20020807 Ver 1_COMPLETE FILE_20020521

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July 10, 2002
Watauga County
DWQ Project No. 02-0807
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
Mr. John E. Cooke
618 Bentley Road
Sugar Grove, NC, 28679
Subject: John Cooke Development
Dear Mr. Cooke:
Reference is made to the Pre-Construction Notification (PCN) you provided to the NC Division of Water Quality (DWQ)
on May 21, 2002, and to our response to you dated May 29, 2002, in which we requested 6 additional copies of your PCN
along with an application fee for the John Cooke Development. Based upon a meeting held July 10, 2002, between your
consultant Patrick Warren and Cyndi Karoly of the 401/Wetlands Unit, we understand that this project involves placement of
3 new 40-foot culverts, for a total project-wide impact of 120 linear feet of perennial streams. With respect to stream and
wetland impacts, your project falls below the written concurrence threshold for General Certification 3362, which
corresponds to Nationwide Permit 39. Provided that you can follow all of the standard conditions of GC 3362, written
concurrence is not required for this project. A copy of GC 3362 is attached for your reference. Your application will be filed
as issued, and the PCN you provided will be considered a courtesy copy.
We apologize for any inconvenience this may have caused you. If you have any questions, please contact me or
Cyndi Karoly in our Central Office in Raleigh at [phone].
JRD/cbk
cc: Corps of Engineers Asheville Regulatory Field Office
Winston-Salem DWQ Regional Office
File Copy
Central Files
J. Patrick Warren, McGill Assoc., P.O. Box 1136, Hickory, NC, 28603
020807
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
MA
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone] Customer Service
1 800 623-7748
\o?or
co
r
May 29, 2002
DWQ # 02-0807
Watauga County
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
Patrick Warren
McGill Associates
Post Office Box 1136
Hickory, NC 28603
Dear Mr. Warren:
On May 21, 2002 the Division of Water Quality (DWQ) was notified by receipt of your
application regarding your plan to fill wetlands for the purpose of a road crossing in Watauga 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
2B .0502, we will require you to locate all streams and ponds on the property. Please show these on
maps of suitable scale (for instance V = 100 feet) so we can begin to determine your projects'
compliance with 15A NCAC 2H.0500.
1. Provide schematics of culvert placement, (grading and riprap).
2. Are you replacing existing culverts? If so, what are the lengths of the existing pipes?
3. Please provide six more copies of the application.
4. If you would like written concurrence, then a certification fee of $200.00 is required.
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.
Y,
a,??
ohn Dorney
Hater Quali C rtification Program
cc: Winston-Salem DWQ Regional Office
Asheville Corps of Engineers
Central Files
File Copy
John E. Cooke.
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D.
Acting Director
Division of Water Quality
ASIM
V6 _N_
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/
U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. 200230900 County Watauga
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property owner: John E. Cooke
Address: 618 Bentley Road
Sugar Grove, NC 28679
Telephone No.: [phone]
Size and Location of project (water body, road name/number, town, etc.):
Unnamed tributaries to the Watauga River located off Bentley Road near Valle Crucis.
Description of Activity:
Construct three road crossings (using 60-inch CMPs) on unnamed perennial headwater
tributaries to the Watauga River. Each crossing will impact approximately 40 feet of stream
channel.
Applicable Law:
(check all that apply)
Authorization:
X Section 404 (Clean Water Act, 33 U.S.C. 1344).
- Section 10 (River and Harbor Act of 1899).
Regional General Permit Number.
39 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, those conditions outlined in the enclosed
NCWRC letter dated 28 May 2002 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/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 are any questions regarding this authorization or any of the conditions of the General Permit or
Nationwide Permit, please contact the Corps Regulatory Official specified below.
Date June 25, 2002
Corps Regulatory Official Tim Smith
Expiration Date of Verification June 25, 2004
Cc: P. Warren (McGill Associates)
Telephone No. [phone]
CFSAW Form 591
Revised July 1995
OF W A rF9
?0 oy
?? r
O `C
June 10, 2002
Mr. John E. Cooke
618 Bentley Road
Sugar Grove, N.C. 28679
Subject:
Dear Mr. Cooke:
Permit No. SW4020517
John Cooke Development
Low Density Stormwater Project
Watauga County
The Winston-Salem Regional Office received the Stormwater Application for the John Cooke
Development on May 17, 2002. Staff review of the plans and specifications has determined that
the project, as proposed, will comply with the Stormwater Regulations set forth in Title 15A
NCAC 2H.1000. We are forwarding Permit No. SW4020517 dated June 10, 2002, to you.
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
conditions and limitations as specified therein.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing upon written request within thirty (30) days following
receipt of this permit. This request must be in the form of a written petition, conforming to
Chapter 150B of the North Carolina General Statutes, and filed with the Office of Administrative
Hearings, 6714 Mail Service Center, Raleigh 27699-6714. Unless such demands are made this
permit shall be final and binding.
If you have any questions, or need additional information concerning this matter, please contact
