20021211 Ver 1_COMPLETE FILE_20020801

VWNgA Michael F. Easley, Governor
?0 9Q
? William G. Ross Jr„ Secretary
North Carolina Department of Environment and Natural Resources
`
r Alan W. Klimek, P.E., Director
Division of Water Quality
O <
Coleen H. Sullins, Deputy Director
Division of Water Quality
July 2, 2003
Gary Morgan Lot #32
Nash County
DWQ # 02-1211
WAIVER of 401 Water Quality Certification
Gary Morgan
1804 Old Barn Rd.
Rocky Mount, NC 27804
Dear Mr. Morgan:
Your application for a 401 Water Quality Certification was received in the Central Office on Aug. 22,
2002. According to our rules [15A NCAC 2H .0507 (A)], if final action is not taken within 60 days, the
Certification is waived unless DWQ has objected in writing to your application. Therefore, DWQ has waived
the requirement for a 401 Water Quality Certification for your plans to impact 130 feet of shoreline for the
proposed bulkhead as described in your application.
However if additional impact occurs or your development plans change, this waiver is no longer valid
and a 401 Water Quality Certification will be required.
If you have any questions, please telephone Mike Horan at 919-733-1786 or Debbie Edwards at our
Raleigh Regional Office at 9197571-4700.
Sincerely,
Cc: Mr. Frankie Faithful
2685 South Old Carriage Rd
Rocky Mount, NC 27803
n R. Dorney
Raleigh DWQ Regional Office
Raleigh Field Office Corps of Engineers
Wilmington District Office Corps of Engineers
Central Files
File Copy
A&Z
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.uslncwetlands
MEMORANDUM
TO: John Dorney Regional Contact:
Non-Discharge Branch WO Supervisor:
Date:
SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS
Facility Name Gary Morgan County Nash
Project Number 02 1211 County2
Recvd From APP Region' Raleigh
Received Date $/1/02 Recvd By Region
Project Type shoreline stabilization
Certificates Stream Stream Impacts (ft.)
Permit Wetland Wetland ` Wetland Stream Class Acres Feet IN - - +
.
Type Type Impact Score Index Prim. Supp. - Basin Req. Req., I
GP 30 Waters PT -@N F- 28-(36) WSIV B NSW 30,302. ?- ? F-
TPBR Buffers ©Y O N F-F-F-r- 30,3Q2. O.IS 1- 1F_
Mitigation Wetland
MitigationType Type Acres Feet
Is Wetland Rating Sheet Attached? 0 Y 0 N Did you request more info? 0 Y 0 N
Have Project Changes/Conditions Been Discussed With Applicant? 0 Y 0 N
Is Mitigation required? 0 Y 0 N
Recommendation: 0 Issue 0 Issue/Cond 0 Deny
Provided by Region: Latitude (ddmmss) Longitude (ddmmss)
Comments:
Coluld be NV for removal of buffer,
Need to address what there is or is not left of buffer. If ACOE OK with the fill and it is truely a bank
stabilization the ISSUE.
cc: Regional Office
Central Office Page Number 1
Triage Check List
Date: Project Name:
DWQ#:
County:
To: ? ARO Mike Parker ? WaRO. Deborah Sawyer
? FRO Ken Averitte ? WiRO Joanne Steenhuis
? MRO Mike Parker ? WSRO Jennifer Frye
? RRO Steve Mitchell
From: Telephone : (919)
The file attached is being forwarded to your for your evaluation.
Please call if you need assistance.
? Stream length impacted
? Stream determination
? Wetland determination and distance to blue-line surface waters on USFW topo maps
? Minimization/avoidance issues
? Buffer Rules (Meuse, Tar-Pamlico, Catawba, Randleman)
? Pond fill
? Mitigation Ratios '
? Ditching
? Are the stream and or wetland mitigation sites available and viable?
? Check drawings for accuracy
? Is the application consistent with pre-application meetings?
? Cumulative impact concern
Comments: 0111 YK ' ?.
s
2002 ' L.
r
4 zit, CrS cfE UP
T!0! 1
A- ? • ?, ? ?' Sul tP
?; p At1G 2 2 2002
Office Use Only: Form version May 2002
US_ACE Action ID No. DWQ No.
(if any particular ih:m is not pplhablc to this project, please enter "Not Applicable" or "NIA".)
1. Processing
1. Check all of the approval(s) requested for this project:
X Section 404 Permit Riparian or Watershed Buffer Rules
0 Section 10 Permit Isolated Wetland Permit from DWQ
f] 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested:_L?
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: x
4. If payment into the North Caroline Wetlands Restoration Program (NCV4'R.P) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ?
5. If your project is located in any of North Carolina's twenty 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: Q
11. Applicant Information
1. Owner/Applicant Information
i Name: 6 r 14
Mailing Address:
Telephone Number:_ Z- , ?x Number:
E-mail Address'
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has si atory authority for the owner/applicant.)
d Name:
Company Affiliation: w 4L
Nailing Address: 2 ?,A-vi , . ;r,6--.T,
7
Telephone Number., 7Z Fax Number:
E-mail Address:
Page S of 12
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111. 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 snap
and site plan must include a scale anu 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: "1111A _
2. T.I.P. Project Number or State Project Number (NCDOT Only):_
?3. Property Identification Number (Tax PIN): ,7?2 )06 32/ U
4
Location
County: -5/,/ Nearest Tol
Subdivision name (include phasellot number):_(?(
Directions to site (include road numbers, landmarks, etc.
Es7`
To ?Lo7t
5.
6. Property size (acres): f ..
7. Nearest body of water (strea ire ound/ocean/lake):
8. River Basin: _/' ', ce l'
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at httg://h2o.enr.state.nc.us/admin/maps/.)
9. Describe the existing conditions o thc_ site and general land use in the vicinity of the pr?lect
at the time of this application: _ ihS??
Pale b of 12
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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 watcrbody.)
Ili. :A,.A M k?!-
10. Describe the overall project in detail, ?includinylhe}ype of equipment to be seed:
11. Explain the purpose,of the proposed
e,
IV. Prior Project History
If jurisdictional determinations and/or permits have bean requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the YISACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
Vll. Proposed Impucts to Waters of the United States/Wnters 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 Mow. 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 Scction VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
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1. ruvide a written description of the proposed impacts:_-? GT SAO&
QM erosr?o n , - --- _
2. Individually list wetland impacts below:
Wetland Impact
Site Nvmber

(indicate on map)
'type of Impact" Area of
Impact

(acres) Located within
100-year Floodplain"

(yes/no) D!STance to
II Nearest Stream

(linear feet) i
? Type of Wetland*
"•
I

I
i
- Lis[ cacti impact separately anc tarntlry semportuy impacts. impacts mcmae, out are not iimiwa to; mcmunizco cicu; wt3, brauuio, vu,
excavation, flooding, ditching/drainagc, etc. For dams, separately list impacts due to both structure and flooding.
M• 100-Year floodplains arc identified through the Federal Emergency Management Agcncy's (FEMA) Flood Insurance Rate Mapi
(FIRM), or FEMA-approved local floodpiain maps, Maps are available through the FEMA Map Service Center sit 1-800-358-9616, or
online at httr://www,fema.p-ev.
00' List a wetland type that best describes wotland to be impacted (e.g., freshwatedsaltwater match, forested wetland, beaver pond,
Carolina B&y, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property:
Total area of wetland impact proposed:_
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
(indicate on map)
Type of Impact" I'M-0th of
Impact
linear feet)
Stream Name` • Average Width
of Strum
Before Impact Perennial or
Intermittent?
(please specify)

Lm cacr. nnpace scparoiety ano wcntay eetnwtury unpweu. unP- ,nUu - ou' - uu, 1 -.- - .---w -- awe--
dams (separately fiat impacts due to bath structure and flooding), relocation (include linear f=t bcfOfc and afkr, and net loss/gain),
slabiiimlion activities (tcrncnt will. tip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, cte. If streum relOCation is
proposed, plans and profiles showing the lineur footprint for both the original and relocated streams must be ineludtd.
"• Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the newest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800.353-9616, or online at
www,vsg v. Several intcrnet sites also allow direst download and printing of USGS soaps (c,g., WW'V'tOrc)7one.WM'
wwH•,ms?Pgie?t.G.Nn, cte.).
Cumulative impacts (linear distance in feet) to all streams on site:
Page 8 of 12
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4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Opsn Wat(x Impact
Site Number
on ma
( P) Area of
Type of Impact* Impact
(acres}
Name of Watcrbody
(if applicable) Type of Waterbody
(lake sound,
, Pond, estuary,
? bay, ocean, etc.)

