20021476 Ver 1_COMPLETE FILE_20020917

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October 29, 2002
Perquimans County
DWQ Project #: 02-1476
APPROVAL of 401 Water Quality Certification with ADDITIONAL. CONDITIONS
Jack Dickerson
162 Arborvitae Drive
Pine Knoll Shores, NC 28512
Dear Mr. Dickerson:
You have our approval, in accordance with the attached conditions, to impact 0.0918 acres of
wetlands for the purpose of residential fill at Lot# 47, Albermarle Plantation as you described in your
application dated August 2, 2002. After reviewing your application, we have decided that this fill is
covered by General Water Quality Certification Number 3362, which may be viewed on our website at
http://h2o.enr.state.nc.us/ncwetlands. This certification allows you to use General 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. 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 211.0506 (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.
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
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.
2. Deed notifications or similar mechanisms shall be placed on all remaining jurisdictional
wetlands and waters or areas within 50 feet of all streams and ponds to notify the state in order
to assure compliance for future wetland and/or water impact. These mechanisms shall be put
in place within 30 days of the date of this letter or the issuance of the 404 Permit (whichever is
later).
OE
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/ncwetiands
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory
hearing. You must act within 60 days of the date that you receive this letter. To ask for a hearing, send
a written petition, which conforms to Chapter 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 ahearing.
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,
Attachments
1
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cc: Corps of Engineers Washington Field Office
Washington DWQ Regional Office
File copy
Central Files
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October 3, 2002
DWQ # 02-1476
Perquimans County
CERTIFIED MAIL - RETURN RECEIPT REQUESTED
Jack Dickerson
162 Arborvitae Drive
Pine Knoll Shores, NC 28512
Dear Mr. Dickerson:
On August 2, 2002 the Division of Water Quality (DWQ) was notified by receipt of your
application regarding your plan to fill wetland for the purpose of residential fill at Lot# 47, Albemarle
Plantation in Perquimans County. Approval from DWQ is required to disturb these wetlands. 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. Please show all wetland impacts including fill slopes onithe site plan. Can fill of area #1 be
eliminated?
2. Please complete Section(s) VI 1, VII, VIII, IX, XI, XII on the application.
3. Which Natiowide Permit are you applying for or did the Corps of Engineers approve?
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.
Sincerely,
JRD/bs
cc: Washington DWQ Regional Office
Washington Corps of Engineers
Central Files
File Copy
b7N
R. Dorney
401 Water Quality Certif cation Program
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
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan Klimek, P.E., Director Division of Water Quality
rDEr.7
U.S.ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action ID. 200211043 County Perauimans
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIF'Zoa
? I.
Property Owner: Jack Dickerson
Address: 162 Arborvitae Drive 22002 Pine Knoll Shores, North Carolina 28512
_uAi
Telephone No.: (2521726-6272 " t
Size and location of project (water body, road name/number, town, etc.) Lot 47 in Randolf
Village of Albemarle Plantation off NCSR 1347. Properly located near Franks Creek, a
tributary of Yeooin! Creek SE of Hertford, NC. Albemarle Sound Basin.
Description of activity Filling ,4,000 square feet of '404' Jurisdictional wetlands to facilitate
the construction of a single family residence..
Applicable Law: X Section 404 (Clean Water Act, 33 USC 1344)
_ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Regional General Permit Number
Nationwide Permit Number 18 Q t
(Ss
Your work is authorized by the above referenced permit provided it is accomplis ,strict
accordance with the attached conditions and your submitted plans. If your activity is A= to
Section 404 of the Clean Water Act (as indicated above), before beginning work you must receive
a Section 401 water quality certification from the N.C. Division of Water Quality (telephone
(919) 7331786). For any activity within the twenty coastal counties subject to regulation under
the Coastal Area Management Act (CAMA), prior to beginning work you must contact the N.C.
Division of Coastal Management (telephone [phone].
Please read and comply with the attached conditions. Any violation of these conditions may
subject the permittee to a stop work order, a restoration order and/or appropriate legal action.
This Department of the Army verification does not relieve the permittee of the responsibility
to obtain any other required Federal, State or local approvals/permits.