Abner Braddy at [phone].
Sincerely,
Steve Mauney
Acting Regional Supervisor
cc: W-0411:'8c`Associat%%
Watauga County Planning & Zoning
Central Files
HQW File
WSRO
N. C. Division of Water Quality//Water Quality Section 585 Waughtown Street Winston-Salem, NC 27107 [phone]
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
A.t-h
OEM
Customer Service
1 800 623-7748
1
CAROLINA
STATE OF NORTH N
DEPARTMENT ATURAL RESOURCES
VIRONME
OF EN NT AN QUALITY
DIVISION OF WATER E P
E T W
LOW DENSITY DEVELOPMENT Carolina as amended, and
21 of Chapter 143, General Statutes of North
rovisions of Article
In accordance with the Rules and Regulations
other applicable Laws, TED TO
pE1Z1vIISSION IS HEREBY GRAN
John E. Cooke
Watauga County
FOR THE
liance with the provisions
ment systems in comp water manageml 11 and the approved storm the Division
construction, operation and maintenance of stormwater manage wr rules) roved by
C data as attached and with anapp
211 .1000 (hereafter ref supporting erred he "storm e Ile
velopfncnt.
l5ANCA
of this permit for the John Cook fi
plans and specifications' and other
rescinded and shall be subject to the following spec
Quality and considered a part
Water shall be effective from the date of issuance until The permit conditions and limitations: I, DESIGN STANDARDS
the project must be maintaTie sdu??zed ?
These levels are
on area percentage or lot saes for
water rules.
in the storm
1 The overall tract built-up levels speci rules):
stringent as the low density
levels may apply in accordance with the
(morestringent LOW DENSITY LEVEL:
DEVELOPMENT THAT IS WITHIN:
30%
The twenty coastal counties 250%lo
One-half mile of and draiimng to SA waters
,vv uustomer Service
N. C. 0 1 800 623-7748
One mile of and draining to HQWs 12% or 1 acre lots
Defined management area for Freshwater ORWs 12% or 1 acre lots
2. The development. must demonstrate that no areas within the project site are of such high density that
stormwater runoff threatens water quality.
3. Approved plans and specifications for projects covered by this permit are incorporated by reference and
are enforceable parts of the permit.
4. The only runoff conveyance systems allowed will be vegetated conveyances such as swales with
minimum side slopes of 3:1 (H:V) where possible, and in no case less than 2:1, rip-rapped swales, or
curb outlet systems as defined in the stormwater rules and approved by the Division.
5. No piping shall be allowed except:
a. That minimum amount necessary to direct runoff beneath an impervious surface such as a road.
b. That minimum amount needed under driveways to provide access to lots.
6. Projects covered by this permit will maintain a minimum 30 foot wide vegetative buffer between all
impervious areas and surface waters.
7. No homeowner/lot owner/developer shall be allowed to fill in, alter, or pipe any vegetative practices
(such as swales) shown on the approved plans as part of the stormwater management system without
submitting a revision to the permit and receiving approval from the Division.
The Engineer/Owner/Developer/Permittee must certify in writing that the project's stormwater controls,
and impervious surfaces have been constructed within substantial intent of the approved plans and
specifications.
9. The following items will require a modification to the permit:
a. Any revision to the approved plans, regardless of size.
b. Project name change.
C. Transfer of ownership.
d. Redesign or addition to the approved amount of built-upon area.
e. Further subdivision of the project area.
In addition, the Director may determine that other revisions to the project should require a modification
to the permit.
10. The Director may notify the permittee when the permitted site does not meet one or more of the
minimum requirements of the permit. Within the time frame specified in the notice, the permittee shall
submit a written time schedule to the Director for modifying the site to meet minimum requirements. The
S. The permittee shall submit to the Director and shall have received approval for revised plans,
specifications, and calculations prior to construction, for those revisions under any of the following
conditions:
a. Any additions, deletions or redesign of the previously permitted amount of built-upon area
proposed regardless of the size of the modification.
b. Further subdivision of the project area.
6. The permit is not transferable to any person except after notice to and approval by the Director. The
Director may require modification or revocation and reissuance of the permit to change the name and
incorporate such other requirements as may be necessary. A formal permit request must be submitted to
the Division of Water Quality accompanied by the appropriate fee, documentation from both parties
involved, and other supporting materials as may be appropriate. The approval of this request will be
considered on its merits, and may or may not be approved.
7. The issuance of this permit does not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances that may be imposed by other government agencies (i.e., local, state, and
federal) having jurisdiction, including but not limited to applicable river buffer rules in 15A NCAC 2B
.0200, soil erosion and sedimentation control requirements in 15A NCAC Chapter 4 and under the
Division's General Permit NCGO10000, and any requirements pertaining to wetlands under 15A NCAC
2B .0200 and 15A NCAC 2H .0500 and all applicable North Carolina Occupational Safety and Health
Act health and safety standards.
Permit issued this the 10`n day of June 2002.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
Steve Mauney, Acting Regi nal Supervisor
Permit Number SW4020517