i -?

w List cacti impact sepurattly and identify temportuy impacts. !-pacts include, but rue not limited to, till, eXcavation, dredbing,
flooding, drainage, bulkheads, etc.
5. 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 includes! with Ibis application.
Pond to be created in (eheok all that apply): (] uplands [] stream wetlands
Describe the method of construction (e.g., dam/embanknient, excavation, installation of
draw-down, valve or spillway, etc.):'
Proposed use or purpose of pond (e.g., 1'vestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): ?/?
Size of watershed draining to pond: Expected pond surface area:
VIZ. 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
techni ues to be followed during construction to red lice impaact/s. `
o .Sri n fro LT /A Uri '7,n,,',,7
SYr9 h . ?% P ?'Lv? ro / n A _
Vill. Mitigation
DWQ - In accordance with 15A N'CAC 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
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:i
USA(
Permi
the Final Notice ssuance and
I Register on rclt 9, ra
r effects the uaiirp ~ed i act and f ' Bete i 'n .cs f miti t nay the site the te s values Qti ' r •r., ring, enh
in the -rshe
ed
necessar5,-to ensure that I
inciu ,ize and type of
aquat s urge
mitig s Exa
but are not limited to: re
and/or upland vegetated bal
aquatic resource functions <
functions and values, prefers
lr mitigation is required for
for USAC' or DWQ to c
lacking a }fired mitiga
in
a
i pr
also ch s
Guide for
ent are minimal. Factor":
tive val?uc of the im acte
appropriate and prac;.i.cablc
ate and practicabl.o in ? ,
g and maintaining 1'
ms; and replacing lossde-.&f
sing, or preserving siitriiar
ration ' n must be attached in r er
to for ocessing. Any appli en
renee all be placed on hold as
rent gui elines for stream restoration
in N' th Carolina, availabie at
/.; ao.enr.state.,a •- /ncweQ s/st ?h ml? U J
i
i.
2.
0
Pr td brief description: Me prop a iWig t
' plan. Thy description should provide
as c informau o? si ,
ncludt b ' iced to: ? to location (attach directions
and/or map, if offsite),
of miti
ation
ro
osed (
es ted stre an i e bat. N
cr
to
atio
en type and amount (acreageilinear feet)
eation
reservation)
a
vi
lan
g
p
p
r p
, o., ?. p
,
;
r
n,
a
preservation mechanism !(e.g., dee conservati in easement, etc.), ;ande
I
`
description of the current site co posed method construction: Please att
Ql - LCD
a :ec rate sheet if more spAce is
i`
r O

Mitigation may also be made by payment into the North C' olina Wetlands Restorati
es
onsibil t
to contact the NC'? r P
P
Pl
h
li
NCWRP
te i
i
t'
p
y
rogram (
can
s r
).
easC no
s t
e app
t
[phone] to determine availability and to request writtezi approval of mitigation gri
to submittal of a PCN. For additional information regarding application process for t
NCWRP, check the NCW?P website at lit i/h2o.er.r,state.nc. rs/wr 'index.htm. If use
the NCWRP is proposed, please check the appropriate box o 'j page three and provi
following information:?
Amount of stream mitigation requested (linear feet): All'?,
Amount of buffer mitigation requested (square feet):_
Amount of Riparian wetland mitigation requested (acres)
Amount of Non-riparian wetland mitigation requested
IX.
X.
V
i
Environmental Documentation (required, by DWQ)
Does the project involve anj expenditure of public (federal/state) funds use of public
(federal/state) land? _'?
Yes ? No? .?.?,.
If yes, does the project req? ire preparation o erivironm . tal d curnent pursuant to the
requirements of the Nationati or North Carolina ironmeKal Po _ PA/SEPA)?
Note: Whether a NEPA/ A document is `m`om' e the SEPA
coordi V&- V
r t 9 r7zM85, o review curren resholds for en ' anent 'Umentation
a No
If ye. ' a i W b inaliz .etS?C, Clearinghouse? If so, please attach a
copy f th . NEPA or SEPA fi al approva r
Proposed Impacts on Riparilan and t t?ec uffer (required by DWQ)
It is the applicant's for ageni's) resp t
Q si i o e ine, delineate and map all impac
required state and local buffers assoc' tevi h ro ect. The applicant must also pr v' e
justification for these impacts iin Sectio VII aboti roposed impacts must be listed h 'n,
and must leanly identifiable on the yin t plan. All buffers must be shown on a
map, whe of impact$ are pro o f bu .s. Correspondence front the D`rYQ
Rebional a ma ineiuded as ppropriat . graphs may also be included at the
applicant's discre ! O
Will ro ect impact ?
j pr . ripari u tified within 150 NCAr
., 2B .4233
(Neus .02 9 -Pam - 1 AC 213 .0230 (Randleman Rules and
Water Supply Buffer Requi s),0 er ide tify_ )?
Yes [] No , If you le s", provide the following information:
!
Identify the square feet and creage . ch zone of the riparian buffers. If IF
mitigation is required calculte tl amount of mitigation by applying the of
multipliers.

zone" i Impact

square feet)
Multiplier RC+ uire

Mitigation v v
I
2 1.5 r-- d
a
Total C
70114 1 Gxi4ndS Out 3 t4et perpendicular from nctu bunk of channel: Zone 2 extends un
additional 20 feat from the edge of Zone 1. ( \
I
i
Page I I of 121
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I
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 BuOer Restoration Fund). Please attach all appropriate irforrnatio.n as
identified within 15A NCAC 20 .0242 or.0260. I
XI. Stormwater (required by
Discuss ht6h-nwater
downsamarn from the
)IT. Sewage Disposal (required by D
Clearly detail the ultimate tre4tn
wastewater generated from the prc
XIII. Violations by
Is this site in vio a ' f

j %vork schedules (e.g., draw-do tivn schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's contro
7=R,
I

existing a proposed) ver total acreage on
sed i orde o prote s
d
urface waters and O of
d i
tion (non discharge or disc
m pcA
zdr O a e capacity of the subject faei
oun"I
211.0500) or any Buffer Rules?
o \1 v
Is this it applic 'on?
Yes Q No 00
XIV. Other Circumstances (Optional):
i
i It is the applicant's responsibility t e application sufficiently in advance of desired
construction dates to allow pfocessing time for these permtits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
Applicant/Agent's Sigel tur-e
(.Agent's signature is valid only yf an authorization
I
£TC!£t0'd OB?S#i
Page 12 of 12
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Date
from the applicant is provided.)
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DRIVE 5p? R/W C4
S
<00
Y

THE LITTLE ZEN CALENDAR
If others had not
been foolish, we
should be so.
WILLIAM BLAKE
i

1 2002
1
Office Use Only:
USACE Action ID No. DWQ No.
(If any particular item is not applimbl: to this project, please enter "Not Applicab
1.
Processing
Form Version May 2002
or
1. Check all of the approval(s) requested for this project:
Section 404 Permit 0 Riparian or Watershed Buffer Rules
Section 10 Permit [] Isolated Wetland Permit from DWQ
401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested:_L12YO-06-20
?, If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: x
4. If payment into the North Carolina Wetlands Restoration ProSram (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII wid check here: 11
5, If your project is located in any of North Carolina's twenty 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: []
11.
Applicant Information
I . Owner/Applicant Information
Name: (5:44r 146 A
Mailing Address:

Telephone Number:_ cAi2
L ) - x Dumber:
E-mail Address:
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has si natorya?ority for the owner/applicant.)
Name: w ?_
Company Affiliation: arvn-s` ?-? D+, --?9--?-?y-
Nfailing Address: 2( kS? a I Cirri :4 a.# X? KG?fC?T
Telephone Number: 2. Fax Number:
E-mail Address:
Page S of 12
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AW 2 :