If there are any questions regarding this verification, any of the conditions of the Permit, or
The Corps of Engineers regulatory program, please contact William Wescott at (252 975-1616
extension 25..
Corps Regulatory Official Lu-jo Date 16-Sept.-2002
Expiration Date of Verification 16-Sept.-2004
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT
PLANS, ETC., MUST BE ATTACHED TO THE FILE COPY OF THIS FORM:, IF
REQUIRED OR AVAILABLE.
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U.S.ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action ID. 200211043
County Perauimans
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property owner: Jack Dickerson
Address: 162 Arborvitae Drive
Pine Knoll Shores. North Carolina 28512
Telephone No.: (252) 7_ 26-6272
Size and location of project (water body, road name/number, town, etc.) Lot 47 in Randolf
Village of Albemarle Plantation off NCSR 1347 Provel: located near Franks Creek, a
tributary of Yeoufm Creek SE--of Hertford, NC Albemarle Sound Basin.
Description of activity Filling 4,000 square feet of 14041 turisdictional wetlands to facilitate
the construction of a single family residence..
Applicable Law: X Section 404 (Clean Water Act, 33 USC 1344)
_ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Regional General Permit Number
Nationwide Permit Number 18
Your work is authorized by the above referenced permit provided it is accomplished in strict
accordance with the attached conditions and your submitted plans. If your activity is subject to
Section 404 of the Clean Water Act (as indicated above), before beginning work you must receive
a Section 401 water quality certification from the N.C. Division of Water Quality (telephone
[phone]). For any activity within the twenty coastal counties subject to regulation under
the Coastal Area Management Act (CAMA), prior to beginning work you must contact the N.C.
Division of Coastal Management (telephone [phone].
Please read and comply with the attached conditions. Any violation of these conditions may
subject the permittee to a stop work order, a restoration order and/or appropriate legal action.
This Department of the Army verification does not relieve the permittee of the responsibility
to obtain any other required Federal, State or local approvals/permits.
If there are any questions regarding this verification, any of the conditions of the Permit, or
The Corps of Engineers regulatory program, please contact William Wescott at [phone]
extension 25..
Corps Regulatory Official Date 16-Sept-2002
Expiration Date of Verification 16-Sept.-2004
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT
PLANS, ETC., MUST BE ATTACHED TO THE FILE COPY OF THIS FORM, IF
REQUIRED OR AVAILABLE.
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U.S.ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action ID. 200_.. 21,E County Perms
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property Owner. Jack Dickersoe
Address: 162 Albal3ft Drive
PLe Knob sl o 292 9=11M 28512
Telephone No.: f2521
Size and location ofpreject (water body, road namelnumber, town, etc.) Let 47 In adex
Description of activity FAMR 4.000 saner feet of'M' igr q-xAJ =gawk L2 &Atr
the cos uggioa of a e,fan& r "Ce..
Applicable Law: A Section 404 (Clean Water Act, 33 USG 1344)
Soction 10 (Riven and Harbors Act, 33 USC 403)
Authorization: Regional General Pemnit Number
Nationwide Permit Number -0
Your work is authorized by the above referenced permit provided it is accomplished in strict
accordance with the attached conditions and your submitted plans. if your activity is subject to
Section 404 of the Clean Water Act (as indicated above), before beginning work you must receive
a Section 401 water quality certification from the N.C. Division of Water Quality (telephone
[phone]). For any activity within the twenty coastal counties subject to regulation under
the Coastal Area Management Act (CAMA), prior to beginning work you must contact the N.C.
Division of Coastal Management (telephone [phone].
Please read and comply with the attached conditions. Any violation of these conditions may
subject the permittee to a stop work order, a restoration order and/or appropriate legal action.
This Department of the Army verification does not relieve the permittee of the responsibility
to obtain any other required Federal, State or local approvals/permits.
If then we any questions regarding this verification, a? of the caaditiosu cif, tons,
,, .
The Corps of Engineers regulatory program please contact Wllliim Weaeott at ?y` "? ' A 127"?ir
eztsasbn A.
.
Corps Regulatory Official &ft Date limit. 2002
Expiration Date of Verifica#ton 116C-Sent-1004
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT
PLANS, ETC., MUST BE ATTACHED TO THE FILE COPY OF THIS FORM, IF
REQUIRED OR AVAILABLE.