MCG_
A S S O C I A T E S
May 14, 2002
Mr. Tim Smith
U. S. Army Corps of Engineers
151 Patton Ave., Room 208
Asheville, NC 28801
Re: John Cooke Development
Watauga County, NC
Dear Mr. Smith:
M
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011AI MS, WUP

Enclosed is the 404/401 application for the referenced project. A quadrangle map
and Site Plan (reduced scale) for the project is also attached.
Thank you for your attention to this matter. Please contact me if you have any
questions or comments.
Sincerely,
t \
Patrick Warre , P.E.
McGill Associates, P.A.
Xc: John Dorney, NC Division of Water Quality
Jennifer Frye, NC Division of Water Quality
Ron Linville, NC Division of Wildlife
Randy Woodrow, Watauga County
E n g i n e e r i n g P l a n n i n g • F i n a n c e
McGill A.s.suriuI r.s, 1'.A. • 1'.U. Ru.c I136, Ili(kurs. NC 2,1'603 • 1236 191h Sr. Lune NW, Ili( kor_v, NC 28601
828-328-2021 • [AX 828-328-3870
Office Use Only' Form Version February 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
Cheek 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 1
3. If this notification is solely a co esy 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:_ -O ?A N V_ G00L1;r_1
Mailing Address: (o l 93 5p wnllp_ Y tzA?M4
5 t3CoAV- 4?t- rL 11,16 z8fo7`?
Telephone Number: $7_8 Z`_7 ? 4070 Fax Number: t3.4A
E-mail Address: NI &
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation: c- C-IGL Gi4,c? ikT'e. S
Mailing Address: ?d 1
t ??c tX:?/ , N G Z >? C? 0 3
Telephone Number: 19LB 3ZQ? (0560 Fax Number: 8Z9 - 3 ZS -; 8 TD
E-mail Address: 'PWARRV-r1 e, MC(,>IL(, CS:d
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 I I 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: hl C o0??l'?t op M?tST-
2. T.I.P. Project Number or State Project Number (NCDOT Only): N11 N
3. Property Identification Number (Tax PIN):
4. Location '
County: IIsP',TIA06 A Nearest Town: V ?L?`E- C?Z?G1 S
Subdivision name (include phase/lot number): A (> Vct S Cook
Directions to site (include road numbers, landmarks, etc.): N G t 05' TO 5M I I I Z
lrob Gi tL 1l l z -VWu?Uvo Vpr",p_ C41-LY-kS -Cu%z N Lti r-T
C? N 5 vt, 1 l1 6>C> l w i L t, rum vj 1, T Gtz la ctATL C.,l tr-ZA-t j
P p4-t?G-r k!, AT ENt> O`F 1Z4AlID
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:
V3 60 owyc> 5 iT? w \.r Et tz- X ls-n u (, 6rzja y,_,? 12X Abs.
7. Property size (acres): D ArG
8. Nearest body of water (stream/river/sound/ocean/lake): W ??14-U !oA 1 ?12.
9. River Basin: W?*?°-y?` ?-\ Vrc.?Z
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
Page 6 of 12
10. Describe the purpose of the proposed work: FR--z, 7) -, G ? 5
T"c?I U 2? ?, c?T S
11. List the type of equipment to be used to construct the project: TGk ?i44G4c{?OE?
u t.t_ DOZ 1rr M
12. Describe the land use in the vicinity of this project: U yLr.> I.C)'y-o , (ZtJ L -AL
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.
L \C?rmI ,
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
W O N Y-
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
tt
1. Provide a brief written description of the roposed impacts: `'l?wx-S. C3 (00 C•? P
Lri r ??c GtLo5 51 NHS - '4D 02r Its LV_l14CV1,6R E6S,C_tt
2. Individually list wetland impacts below:
Wetland Impact
Site Number
(indicate on ma)
moo?,
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(es/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***