111. Project .Information
Attach a vicinity neap 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 neap
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
USACF-. requires information to be submitted on sheets no larger than l 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 ii illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of proj ect: A11A
2. T.I.P. Project Number or State Project Number (NCDOT Only):_
3. Property Identification Number (Tax PIN): -r3
Location
County: F S Nearest Town:
Subdivision name (include phasellot number):- ?J)J?Idn
Directions to site (include road numbers, landmarks, ete.):..e
Es7`
%o ?Lo7L
c2i1 ?',ry?7c
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.)
& Property size (acres)
7. Nearest body of water (strewn lve ound(oceart/iake):,_ A2'uer _
8. River Basin: if /-
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at htt2://h2o.enr.state.nc,us/admin/mapsl.)
9. Describe the existing conditions o site and general land use in the vicinity of the project
at the time of this application: athe / ? C IMLe?
r _ / A. ,
Pa.- e b of ', 2
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r
400M ;-AM
10. Describe the overall p , ct in detail, including heVype of equipment to be used:
11. Explain the purpose of the proposed work:
IV. Prior Project History
If jurisdictional determinations and/or permits have bean requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the CISACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn, Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
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 T of 12
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1.,?r_ov??i_de a written description of the proposed impacts: cT sAaa. ne
e/`Qs r O n' 2. Individually list wetland impacts below:

Wetland Impact
Site Number
(indicate on map)
Type of impacts Area of
Impact
(acres) Located within
100-year Fioodpiain"
(yedno) Distance to
Nearest Stream
(linear feet) j
Type of Wetland'"'

I

` List each impact separatcly and identify temporary impacts. Impacts include, but arc not limited to: roe-hmiud clearing, grading, 2511,
excavation, flooding, ditching./drainage, ate. For dams, separately list impacts due to both Aructurc and flooding.
+• 100-Year floodplains arc 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 I-800-358.9616, or
online at httn://www,fwia.sev_.
••• List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Buy, bog, etc.) Indicate if wetland is isolated (determination of isolation to be mode by USACS only).
List the total acreage (estimated) of all existing wetlands on the property:
Total area of wetland impact proposed:_
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Sitc Number
(indicate on map)
Type of ImpaaO Length of
Impact
linear feet
Stream Name' • Average Width
of Stream
Before Impact Perennlsl or
Intermittent?
(please specify)

List cart: impact separately and identify temporary impacts. Lnpaets Ux-lude, but anti not limit a to: culverts ana moci teo rip-rap,
dams (separately fiat impacts due Lo both structure and flooding), relocation (include linear fit bcforc and after, and net loss/gait),
stabiiization activities (cement will. rip-rap, crib wall. gabions, etc.), excavation, ditching/straightening, etc. If stream relocation ie
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
" Stream namrs can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downuresm named stream into which it flows. USGS maps are available through the USGS at 1.800.358-9616, or online at
www.vsuaov. Several intcrnet sites also allow direct download and printing of USGS Wraps (e.g.., wwY,tOrx»ar%c.wm,
Www.mtsoser6axn. CIO.).
Cumulative impacts (linear distance in feet) to all streams on site:
Page 8 of 12
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It
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• ,v?=?na.?earr?tyt,'+-fit
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
indicatr, on ma
? p) Area of
Type of Irnpact* TmpACt

(acres)
Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,

bay, ocean, etc.)

3U ? r rr i!
i

* List cacti impact separat„ly and identify temporary impacts. Impacts include, but are not lirai,,ed to: rill, excavation, dredging,
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 neaps included with this application.
Pond to be created in (check all that apply): (D uplands [? stream 0 wetlands
Describe the method of construction (g., darn/embankment, excavation, installation of
draw-down valve or spillway, eta):
Proposed use or purpose of pond (e.g.,
local stormwater requirement, etc.): 3
watering, irrigation, aesthetic, trout pond,
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoids-nee and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful tp 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 redlice impact/s. ?/
e) -5A n &rO :S16n /7/7/Y/ S7Fl h /r s° '<'4 r0 ZAP _
VIII. Mitigation
DWQ - In accordance with 15A NCAC 214 .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
ETV TO'd 08?8#
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E71
I
I
USA(
i'ermi
in
inciu
to cnsurc that I
;ize and type of
mitigatinn-lcs ernr?nced Ex
but are not limited io 'rec
and/or upland vegetated bl
aquatic resource functions
functions and values, prefe
if mitigation is required for
for USAC or DWQ to cc
lacking a }fired mitigat

I
? I
I
1.
I
! j
I
I
I I
'IT: 1.71-101 NX
i
is
the Final Notice ssuance and , o "o `ationwide
t Register on rch 9, 200G, m1 " 11011 wt equir> en
'er effects the uatic e o ant are minimal. acto
op Mod i act and f o and re" tivc valu4 of the im acte
dete r 'n .ability appropriate and practicablc 1
Ilcs of miti t at Ynay- appxo iate and practicable in I ,
the site the of : estahli, g and maintaining w ! N%
s to e s ch as str.' rs; and replacing lossd&-ef)
l values ti r •r., ring, enh? icing, or preserving sirnirg,
in the ,Arsh
s projcc a py o' tale igation p n must be attached in r ;.r
ider th applicatid r lete for r ocessing. Any appli 'cn
! plan r P once .all be placed on hold as
also ch s r - , the rrent gui elines for atrea n restoration.
Guide for Sere k in N' th Carolina, available at
s/st .h m
1. Pr td brief description: t e prop a Mig ai plan. Th- description should prmtide
as c info rrnaI.ro 4si , 'neludt bited to-, ? e location (attach directions
and/or map, if offsite), cted stye i?es?ba.: rz, type an amount (acreage/linear feet)
of mitigation proposed (restoration, en e . creation, o. preservation), a plan view
preservation mechanism !(e.g., d conservati, n easement, etc.), ;andQ
description of the current site co posed method ,. construction: Please attaeh
a s sheet if more spice i
Tr : 0
2. Mitigation may also be nude by payment into the North C' olina Wetlands Resto.at'i
Program (NCN'RP). Please note it is the applicant's responsibil ty to contact the NC'!XW at-:
[phone] to determine availability and to request, written iapproval of mitigation pri
to submittal of a PCN. For additional information regarding application process for t
, CWRP, check the NCWRP website at http://h2o.enr.state.nc. ?s.'wr 'index.htm. If use
the NCWR.P is proposed, please check the appropriate box o `'j page three and provi
following information:
Amount of stream mitigation requested (linear feet): AI
Amount of buffer mitigation requested (square feet):T
Amount of Riparian wetland mitigation requested (acres) _
Amount of Non-riparian wetland mitigation requested
f
41
tlMt Ilm
r
1X. Environmental Documentation (required by DWQ)
!
Does the project involve anj expenditure of public (federal/state) funds
(federal/state) land? j "-
Ycs ? No? -_:...
If yes, does the project require preparation o enviromn , tal d current
requirements of the Nationah or North Carolina ironnieital Po
Note: , whether a NEPA/ A document is
coordi r t 4 ;5083No review Curren resholds for en. ' . ent ac
If ye, a die-tirt7?pnr rep
'
COPY f th . NEPA or SEPA
0
X. Proposed Impacts on Riparian and
It is the applicant's (or ageni's) respo
required state and local buffers assoc'
justification for these impacts jin Sectio
and must learly identifiable on the
map, wil pacts are pro
Regional a minc?uded as
applicant's dWill r
oject impact pr rtpr

use of public
pursuant to the
PAISEPA)?
c the SEPA
imat,tn+inn
Clearinghouse? If so, please attah a
(required by DWQ)
U
i o elm ine, delineate and map all impac
;e
ii . h ro ect. The applicant must also pr V e
VII abov roposed impacts must be listed h 'n, AO
ym t plan. All buffers must be showi? on a
) ) bu .s. Correspondence from the Dot Q
)propriat li i graphs may also be included at the
(Nees .02,9 ( -Pam
Water Supply Buffer Requi tso
Yes (?] No ? ; If you
Identify the square feet and ;acreagep?o-.
mitigation is required calculate t1440
multipliers.
i
tujics tified within 15A NCAC 2B .0233
1 U AC 213 .0250 (Randleman Rules and
s ide tify_ }?
le s", provide the following information:
ch zone of the riparian buffers. If r
amount of mitigation by applying the u
O
Zone" ! Impact