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U.S.ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action ID. 200211043 County Perguimans
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property Owner: Jack Dickerson
Address: 162 Arborvitae Drive
Pine Knoll Shores North Carolina 28512
Telephone No.: [phone]
Size and location of project (water body, road name/number, town, etc.) Lot 47 in Randolf
Village of Albemarle Plantation off NCSR 1347. Property located near Franks Creek, a
tributary of Yeopim Creek SE of Hertford, NC. Albemarle Sound Basin
Description of activity Filling 4,000 square feet of 14041 Jurisdictional wetlands to facilitate
the construction of a single family residence..
Applicable Law: X Section 404 (Clean Water Act, 33 USC 1344)
Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Regional General Permit Number
Nationwide Permit Number 18
Your work is authorized by the above referenced permit provided it is accomplished in strict
accordance with the attached conditions and your submitted plans. If your activity is subject to
Section 404 of the Clean Water Act (as indicated above), before beginning work you must receive
a Section 401 water quality certification from the N.C. Division of Water Quality (telephone
[phone]). For any activity within the twenty coastal counties subject to regulation under
the Coastal Area Management Act (CAMA), prior to beginning work you must contact the N.C.
Division of Coastal Management (telephone [phone].
Please read and comply with the attached conditions. Any violation of these conditions may
subject the permittee to a stop work order, a restoration order and/or appropriate legal action.
This Department of the Army verification does not relieve the permittee of the responsibility
to obtain any other required Federal, State or local approvals/permits.
If there are any questions regarding this verification, any of the conditions of the Permit, or
The Corps of Engineers regulatory program, please contact William Wescott at [phone]
extension 25..
Corps Regulatory Official Date 16-Se t.2002
Expiration Date of Verification 16-Sept.-2004
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT
PLANS, ETC., MUST BE ATTACHED TO THE FILE COPY OF THIS FORM, IF
REQUIRED OR AVAILABLE.
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U.S.ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action ID, 2001URO County fIrMftens
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property Owner: Jack ekerson
Address: IQ Arbnrvltu 2ft
Plae ICno13 Shores. North Caro n 2012
Telephone No.: (252172 JO72
Size and location of project (water body, road name/number, town, etc.) I.ot 47
Description of activity
Applicable Law: X Section 404 (Clean Water Act, 33 USC 1344)
Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Regional General Permit Number
Nationwide Permit Number If
Your work is authorized by the above referenced permit provided it is accomplished in strict
accordance with the attached conditions and your submitted plans. If your activity is subject to
Section 404 of the Clean Water Act (as indicated above), before beginning work you must receive
a Section 401 water quality certification from the N.C. Division of Water Quality (telephone
[phone]). For any activity within the twenty coastal counties subject to regulation under
the Coastal Area Management Act (LAMA), prior to beginning work you must contact the N,C.
Division of Coastal Management (telephone [phone].
Please read and comply with the attached conditions, Anv violation of these conditions may
subject the permittee to a stop work order, a restoration order and/or appropriate legal action.
This Department of the Army verification does not relieve the pennittee of the responsibility
to obtain any other required Federal, State or local approvals/permits.
If there are any questions regarding this verification, any, of the
The Corps of Engineers regulatory program, please contact wow at 1_ 9'1
•#en*n 2..
Corps Regulatory Official Date X6.5 L -
F.xpiradon Date of Verification 16 ftt-. 2 ,.000_4
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT
PLANS, ETC., MUST BE ATTACHED TO THE FILE COPY OF THIS FORM, IF
REQUWD OR AVAILABLE.
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U.S.ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action ID. 200211043 County Perquimans
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property Owner: Jack Dickerson
Address: 162 Arborvitae Drive
Pine Knoll Shares, Nortb. Carolina 28512
Telephone No.: L2252j 726-6272
Size and location of project (water body, road name/number, town, etc.) Lot. 47 in Randolf
Description of activity Fillies 4,000 square feet of 1404' Jurisdictional wetlands to facilitate
the construction of a Linde family residence..