.

t:._:...a a ..
nr-t
,.1.., vA Flo 4;- F11
* List each impact separately and identify temporary impacts. impacts mctuue, uu, afe „O, „„t,=?u ...??..u=•=??? ?•r •.••b, 6 b>
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at h_p://www.fema.gov.
'*• List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of all existing wetlands on the property: 0&yOF-
Total area of wetland impact proposed: OOV I'E',
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?
(please seci )
'F(ft I Ci U(. t/k_?vZT is µ ?"1Fi? ?` ?' 3 r- R N 1 A L
,171 pV
U L.vltm
al 0
t?
? t
?l
CXLM V'tf 40
tl
?t
tl

List each impact separately and identify temporary impacts. impacts include, out are not ulnnru w. cu,vc„a d,U -1•u• ••r •?V,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.gov. Several intemet sites also allow direct download and printing of USGS maps (e.g., www topozone.com,
www.mapguest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
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.)

t- All PYravatinn dred¢in¢_
' List each impact separately and identity temporary impacts. unpacts tuctuuc, VUL W, iuu
flooding, drainage, bulkheads, etc.
Pond Creation
if construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N 041r,
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): mC-TN ,
Size of watershed draining to pond:- r,3 I I Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
Fkft, T-o Po <- V-*mP WY of _C? ? `czZy ?' QU l tom- P
1 k'_ To C, t s (. -
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
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.nc.us/ncwetiands/strmgide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
o k rf,
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 htil)://h2o.enr.state.nc.us/wry/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.
X.
Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public (federaUstate) 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 ? No ?
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 B er Requirements), or other (please identify N' Q W )?
Yes Supply 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 Wf- 3
2 N) 04 F 1.5
Total _
• Zone 1 extends out 30 feet perpendicular from near bank of channel; Lone 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.
h3 ( f --
XI.
XII.
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.
(. 5 PrGrm-_ Ir of err o. v?L ?2 orb s ( t+0 v5 r,- / t o PAL t-0 -r
w14-Lr- s A-vx> X?-(P-R-Acl' ptsy PbTU2 s
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.
Rn \ yo,Ty_, its o i f t P y a C. S(LPTt L TA?Nk.? L Vx 1 V. L D 5-
XM. Violations (DWQ Only)
Is this site in violation of DW etland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Is this an after-th act permit application?
Yes No ?
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).

Applicant/Agent's Signature Date
(Agent's s}gnature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
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