(square feet)
Multiplier RL+quire

Mitigation
I 3
2 ! t.5
Total
t
V
Cam
zonC i cAM& out 30 feet papcndicular from near bunk of channel: Zonc 2 extends an
additional 20 feet from the edge of 7one I. i
i
i
i
Page 1 I of 12
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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 Bufl,6 Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 20.0242 or.0260.
XT. Stormwater (required by
Discuss
from the

existing aO proposed)
r total acreage on surface waters and

)IM. Sewage Disposal (required by T)i'KQ?'" (? V
Clearly detail the ultimate treatment m, d d'' ' ition (non-discharge or disc
wastewater generated from the proposedy r .Ia a capacity of the subject fac
XIII. Violations by DWOJ IL(
- U
1 is this site in vio a' f D 'etlan 'Ru 5 2H .0500) or any Buffer Rules?
'o
OV-0
Is this it 4plic 'on?
i Yes Q No I f 1
0
XIV. Other Circumstances (Optio"l). V
It is the applicant's responsibility t e 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
j 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 contro
C
G+
C)
Applicant/Agent's Sam a late,
(.Agent's signature is valid only yf an authorization letter from the applicant is provided-)
Page 12 of 12?. )
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Office Use
USACE Action ID No. DWQ No.
(if any particular item is not applicably to this project, pease eater "Not
1.
H.
Processing
F AUG 22 2? }}"
j L.
' L7-7,,E-T--
.
Form i ;J
version May 2002
or
1. Check all of the approval(s) requested for this project:
X Section 404 Permit Riparian or Watershed Buffer Rules
Section 10 Permit Isolated Wetland Permit from DWQ
(] 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested:/ g?(,?Q Fao
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: x
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCVIWRP prior to submittal ofPCN), complete
section VIII and check here: ?
5, If your project is located in any of North Carolina's twenty 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: []
Applicant Information
1. owner/Applicant Information
i Name: ? 67,41-y /1'16rVAw
Mailing Address: TAG

01 1
Telephone Number._ s.ax Number:
E-mail Address: 07
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has si natoryr?autlaority for the owner/applicant.)
Name:
/?
Company Affiliation: rv /:4 .-? -;7O
Nailing Address:
Telephone Number: Z Fax Number:
'931 YF-
E-mail. Address:
Paga 5 of t2
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?I.
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 snap
and site plan must include a scale anu 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 l 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 ofproject:
2. T.I.P. Project Number or State Project Number (NCDOT Only):_
3. Property Identification Number (Tax PIN):-3 72 )66 4.

Location
County:-- IS
Subdivision name (include phaselot number):
Directions to site (include road numbers, lands
Es7`
To S" /-.,
c2i1 ?,ryl?
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 watefoody.)
6. Property size (acres)
7. Nearest body of water (strea the ound/ocean/lake): 7?24 'Wf __
8. River Basin:?
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at htt ://h2o.enr.state.nr..usiadmin/ma s/.)
9. Describe the existing conditions o the site and general land use in the vicinity of the project
at the time of this application: i i / r?Pn/ P??; i h Sl?4,
11 f _ / At
Pane 6 of '.2
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10. Describe the overall project in detail, including theppe of equipment to be used:
11. Explain the purpose of the proposed work:
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
comstruetion schedules.
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provvide justification for the exclusion of this work from the current application.
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 bclow. 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
ETV800'd 08;x# 0=5 T?d :-:Oq1Sri CZ8y9L86T6 T!:9T 709Z.G?"7Lt'
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I. ruvide a written description of the proposed impacts:•?eT SAO&- /rte
?n CJ`Qs r 0 n , __---
2. Individually list %vetland impacts below:
Wetland Impact
Site Nvnf"r
(indicate on map)
Typo of Impact' Area of
Impact
(acres) Located within
100-year Floodplain" I
es/no) Distance to i
Neamst Stroarn Type of Wetland*'*
(linear feet)
I _?
I

L &r, eaCn impact separaicty enc talCrmry ccmponuy tmpat:ta. tmymar. ,nc,uae, Vuc arc taut ,u:u. tu. a.«. 6b .,.y
excavation, flooding, ditching/drainage, etc, For dams, separately list impacts due to both stt-ucturc and flooding,
•• 100=Year floodplaina arc identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate 'daps
(FIRM), or FEMA-approved local floodpiain maps. Maps are available through the FEMA Map Scrviec Center at 1-800-358-9616, or
online at httn://www,fenia.fiev.
•?• List a wetland type that best describes wotland to be impacted freshwaterlsaltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (drfermination of isolation to be made by USACS only).
List the total acreage (estimated) of all existing Wetlands on the property:
Total area of wetland inipact proposed:_
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
(indicate on map)
Type of Impact* LWEth of
Impact
(linear feet)
Stream Name* Average Width
of Stream
Before Im act Perennial or
Intermittent?
(please spcxify)

List Caen Impact separately ana aacattry temporary ampwis. Lnpacts trtc:uue, out art: oat utmwo tai cu:vsuis aJtu nsauc„utcu t+p-r u{+.
darns (separately lint impacts due to both structure and flooding), relocation (include linear fait baforc ind after, and net loss/gain),
stabfiiuttion activities (cement wall, rip-rap, crib wall, gabions, otc.), excavation, ditchingrstraightcning, etc, If stream relocation ix
propose d, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
Stream names can be foand on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downsLtcs rt named stream into which it flows. USGS maps arc availabl: through the USGS at 1.800.35a-9616, or online at
www,vs s. ov. Several intcrnet sites also allow direct download and printing of USGS maps (cg., w.rv,t pctzone.com,
wwN•.marns,e.`t.axt,. etc.). •
Cumulative impacts (linear distance in feet) to all streams on site:_ --
Page 8 of 12
CTolr'r.n•a n,G:ACfl n7N RNA T"WCn f7CCQ'QrTn' TT:QT

4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Waror Impact

Site Number
(indicate. on map) Area of

Type of Impact' Impact
(acres) Name of Watcrbod

(if applicable) y Type of Watcrbody
J
(lake, pond, estuary, sound,
bay, ocean, etc.)
l
3v ;? ;Y,

I
" List each impact separately and identify temporary impacts. Impacts include, but are not limited to, till, excavation, dredging,
flooding, drainage, buikhcaads, etc.
5. 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): 0 uplands ? stream 0 wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., 1'vestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): ?/? _
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. if applicable, discuss construction
techniques to be followed during construction to red ce impacts. ``
V111. 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
ETG!010'd 08?q# 091 ?'d'd zoy3n. £7.A4N;.Atitn 7 1 : I T 7.; ?.'.. G%'?!lr

I I
I
j ... :.. :y to
I
i
USAC accor nee W1 the Final ?JOtice ssuance and I o - o `ationwide
r?ermits, pub "c de t Register on rcli 9, 2000 ; m'•'' ion eaquire an
necess to ensure that vor effects the uatic en o ant are minimal. ac to
inciu -ize and type of p 'ed i act and f n 'o and re tive value of the im acte -
aquat s urce dete i 'n .ability appropriate and pracl= blc 11
mitib s Examlplcs of miti t t nay e afp;,o iate and practicabl.c in 1 r
but are not limited to: re the size the bj establi^ g and maintaining w !
and/or upland vegetated buff s to ° e s ch as str. uns, and replacing lossd-Of)
aquatic resource functions an values QU r •t. ring, erih' icing, or preserving sunTr='
functions and values, preferablin the trsh.e
If mitigation is required for this projec a Uply c> tj e igation pl n must be attached in r ;.r
for USAC• or DWQ to confider the applicatio r lete for ocessing. Any uppli 'oi
lacking a iced mitigation plan r P ence :.all be placed on hold as
incomple A a cant may also ch s the rrent guy elines for stream restoration
in DWO ' c ' al Guide for S.tre k in N' th Carolina, available at
hti :,';; o.enr.state.? /ncwe- s/st h m .
1.
as -rracn tntormano o?sr ",c
and/or map, if offsite), " ated stre
of mitigation proposed (r4toraticn,
preservation mechanism ?(e.g., dec
description of the current si lite co
a 3cr,rate sheet if more splice i `
plan.
ited to:
type aj
description should provide
S e location (attach directions
amount (acreageilinear feet)
preservation), a plan v'i;w
j on easement, etc.), jando
construction. Please avac,
d
olina Wetl=ds Restorati?U?
I ty to contact the NC'?W ?t-.->
J approval of mitigation pn
application process for
.,is/wrpjndex.htm. If use
raj page three and provi
conserva
i method
2. Mitigation may also he made by payment into the North
Program (NC)N'RP). Fleas note it is the applicant's responsi
[phone] to determine availability and to request writt
to submittal of a PCN. Far additional information regarding
NCWRP, check the NCWRP website at ltttp:ilh2o.enr.staiej
the NCWRP is proposed, please check the appropriate box
following information:
Amount of stream mitigation requested (linear feet
Amount of buffer mitigation requested (square feet):_
Amount of Riparian wetland mitigation requested (acres) _
Amount or Non-riparian wetland mitigation requested (acresl:__ _.-
i
IX.
i
i
i
i
Environmental DocumentnOon (required by DWQ)
Does the project involve ani expenditure of public (federal/state)
(federal/state) land?
Ycs ? NoI .C?
If yes, does the project req ire preparation o envirom1 taI
requirements of the National or North Carolina ironmeilfal 1
Note: etw- ... , ' whether a N IEPA/ A document i
coordi r t 9 7 ;5083N o review Curren resholds for en-AW
Ifyes'?'??e?ieea?e?L
copy f th NEPA or SEPA
0
X.
Proposed Impacts on Riparian and
It is the applicant's (or agen
required state and local buff,
justification for these impacts
and must learly identifiat
map, whe of impact.
Regional ; e ina inc:
applicant's discre
Will