Applicable Law: X Section 404 (Clean Water Act, 33 USC 1344)
_ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Regional General Permit Number
Nationwide Permit Number 18
Your work is authorized by the above referenced permit provided it is accomplished in strict
accordance with the attached conditions and your submitted plans. If your activity is subject to
Section 404 of the Clean Water Act (as indicated above), before beginning work you must receive
a Section 401 water quality certification from the N.C. Division of Water Quality (telephone
[phone]). For any activity within the twenty coastal counties subject to regulation under
the Coastal Area Management Act (LAMA), prior to beginning work you must contact the N.C.
Division of Coastal Management (telephone [phone].
Please read and comply with the attached conditions. Any violation of these conditions may
subject the permittee to a stop work order, a restoration order and/or appropriate legal action.
This Department of the Army verification does not relieve the permittee of the responsibility
to obtain any other required Federal, State or local approvals/permits.
If there are any questions regarding this verification, any of the conditions of the Permit, or
The Corps of Engineers regulatory program, please contact William Wescott at [phone]
extension 25..
Corps Regulatory Official Q Date 16-Sent.-2002
Expiration Date of Verification 16-Sent. 2004
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT
PLANS, ETC., MUST BE ATTACHED TO THE FILE COPY OF THIS FORM, IF
REQUIRED OR AVAILABLE.
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U.S.ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action 1D. 200211043 County Perauimans
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property Owner: Jack Dickerson
Address: 162 Arborvitae Drive
Pine Knob Shores. North Carolina 28512
Telephone No.: [phone]
Size and location of project (water body, road name/number, town, etc.) Lot 47 in Randolf
Village of Albemarle Plantation off NCSR 1347. Property located near FMnks Creek, a
tributarv of Yenuirti'Creek SE of Hertford.. NE. Albemarle Sound Basin.
Description of activity Filling 4,000 souare feet of '4041 Jurisdictional wetlands to facilitate
the construction of a single family residence..
Applicable Law: IX Section 404 (Clean Water Act, 33 USC 1344)
Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Regional General Permit Number
Nationwide Permit Number 18
Your work is authorized by the above referenced permit provided it is accomplished in strict
accordance with the attached conditions and your submitted plans. If your activity is subject to
Section 404 of the Clean Water Act (as indicated above), before beginning work you must receive
a Section 401 water quality certification from the N.C. Division of Water Quality (telephone
[phone]). For any activity within the twenty coastal counties subject to regulation under
the Coastal Area Management Act (CAMA), prior to beginning work you must contact the N.C.
Division of Coastal Management (telephone [phone].
Please read and comply with the attached conditions. Any violation of these conditions may
subject the permittee to a stop work order, a restoration order and/or appropriate legal action.
This Department of the Army verification does not relieve the permittee of the responsibility
to obtain any other required Federal, State or local approvals/permits.
If there are any questions regarding this verification, any, of the condat= of 4W-r4aatigy:a ?},
The Corps of Engineers regulatory program, please contact William Wgt at `(Z32§ `
extension 25..
Corps Regulatory Official Date 16-Sept.-2002
2002
Expiration Date of Verification 16-Sept.-2004
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT
PLANS, ETC., MUST BE ATTACHED TO THE FILE COPY OF THIS FORM, IF
REQUIRED OR AVAILABLE.
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162 Arborvitae Drive
Pine Knoll Shores,NC
October 20, 2002
To: DWQ
Attention: Mr. JR Dorney
Reference: # 02-1476
Hello,
I am sorry about the delay in responding to your letter of October 3. We had did h opr
IJ

Please find enclosed seven copies of each: f
1. General Permit # 404 OCT 2 2 20

2. Page 8 (section VI ) 02
I j
3. Page 10 ( section VI 1 and VI I I
)
4
Pa
e 13 (sections Xl
Xi 1
nd Xl i 1)

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5. Attachment #6 ( proposed fill area ro
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Your assistance is very much appreciated. Thank you for your patience. Please call me if you need more info
Regards,
a r
Jack Dickerson
C!
Acle
162 Arborvitae Dr.
Pine Knoll Shores,
NC 28512
September 8, 2002
NC Div. of Water Quality
Raleigh
Request for 401 Certification
Hello,
I have been informed by Mr. Wm. Westcott ( Corp of Engineers- Washington, NC ) that my application for
a 404 permit has been approved.
