ` ' , . ACCOMPANYING DOClNr1EENNTS ARE F( NC AND ANY
1 ~ ~ m THE ~ e ~ , • pERSON(S NAME THEREON AND IS i ARE FURL HMON AND IS
O~ iv D B 606 P ~ F~ TFIEIR E>< VE 9Oi ~ ~ ~ ~ t
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~ o `0 63 a 1~$ RODEILl E. HIHrSt?p(ER ! AS90C., M1C. ~ 5 tP~ THIS MAP IS NOT FOR REOORDATION, ?Bw . NC,
Ao ~ SO ~ WDATfCK
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NEW LOT SURVEY FOR
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and wif ~
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~I r'~'~_ EAST CEN T 1 r} TER , ONAdSHIPt STANLY CO., N.C. 4~ SCALE: 1:30 1 J&Y CO., N.C
.___._.-___--I 13 SEPTEMBER t9S19 H,, ; , ~ MAP NO. 99{~I IAP No 99059
' , ` RO(;~Lt. f~ NUNSUt~t ~ t~rv~r~ ER R A,SSOpATES. ~?ud . ,,.Nw, n<~~A<..... k, N J,J~1~`M(hR poi .S. I_
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