use of public
pursuannt to the
PA/SEPA)?
CO the SEPA
Clearinghouse? Alf so, please attah a
(required by DWQ)
i -
respo si f o eV ine, delineate and map all impac
s associ to I ro ect. The aoplieant must also pr v• e (j
i Section VII abovroposed impacts must be listed h ?,
on the ac r yin t plan. All buffers must. be shown on a
are pro oa e?%, bu .s. Correspondence from the DWQ
ded as :ppropriat li graphs may also be included at the
Water Supply Buffer Requii'kmot,6ts),
Yes ? No
Identify the square feet and f creage
mitigation is required calculate t14
multipliers.
6
ipari u'rs? tified within 15A NCAC 2B .0233
-Pam i • 1 AC 2B .0250 (Randleman Rules and
o er ide tifj_ )?
If you ?e s", provide the following information:
ch zone of the riparian buffers. If r
amount of mitigation by applying the of
O

Zonc Impact

(square feet) ?'
Multiplier R<?quirec

Mitigation
t 3
2 1.5
Total
i
G G
I
a ? ?
' "Lone I cxtbnds out 30 fcdt perpendicular from new bttnk of channcl: Zonc 2 cxtcnds im
additional 20 feat from the edge of Mne 1.
i
i
Page l 1 of 12
£TO!ZTC'd OBag# osx zNa Ea•?sn £ZE59G86i6 BT:9T c00Zjg.?'JL1
¦
M....., ... .
M
1
If buffer mitigation is required,! please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Basement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Bufi}er Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 20.0242 or.0260.
XI. Stormwater (required by
Discuss
X11. Sewage Disposal (required b,
Clearly detail the ultimate tre
wastewater generated from the
X1II. Violations t
Is this site in
Is this
XIV. Other Circumstances (Optional):
It is the applicant's responsibility t 49w
on sufficiently in advance of desired
construction dates to allow pfocessing time for these perms ts. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
U
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 contro
2H .0500) or any Buffer Rules?
C
o
i
C?
C)
Applictt t/Agenk's Sigria ure hate
(.Agwnt's signature is valid only of an authorization letter from the applicant is provided.)
TC!C!0*a 08x0
Page 12 of 12
r
03d qYd 23vsn CZ8S)s.8616 *7t:91
V U
e applicati
r itr `"? _ ..... _.
'.1
Aur,
Office Use Only: rorm version May 2007
US_ACE Action ID No. _ DWQ No.
_
(if any particular item is not applicab(t to this project, please enter "Not Applicable" or "MA".)
I. Processing
i 1. Check all of the approval(s) requested for this project:
Section 444 Permit Riparian or Watershed Buffer Rules
j 0 Section 10 Permit ® Isolated Wetland Permit from DWQ
401 Water Quality Certification
2. Nationwide, Regional or General Permit Nwnber(s) Requested:__L2j Y666 S0
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 Carolinz Wetlands R-estoration Program (NCavRP) is proposed for
mitigation of impacts (verify availability with NC'WRP prior to submittal of PCN), complete
section VIII and check here: [-1
5, If your project is located in any of North Carolina's twenty coastal counties (listed on page
j 4), and the project is within a North Carolina Division of Coastal Management Area of

i Environmental Concern (see the top of page 2 for further details), check here: []
j I1. Applicant Information
I
1. Owner/Applicant Information.
Name: G / 146 AN
_
Mailing Address:
_,0V ?1121
_.?GL/??•?awwr ?? ? ? goy
j Telephone Number:_ _ Z• .> x Number:
07
E-mail Address:
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has st natory authority for the owner/applicant.)
Name: k7
Company Affiliation:
Nailing Address: _^????k
Q3
j Talephone Number: q? 77
Z Fax Number:
E-mail. Address:
Pate S of 12
*,C!900'd 0??# -^3K ZNN T_1*)'dSn C-39y)L8e)16 0 t:4i IC.OZ,5 •"Ini

M. Project Information

Attach a vicinity neap 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 anu 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 MRCS 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 infornration 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: All"/ -
2. T.I.P. Project Number or State Project Number (NCDOT Only):_ 4///L._-
3. Property Identification Number (Tax PIN): f?
d.
Location /
County: Nearest Tow
Subdivision name (include phase/lot number):I
Directions to site (include road numbers, landmarks, etc.):
ESf
To 9' Ze7L
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, Property size (acres) _ _/ ____1.4zC
7. Nearest body of water (strean ive ound/ocean/iake): 7ar ,/> < vet
8. River Basin: ?f
(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/rnaps/.)
9. Describe the existing conditions o the site and Veneral land use in the vicinity of the project
at the time of this application'
rA'-t?s?an
Pale 6 of :2
ZOOGe?Z'^-;:P
T0 !Li,0'-i 08?G# X33 rFd soysa C3899L86Tc 07:91

IV.
V.
VI.
10. Describe the overall project in detail, ,'
11. Pxplajn the purpose of the proposed work:
Prior Project History

of equipment to be used:
If jurisdictional determinations and/or permits have bean 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 infcmnation. 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
corutruc 'on schedules.
- al-IA
]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.
Proposed Impacts to Waters of the United States/Witten 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 bclow. 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 s4xictly for wetland or stream
mitigation, list and describe die impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of t2
vIC!8C^'? Oct y?i `Jet T??+ ^i?S l £G@y9L86To :: 37 GO??.??' ai.r
ttttpe "M .t .. ,t 0 141140
1. rovide a written description of the proposed impacts:- ATD °c7- sAol r•
ros<0/), - I F
2. Individually list %vetland impacts below:
Wetland Impact
Site Nvniber
(indicate on rnap)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodp;nin"
(yoytno) -Distance to
l Nearest Stream
4 (linear feet)
? Type of Wetland".

I -T

- List cam Impact se?aratcry ane taenitry xmpOnuy Impacts. tmpatru :ncmue, out arc naF nrn:ca :o: me fmtzca cicu; xn?, grauuiy .xi,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both Amcturc and flalding.
00 100=Year foodplains arc identified through the Federal Emergency Maragctncnt Agcney's (FEMA) Flood Insurance Rate ?,taps
(FIRM), or;~EMA-approved local floodplain maps. Maps are available through the FEMA Map Scrvice Centcr at 1.600-358-9616, or
online at httr:/twww,ferna.p-ov.
""" List a lvedwd type Ilea best describes wotland to be impacted (e.g., freshwaterlsaltwater marsh, forested wotland, beaver pond,
Carolina Sty, bog, etc.) Indicate if wetland is isolated (deterrtinution of isolation to be muds by USACR only).
List the total acreage (estimated) of all existing wetlands on the property:
Total area of wetland impact proposed:_
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
(indicate on map)
Type of impact'" Length of
Impact
(linear feet)
Stream Name"" Average Widtlt
of Stream
Before ]mpact Perennial or
Intermittent?
?(please specify)

i
L1 L dace Impact scparaioty EnG tacmny umparUIY Umpuci.+. r,.tnp:_t:u uIL4"U', out arc uvt 41'11LL:u tut UUtVsns WIU aaavwr tie 4.J;-'"F.
darns (separately list impacts due to both strucdura and flooding), relocation (include linear fet:t bvforc and after, and net losslgaic),
staW;'iisttion activities (cement wail, rip-rap, eft will, aabions, etc.), excavation, ditching/straightcning, etc, tf st.-Cum relocOCIP i4
proposed, plans and profiles showing the linear Iootprint for both the original and relocated streams must be ineiuded.
Strom namra can be foand on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the m:uest
downsatsm named stream into which it flows. USGS maps arc availaole through tic USGS at 1-800-358-9616, or onim.- at
yvww,t!sj ov. Several intemet sites also allow direct download and printing of USGS neaps (e,g., w.rv,torc»('ne..ctm,
www,mtq;:est,G)nt, etc.),
Cumulative impacts (linear distance in feet) to all streams on site:_
Page 8 of 12
iVcco'? 0899# ?3'd 7y'8 -T?DWsn rZ899?9618 TT:-QT ZU?Zt -7,'7f:

4. Individually list all open water impacts (including lakes; ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Opim Water Impact
Site Number
(indicate. on map) Area of
Type of Impact* Impact
_ (acres)
Na(if applicable) Wat)
(if Type of Waterbudy
(rake, pond, estuary, sound,
bay, ocean, etc.)