Enclosed are seven copies of my application as submitted to the Corp. My check for $200.00 is also
attached. If a tape recorded version of approval from you folks would save me the 200, I'd be glad to make
the telephone recording. {? R
Regards, LS 0 W
Jack Dickerson 12 ? f
O'Z ? JET 7 2002 j r
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WET15ine
APFLICATYON FORM BEGINS ON PAGE 3. PLEASE DO) NOT SUBMIT
PAGES I - 4.
Office Use Only:
VMiM May 2002
Form
ItSACE Acdoa ID No. DWQ No.
of any particular item is not applicable to this proleat, please enter "Not AMIhmWe" or "N/A".)
L rrocusiaa
1- Check all of the approval(s) requested for this project
Section 404 Permit V Riparim or
Watershed Buffer Rules
Section 10 Permit Isolated Wetland
Permit from DWQ
401 Water Quality Certification
2. Nationwide, Rq onal or Coneral Permit Number($) Requeste&
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 Prom (ICWRP)
is proposed for mitigation of impacts (verify availability with NCWRP prier
to submittal of PCN ), complete section VIII and check here:
5. If your project is located in any of North Carolina's Monty coastal counties
(listed on page 4), and the project is within a North Carolina Division of
Coastal Management Area of Environmental Concern (see the top of page 2
for further details), check here: v
i t. Applicant Information
1. Owner/Applicant Information
Name: ,. j IN 091 Z tC Keg'>&
Mailing Address: i62 A PQ;& %) fCNr=
?t14woCL . ?4/aaz?5 7 iu C
Telephone Number: -z g 2. - -7 2 L,-- &2 -7Z. Fax Number. 29 2- '72(p
E-mail Address: ?c.tc tt1++k kD Co&%'rAL+JCr, e-O K
2. Agent/Consultant Information (A signed and dated copy of the Agent
Authorization letter trust be attached if the Agent has signatory authority for
the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:
"Telephone Number:
E-mail Address:
III. Project Wormation
Fax Number:
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 afte
plea 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, impenious surfaces, or
other facilities roust 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 USACB 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 wil I
be infomed that the project has been placed on hold until decipherable maps are
provided.
1. Name of project: Z-a3-40?'-5
I
2. T.Z.P. Project Number or State Project Number (NCDCT Owy):
{aa574%?4-12 ? ?d?
3. Property identification Number (Tax FIN): 2.9 7 *9 q
736'?'tiEL 2--'D092- - yo q7- A?'
4. Location
County: ??? ?rr?+ Nearest Town: Nae•P-41
Subdivision name (include phasOot number): At r3rffA&LE
Directions to site (include road numbers, landmarks, etc.):
tj0'S' A- rA cAtU NTH
5. Site coordinates, if available ([JTM 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 47rossing of a distinct waterbody. )
6. Property size (acres): z 1 16C !9Q - ^ r
7. Nearest body of water (strearnlriver/sound/nceanlleke): ;,eAAjgs
6'air A-70-ckkt eAw a..
8. River Basin:
(Note - this must be one of North Carolina's seventeen designated major river
basins. The River Basin map is available at
,1_ o. * state nc.usfa4rniAk-4 l.)
9. Describe the existing conditions on the site and general land use in the
vicinity of the project at the time of this application:

10. Describe the overall project in detail, including the type of equipment to be
used,
11. Explain the purpose of the prQpased work:
tv. Prior Project Blstery
If jurisdictional determinations anchor permits have been requested aridlor
obtained for this project (including all prier 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
ether usefW 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 fu#ure 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. OD
V1. Proposed impacts to Waters of the United States/Waters of the State
It is the applicant's (or agenrs) 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. Ali wetlands and
waters, and all streams (intennittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetiand
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 V HT below. If additional space is needed for listing or description, please
attach a separate sheet.
1. provide a written description of the proposed impacts,
2. Individually list v Cd9nd impacts boloW'

* List cinch impact separately ad MMiry benpo wy its. hapaots bwkde, but ace not HMft d to: maho ized
---I v w,ayi.
List the total acreage (estimated) of all existing wetlands on the property-.
4 Total area of wetland impact proposed: yooo ja?.Fir
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact Site Number (indloate on map) Type oflmpws Langth of impact
(linear feet) Stream Name" Average Width of Stream Before impact PnretmW or
InterrniEta tt? (please specify)
• fist each impact separately and Wmx* tamporaty napaets. Impacts include, but an not limited ta: culverts and
asswalcd rip-rap, dams (separately list impacts due to bath stzwttue at)d flooding), rekx;atm (include linear feet
before and after, and nee loWgain), stabilization activities (ce a t welt, rip-np, Drib walt gabions, etc,),
cmavation, di%hMglstraiAhWft etc. If oft= miccati= is pmppsed, piass and prohlcse showing the linear
Iaowint for bolls the original sad relocated suems vwst be included.
Streem names can be found on USGS topogr hic soaps. If a stream fug no name. tier es UT (tansdmw tributd y) to
the nww dawn ftm sew" s' rem into +wbicb it zlowa USGS Wraps arc available through the USGS at 1-800-
?58.961 6, or amine al www:sz-104gy. Several issters>et sites also a13aw direct download and printissg of USOS
VtS E'#ll TWA etc-).
Cumulative imp" (linear distance in fm) to all streams on site:
4. Individually list all open water impacts (includinS lakes, ponds, estuaries,
sounds, Atlantic Ocean and any other water of the U. S.) below:
Open Water Impact Site Number (indicatr~ on map) Type of Imp4am Area of
Impact (acres) Dame of Waterbody (if appbcable) Type of Waterbody (lake, pond, estuary,
sound, bay, ocean, etc.)
List each impart supan b ly andidsrabiiy toppmmy impacts. Impacta indudc, but are not limited too: 611, exea4s6on,
dredging, flooding, fthage. bWkbeatls, etc.
S. Pond Creation
If construction of a. pond is proposed, associated wetland and sft=m impacts
A?14 6 Z x u,-) + i jtt!W. >7 -1
12.5 x tDo
- e z Sv -f- 4000 /01Z.,go e-,- FT
1z
q.,

?p/(? Vf7vv ? - -
r
should be included above in the wetland and strewn 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 o€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, Irout pond, local stormwater requirement, etc.),
Size of watershed draining to pond: Expected pond surface
area:
VIL Impact Justification (Avoidance and Minimization)
Specifically describe measum 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 thernative, lower-impact site layouts, and
explain why these design options were not feasible. Also discuss low impacts
were minimized once the desired site plan was developed. If applicable, discuss
construction techniques to be followod daring construction to reduce impacts.
vnL Mitigation
DWQ - In accordance with I SA 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 sftama.
'USAGE - In accordance with the Final Notice of Issuance and Modification of
Nationwide Permits, publisbed 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
%mpact and function. at relative value of the impacted aquatic resource will be
considered in deterxntining acceptability of appropriate and practicable mitiption
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 prouct open waters such
as streams; and replacing losses of aquatic resource functions and values by
creating, restoring, enhancing, or preserving similar flmctions and values,
preferable in the same watershed.
1r
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, av"able at
114g.,J/h2o. enT. Uak. n,.,?c sl c dan Jstrm i , itrn? .
I. Provide a brief description of the proposed mitigation plan. The description
should provide as much information as possible, inching, but not limited to:
site location (attach directions and/or map, ifofriite), affected stream and
river basin, type and amount (acreage/lincar 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
constrmtion. Please attach a saparate short if more space is .needed.
2. Mitigation may also be made by payment into the North Carolina Wetlands
Restoration Progm m (MCWRP). Please note it is the applicant's
respcrosibility to contact the NCWRP at [phone] to determine
availability and to request written approval ofrnitigation prior to submittal of
a PCN. For additional information regarding the application proms for the
NCWRP, check the NCWRP website at
state. nc,t ?'varolin hag, If m 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 (ages):
Amount of Coastal wetland mitigation requested (acres):
IX. Faviroamental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal<`state) finds or the use
of public (federal/state) land?
Yes N1
If yes, does the project require preparation of an environmental document
pursuant to the requirements of the National or North Carolina Environmental
Policy Act (NE?A/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 envirQwnental documentatioll.
Tres No
If yes, has the document review been fiaalized by the State Clearinghouse? If so,
please attach a copy of the NEPA or SEPA final approval letter.