3uQ r'

List cacti impact separately and identify temporrtry impacts. Impacts include, but are not limited to, bill, excavation, dredging,
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 dam/embanknnent, excavation, installation of
draw-dowrx valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwatcr requirement, etc.): ?>/?/ -
Size of watershed draining to pond: Expected pond surface area:
V11. 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 impact/ s. // r
/
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
£TO!OTO*d 0899x 03? ?vd 23v2n MliDL8616 Z1:9T ZvOZAyc' Trif
"!F`14 VIP

Permits, pub
nccess ? to ensure that
ineiu `ize and type of
mtttb s o. tx
but are not limited to: re
and/or upland vegetated bt
aquatic resource functions
functions and values, prefer
If mitigation is required for
for USAC or DWQ to c
lacking a ired mitiga
incomple a cant rr
in DWQ e .I
hrn:;; ltio.enr state.« .- /nc,
the Final Notice
I Register on
:r effects the
op ?ed i act and
' dete i h
?lcs of mlti t
the sere the
s t0
I values I?Atl
in the
s projec a py of
Sider the applicatic
i plan r
also ch s t.
Guide for S„tres
I.
I
ssuarce andl o o `ationwide
9, 2000: nit ion wt aquir> . v en
iatic e o ant are minimal. acto
o and re ttve vahl'of the im acte?
ability ? apptiopria:e and prxciira'blc `-?
ray e app;,o Late and practicabl.c in I r
estahli? . g and maintaining w " V
Us' ch as str' tms; and replacing loss
r, ring, enhii icing, or pr;serving situ
i
lccirrance igation pn must be attached in er 0
leCe fcr ocessing. Atty appli all be placed on hold as
he rrent gui elines for stream restoration
k in N th Carolina, available at
plan.
ited to:
type at
ration,
as4imen tnrorrnauorr- ohs} nc
and/or map, if offsite), " cted stre
of mitigation proposed (rOtoraticn,
preservation mechaunism de,
description of the current site copo
a imr.4r to sheet if more sprtce iso"'?
Ad'd
method
'. Mitigation may also he made by payment into the North C4
Program (NCIN'RP). Please note it is the applicant's responsibtl!
[phone] to determine availability and to request written;?[
to submittal of a PCN. Fcir additional information regarding
NCWRP, check the NCW'RP wehsite at http:J/li2a^en.r.sta_te.nc.'
the NCWRP is proposed, please check the appropriate box of j
following information:
I
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):T#
Amount of'Riparian wdtland mitigation requested (acres Amount of Non-riparian wetland mitigation requested (acres)
description should provide
e location (attach directions
amount (acreageilinear feet) T?
preservation), a plan vt W
` l
n easemeztt, etc.), ,ar""
T
construction: Please avac, L

a

olina Wetlands Restor.itt
NC'1
ItP
th
t
r
act
e
ty to con
approval of mitigation pri
application process for t
,s.'vrTp'index.htm. If use c
page three and provi
D
IX. Environmental Documentation (required by DW Q)
{
Does the project involve anj expenditure of public (federal/state) f
(federallstate) land?
Yes ? No .??
If yes, does the project require preparation o C,ironmertol n . tal
requirements of the National or 'North CaroliR
Note;: whether a NEPA/ A document is "ftrc coordSi tCurren resholds fo? No
i
If ye. ' a ???nr r?
copy f t}} NEPA or SEPA
es
X. Proposed Impacts on Riparian and
I
It is the applicant's (or ageni's) respo
required state and local buffers associ
justification for these impacts lin Sectio
and must leanly identifiable on the
map, %A of impacts are pro
Region"elp.4"Elp- ma included as
applicant's discrz
i
Will roject impact pr .
(Neus .02 9
Water Supply Buffer Requi ts),
Yes No
Identify the square feet and acreage
mitigation is required calculate t1
multipliers.
0

use of public
.pursuant to the
PAISEPA)?
Y c?JY the SL-PA
Clearinghouse? If so, please attach a
(required by DWQ)
i i o elf ine, delineate and map all impac
i h ro ect. The applicant must also pr v e
VII aboti roposed impacts must be listed h 'n,
yin t plan. All buffers must. be sU"i- on a
bu is. Correspondence from the DWQ
)propriat . It graphs may also be included at the
6
rlparia?I Sul j'rs i - tified within 15A NCAC 2B .0233
-Pam(t 1 C. 2B .0250 (Randleman Rules and
o er s ide tify_ }7
If you a s", provide the following information:
ch zone of the riparian buffers. If r
amount of mitigation by applying the Lnf
G
O

Goner i Impact

(square feet) -
Multiplier Require

Mitigation
t ! 3
2 t.5
Total
1 ? G
I
C c7
` "Lone I cxtbads out.10 fcbt perpendicularm near be;nk of channel; Zonc 2 rxtcnds an
additional 20 feet from the edge or 7.0ne 1.
i
i
I
Page 1 I of 12
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1
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or Au
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NOTE:
Lots 29 Th
on MA 19
current 5 1
hereon, as
County Sub
Instrument,
hereon.
I?t
? • ` ,- - ? aP s`¢. his i -- - ---
hip
EIP Ns,.'g>>2 ? 29 ry? EIP i
i r N
0),
P4 NS" NIP X.9
07-
? CONTROL
I ?. CORNEA \ ti6
4
•\
NUMBER DELTA
C II 6734'5
C12 20'00'C
C13 04'26' 1
C/L CURVE DATA NOTE
CND. BEARING
'
- TANC'T. RADIUS LENGTH NON - BUILDABLE

S
S28E
76
5.28
153.92
230.00
255.83 .
S
5
N42'38'5 I"E 86.54 500.00 170 .54 - - - LOT 29 TO BE USED FOR SEPTIC
30.99 800.00 61,94 TANK DRAIN FIELD LINES FOR LOTS 32 AND 33
,
WOCK A.
it 4b
o.? ?. r G
y
"X' in Conc.. iQ
CONTROL
CORNER
4.1'-up
f
i
i
I
I
f
1
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation casement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Bufi'er Restoration F=d). Please attach all appropriate information as
identified within 15A NCAC 20 .0242 or.0260. I '
XI. Stormwater (required by DWiQ)
Discuss ht6nknwater
downst %= from the
existing a proposed) er total acreage on
sad i order-go prof v surface waters and