Yes No
X. Proposed Impacts an Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (Or agent's) reWnsibiiity to determine, delineate and snap 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 trust be listed herein, and must be clearly identifiable on
the accomPaaying site plan. All buffers must be shown on a map, whether of not
impacts are proposed to the buffers. Correspondence from the DWQ R.egional
Office may be included as appropriate. Photographs may also be included at the
applicant's discretion,
Will the project iMpact protected hpariann buffers identified within I SA NCA.C
2B .0233 (Meuse), 151. NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250
(Randleman Rules and Water Supply Buffer Requirements), or other (please
identify V
Yves No If you answered "yes", provide the
fallowing 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) Multi p Re
1 2 P guirejd Mttiaee
2 1.5
'total
r Zow 1 add out 30 fit porprndicular firm tint bank of4mml; Zono 2 extends aft
adetitiona120 fact fkam the add of Zone 1.
ff buffer mitigation is required, please discuss what type of mitigation is proposed
(i,e.t Donation of Property, Conservation Easement, Riparian Buffer Restoration !
Ettbancement, Preservation or Payment into the Riparian Buffer Restoration
'Fund). Please attach all appropriate inkm ation as identified within ISA NCAC
2B .4242 or .0260.

XT. Stormwater (rewired by DWQ)
Describe impeMous acreage (bails existing and proposed) versus total acreage on
the site. Discuss storrnwater controls proposed in order to protect surface waters
and wetlands downstream from the prop".
XIS. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non dischaxge or
discharge) of wastewater generated from the proposed project, or available
capacity of the subject facility.
XIIL Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any
Buffer Rules?
'y'es No
Is this an after-the-fact permit application?
Yes NO
XJV. Other Circumstances (Optional):
It is the applicants 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 Threatt:ned Species,
accessibility problems, or other issues outside of the applicant's control).
ApplkcasstlAgenVs Signature Date
(Agent's signatures is valid only if an authorization letter from the applicant is
provided.)

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Plan Detail Incomplete
fern d0
? Please provide a location map for the project.

? Please show all stream impacts including all fill slopes, dissipators, and bank. stabilization on the site plan.
Please show all wetland impacts including fill slopes on the site plan. -- CAM ?l (VY?a # l !ot
? Please indicate all buffer impacts on the site plan.
? Please indicate proposed lot layout.
? Please indicate the location of the protected buffers.
? Please locate all isolated or non-isolated wetlands, streams and other waters of the State as overlays on the site
plan.
? Please provide cross section details showing the provisions for aquatic life passage.
? Please locate any planned sewer lines on the site plan.
? Please provide the location of any proposed stormwater management practices as required by GC
? Please provide detail for the stormwater management practices as required by GC
? Please specify the percent of project imperviousness area based on the estimated built-out conditions.
? Please indicate all stormwater outfalls on the site plan.
? Please indicate the diffuse flow provision measures on the site plan.
Avoidance and/or Minimization Not Provided
? The labeled as on the plans does not appear to be necessary. Please eliminate the or
provide additional information as to why it is necessary for this project.
? This Office believes that the labeled on the plans as can be moved or reconfigured to avoid the
impacts to the . Please revise the plans to avoid the impacts.
? This Office believes that the labeled on the plans as can be moved or reconfigured to minimize
the impacts to the . Please revise the plans to minimize the impacts.
? The stormwater discharges at the location on the plans labeled will not provide diffuse flow through
the buffer because . Please revise the plans and provide calculations to show that diffuse flow will be
achieved through the entire buffer. If it is not possible to achieve diffuse flow through the entire buffer then it may
be necessary to provide stormwater management practices that remove nutrients before the stormwater can be
discharged through the buffer.
Other
? The application fee was insufficient because over 150 feet of stream and/or over 1 acre of wetland impact was
request. Please provide $ . This additional fee must be received before your application can be
reviewed. 'I-}?
? Please complete Section(sLw the application.
? Please provide a signed copy of the application.
$$) Mitigation
of compensatory mitigation is required for this project. Please provide a compensatory
mitigation plan. The plan must conform to the requirements in 15 A NCAC 2H .0500 and must be appropriate to the
type of im acts proposed.
3"'4 ?_&* 't , ? w-? `?' 'V A CCK
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