X11. Sewage Disposal (required b,
Clearly detail the ultimate tre
"astewater generated from the
X1I1. Violations el?by
Is this site in vita '_f
0
on (non-discharge or
capacity of the subject
21-1.0500) or any Buffer Rules?
o -*,I v
Is this A a plic 'on?
Yes ? No [? ' V O
i
XIV. Other Circumstances (Optional):
I
It is the applicant's responsibility t e 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 Fndangered and (,1
Threatened Species, accessibility problems, or other issues outside of the applicant's contro -?
Lt -C).2-
Applicant/Agent's Signature / - I/ - Hate
(.Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
o r C
G Cr ;9
l
. iC!£TO'c 0£+a5#?ri?d ZN? ???SP. £:BSaL$5 is 'L?3t ^'3Z. _.."?'=-
6 F',?J 7 r i 2002
t 5 ww
,
AUG 2 2 2002
L
WEMTL7!-,
:
,
Office Use Only: Form version May 2002
USACE Action ID No. DWQ No.
(If any particular item is not applica,bic to this project, p':ease enter "Not Applicable" or "N/A".)
1. Processing
i 1. Check all of the approval(s) requested for this project:
X Section 404 Permit Riparian or Watershed Buffer Rules
j 0 Section 10 Permit [] Isolated Wetland Permit from DWQ
C] 441 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested:
I
3, If this notification is solely a courtesy copy because writteen approval for the 401 Certification
is not required, check here:
4. If payment into the North Carolim. Wetlands Restoration Program (NCWR.P) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: 0
5. If your project is located in any of North Carolina's twenty 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: Q
II. Applicant Information
1. Owner/Applicant Information
Name: G r Ma AN _
Mailing Address: /n iu
Reje-k&-JWdN./? ? ? ?9
Telephone Numbtr: 2- x ItiumE?cr: 07
E-mail Address:
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has st natory authority for the owner/applicant.)
/?
Name:
CompartyAfr;iliation: Camv /-?c?
Mailing Address:
Telephone Number;ZS2 Z Fax Number:
E-mail Address:
Page 5 of 12
. C/900'd 06;':4 3s- 'I'ds- ;',)Nsr £7F,'alArTi t)i:4I

III. Project Information
Attach a vicinity neap 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
botndaries and development plans in relation to surrounding properties. Both the vicinity snap
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be inelude6. 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 l l by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size constrsction
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 i illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: All'y-
2. T.I.P. Project Number or State Project Number (NCDOT Only):_ f?/B
3. Property Identification Number (Tax PIN): ,772 760 3276.x.3
4. Location /
County: Sl? Nearest Town:
Subdivision name (include phase/lot number): JJ ?1nICI
Directions to site (include road numbers, landmarks, etc.):,,
5. Site coordinates, if available (UTM or Lat(Long):
('.vote - 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 watcrbody.)
4re
6. Property size (acres): ,
r _
7. Nearest body of water (streat ve ound/oceanllake): 7a-r , yel`
8. River Basin: %&/'
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at htt :l/h2o.enr.stato.nc,.us/admin/ma s/.)
9. Describe the existing conditions o the site and general land use in the vicinity of the project
P?rP ih s ?
at the time of this application: al I
Pa-e b of :2

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Q/7 rryL7?
??VLro'd .0890 oad 'Vd 20ysn. EZBS?LBtiTc 07:97
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10. Describe the overall p , ct in detail, including the)ype of equipment to be used:
z2-. IL-",l _ 4 L211 I r _ -/ . ,- _r , . _ T-
11. Explain the purpose of the proposed work:
IV. Prior Project History
If jurisdictional determinations and/or permits have bean 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.r. project, along with
construction schedules.
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
VI. Proposed Impucts 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 identifcdble on an accompanying site
plan. All wetlands and waters, and all streams (intemiitte;at 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 applicants discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Scction VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
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i00Z'.SZ'ii:r
77... lliRl! Ir ."rn net i•alrltllttl
ide a written description of the proposed impacts:0 /'D7CCT Shofe ere
It el?os of o n
2. Individually list wetland impacts below:
Wetland Impact
Site Nomter
(indicate on map)
Type of Impact" Area of
Impact
(acres) Located within
100-year Floodpiam"
(yes/no) Dstance to
Nearest Stroam Type of Wetland'''
(linear feet) I

I -
" List each impact separately and identify temporary impacts. rmpacu include, but are not limited to: me.hmiznd clearing, gradhtg, 811,
excavation, flooding, ditching/drainage, M. For dams, separately list impacts due to both structure and flooding.
"" 100-Year fLoodplains are identified through the Federal Emergency Management Agcncy's (FEMA) Flood Insurance Rate Maps
(FIRM), or FIRMA-approved local floodpiain maps. Maps are available through the FEMA Map Service Center at 1400-358.9616, or
Online at httn://www,fenia.?OV.
"'• List a wetland type that best describes wotland to be impacted (e.g., freshwater/saltwater marsh, forested wotland, beaver pond,
Ciirolina Buy, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACS only).
List the total acreage (estimated) of all existing wetlands on the property:
Total area of wetland impact proposed:_
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
(indicate on map)
Type of Impacts' Length of
Impact
(linear feet)
Stream Name' ` Average Width
of Stroam
Before Impact Perennial or
Intermittent?
(please spcxify)

' List melt impact separately and idcttify temporary impaw. Lmpacts include, ut are not timitzd to: culverts and assooh-tWd rip-rap.
dams (separately lint impacts due to both structure and flooding) ' relocation (include linear fat before and after, and net loss/gain),
stabiiization activities (cement will. rip-rap, crib will. gabions, etc.), excavation, ditchingrsuaightening, etc. If stream relocation it
proposed, pinny 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 :nream has no name, list as UT (unramcd tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through Vic USGS at 1-800.353-9616, or online at
.wtirv.tora>one.ceim,
www,usg,s go . Several intcrnet sites also allow direct download and printing of USGS maps (e.g.,
www mimo1:e?6axn, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: Page 8 of 12

crr.1Fr.n•.7 no:ACit Cl'7N R`.r'N _'WCn c7oeQ'QA7A TT:aT 7nn7.C7-.Trr'
NORM"
Q. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Opsn Water Impact
Site Number
indicate, on map) Area of
Type of Im'pact' Impact
(acres)
Name of Watcrbody
(if applicable) Type of Watcrbody
(lake, pond. estuary, sound, I
? bay, ocean, etc.)

i
• List tact) impact separately and identify temporary impacts. Impacts include, but arc not limited to: fill, exct?vatlon, dredging,
flooding, dminagc, 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), C] uplands ? stream [] wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-dowr. valve or spillway, etc.):'
Proposed ase or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):-
Size _
Size of watershed draining to pond: Expected pond surface area:
VIZ. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful tp 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
techni Res to be followed during construction to reduce impact//s. `` 11
/ n . AA &rtj 5' iA in !1 n S?i h , /l -& p _
V111. 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
FTO!:110'd 08?.G# 03'd 7Ye SJKSf. £7.8+? t,'.Atiin ?[:?i ?;;??.. C2 ? lh
t
o?
flP
or Au
/ `?s Lp L?? \< Nast
flP
?ry9.
flP NOTE:
9' 14(.
Lots 29 Th
33 on M.B. 19
`? \ N ?kk? , ,?0 /•'? .? !ps ?/ / current 5 I
1.19 AC. hereon, as
(32 flP Court Sub
k k / ,? ?? a \ Instrument,
`` Z \ \ SD` tlgL ?.. / p k0? ' i / hereon.
\ al Np P ---- ?08.48 w VIA /
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Ep N81'1
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1 s? s qA \ A
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14
_IP 29 J ' ?EiP % `"v
O
40
NIP (B)
1 ? CONTROL v`5 U ?0?; / ??
I I CORNER b
in Conc.. ?Q
CONTROL ,<If,-
CORNER
CIL CURVE DATA NOTE
NUMBER DELTA CHD. BEARING TANG'T. RADIUS LENGTH NON - BUILDABLE.
C11 6734'54" S76'55'28`E 153.92 230.00 255.83 '
C12 2000'00" S5256 54"E 86.54 Soo.oo 170.54 --- LOT 29 TO BE USED FOR SEPTIC
C13 04.26'14" N423851"E 30.99 eoo.oo x1.94 TANK DRAIN FIELD LINES FOR LOTS 32 AND 33,
AtOCK A.
i
i
!
!
i
t
USAC - accor ce w7 the Final Notice ssuance ands o' "o `ationwide
'ermpub edQ t Register on rch 9, 2000, m' >ou wt equir> en
necess to ensarc that vor effects the uatic e . o ant are minimal. acto
inciu n maize and type of p -ed i act and 'f rAo and ro tive valtic of the im acte
squat, s urce dete z 'n aability appropriate and prac:icablc `?
mitig s d. Examples of miti t at Ynay a app:,o iate and practicabl.c in I ,
but are not limited to: re1t? " the size the of estahli^ g and maintaining 1, V
and/or upland vegetated buff s to e s ch as str, uns; and replacing loss
aquatic resource functions an values i r •t., ring, enh' icing, or preserving sup
functions and values, preferablin the 0,44rsh
! v i
It mitigation is required for th s ro'cc a v o't e i ation in must be attached in r er
p P,
for USAF' or DWQ to con?ider the applicatio r lete for ocessing. Any appli on
lacking a fired mitigation plan rni,the l' ence all be placed on hold as
incomple . a cant may also eh s rrent gui elines for stream restoration
in DWQ e ' ' al Guide for S.tre k in N` th Carolina, available at
hrp:/,'; 2o.enr.strte.ra dllcwe slst .h m .
i. Pr id brief description: a prop e 1018 t plan. Tb description should provide
as c inforrna? o ai , 'neludr b ited to; is e location (attach directions
and/or map, if offsite), ted stre an i e bas. h. type and amount (acreage/linear feet)
i't•'?,
? preservation), a plan vie?-?
of mitigation proposed (r?storatten, en e creation o
i preservation mechanism (e.g., de conservation easement, etc.), ;an'? `
description of the current site co posed method o' .. construction. Please attaeh .
a : rate sheet if more spttce is _
0 .
17
fi,
d
i 2. Mitigation may also he made by payment into the North C olina Wetlands Restorati ?
Program (N%11WRP). Pleas note it is tine applicant's responsibil ty to contact the NCW 1P
[phone] to determine availability and to request written approval of mitigation pri
to submittal of a PCN. F& additional information regarding application process for t
NCWRP, check the NC9 P website at http://h2o.erx.state.nc ?'is,'wr 'index.htm. If use
the NCWRP is proposed, please check the appropriate box o 'i page three and provi
following information:
i
Amount of stream mitigation requested (linear feet): ?""? .
Amount of buffer mitigation requested (square feet):T !Y; _
Amount of Riparian wetland mitigation requested (acres)
Amount of Non-riparian wetland mitigation requested (acres):_____

IX. Environmental Documentation (required. by DWQ)
Does the project involve anj expenditure of public (federal/state) funds
(federal/state) land? i ,-----
Ycs F", NoI =
If yes, does the project require preparation o enviromn , tal d curnent
requirements of the Nationah or North Carolina. ironnaeifal Po.
Note: eer-ziie-rrdr"SMe,j whctlicr a NEPA/ A document is
coordi r t 4 5083: o review Curren resholds for en-, ent r,
If ye, ' a the?deeaau4rs ,
copy f t}i NEPA or SEPA
r
X.
Proposed Impacts on
It is the applicant's for agen
required state and local buff
justification for these impacts
and must leanly identiflat
map, whe of impact
Regional a ma inc.
applicant's discre
Will
Water Supply Buffer RequA
Yes 0 No
Identify the square feet and
mitigation is required calcu
multipliers.
0
and
}
? Sectit:
on the
are prc
ded as
use of public
pursuant to the
PA/SEPA)?
c the SEPA
! Ien all t50+; -% 1 r
Clearinghouse? if so, please attah a
(required by DWQ)
i i o dW ine, delineate and map all impact- .
,e i h ro eet. The applicant must also pr v' e
0
V
II aboe roposed impacts must be listed h -?,
%r%?in t plan. All buffers must be show; on a
>?e 1 bu ris. Correspondence froth the DWQ
)pro priatt. It graphs may also be included at the
6
iipariat Ptl 'rs?• tHied within 15A NCAC 2B A233
-Pam i • 1 AC 213 .0250 (Randleman Rules and
o er ide tify_ )?
If you a s", provide the following information:
ch zone of the riparian buffers. If r
amount of mitigation by applying the ttf 40,
Zone* I lrnpact
t!sgoare feet)
Multiplier Require
Mitigation
! 3
2 ' 1.5
Total
1 ? G
i ?
e - d
a :
70nt 1 cxteads oul 3 fcOt perpendicular from nca bunk ofchanncl. onZ c 2 extends in-
additional 20 feet from the edge of 7one 1.
i
i
I
I
f
Page I I of 12
?TO!Z:o`d 08x94 egu Wd 21nysn £Z8S9G86T6 £1::9T ZOOi52`T?_i'
¦
Is this
2H .0500) or any Buffer Rules?
XIV. Other Circumstances (Optional):
It is the applicant's responsibility t sufficiently in advance of desired
construction dates to allow ptocessing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
gie Wapplication Agent's Si4e1 t bate
work schedules (e,g., draw-down schedules for lakes, dates associated with Endangered and ilk
Threatened Species, accessibility problems, or other issues outside of the applicant's contro C
i Al
(.Agent's s
i
I
£iC'!£t0'c ?895?

If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Basement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buf? r Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 20.0242 or.0260.
Xl. Stormwater (required by
Describ
Discuss
downsk
X11. Sewage Disposal (required b;
Clearly detail the ultimate tre
wastewater generated from the
XIIL Violations ?i
is this site in
?V
4ZA11 r--4
is valid only f an authorization letter from the applicant is provided.)
Page 12 of 12
o ? C
O C'
X311 'It»3 Eoysn £7,8?L8616 fit:91
^,'3Z.': '?[:=

2602 i

Office Use Only: ? Form Version May 2002
USACE Action ID No. DWQ No.
(if any panicular itorn is not app iuabie to this project, please enter "Not Applicable" or "NA".)
1. Processing
i 1. Check all of the approval(s) requested for this project:
X Section 404 Permit Riparian or Watershed Buffer Rules
j Q Section 10 Permit [] Isolated Wetland Permit from DWQ
C] 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested:
??
I
j 3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here:
4. If paymet'it into the North Caroline: Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability A th N('1WRP prior to submittal of PCN), complete
section VIII wid check here: ?
5, If your project is located in any of North Carolina's twenty coastal counties (listed o
Y ) o 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:
Ill. Applicant Information
I . Owner/Applicant Information
Name: G r /4a A
Mailing Address:
j Telephone Number:_ 2- P?x Number:
I E-mail Address: _
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has si natory authority for the owner/applicant.)
CotrpanyAffiliation: Mailing Address: ,$ a k GA
Q3
i
I
Telephone Number. Z Fax Number:
E-mail Address:
Page 5 of 12
'C•/ 1) 0*d 011a11; # - Z?CN ?oC Sn F7 ?: r`?%.?f Yittl n1:01 4 Rd

1:1I. Project Information
Attach a vicinity neap 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 properly
botndaries and development plans in relation to surrounding properties: Both the vicinity snap
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 1 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 ofproject: .1f/i? _.r
2. T.I.P. Project Number or State Project Number (NCDOT Only):_ r
3. Property Identification Number (Tax PIN):_ ?Z 7?d -?17
4. Location
County: /UfSb Nearest Town:
Subdivision name (include phaseflot number):A?Idr?
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. Property size (acres): _ f ..
7. Nearest body of water (strew the ound/ocean/iake): , e4
8. River Basim, ; i _
(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/adrnin/maps/.)
9. Describe the existi pconditions op th? site and general land use in the vicinity ofproject
at the time of this a (`cation: ?a- / C PAP i/I
Pa?e 6 aP 12
Es7`
?o S?La?
ort rryl ?
E?0 /LCA "d 0830 ?3d I:vd 20vsn CUS9L86191 Ot:9 i Z00'LSZ'^.: r
fin..... ? lll?r5!!1
10. Describe the overall project in detail, including he)ype of equipment to be used:
11. Explain the purpose,of the proposed.work:
IV. Prior Project History
If jurisdictional determinations and/or permits have bean requested and/or obtained for this
project (including all prior phases of the samc 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 sane T.I.P. project, along with
cor? y?n schedules.
V. Future Project Plans
Are any future permit requests anticipated for this project? if so, describe the anticipated work,
and pro,,v^de justification for the exclusion of this work from the current application.
VI. Proposed Impacts to Waters of the United States/Waters of floe 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 V11 bclow. 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 9 of 12
ETQ!8C4'd 0895 J?`d TIN' Is 1 U@99LB616 :::'?T ZOOZ.97' :CS
111W 'I, 611 ' P I•idlidllAlg
1. rovide a written description of the proposed impacts:- ,oaled4- SA 6 L(,'
2. Individually list %vetland impacts below:
Wetland Impact
Site Nvniher
(indicate on map)
Typc of Impact" Area of
Impact
(acres) Located within
100-year Floodpiain"
ea/no) Distance to
Nearest Stroam
t (linear feet) i
Type of Wetland'
I
ff

I

List earn impact ae?aratciy and identity temporary Impacts. impacts include, but arc not iirtuted to: me^-Cantxed eiearing, gradma UU,
excavation, flooding, ditchingrdrainage, W. For dums, separately list impacts due to both structurc and flooding.
100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodpiain maps. Maps are available through the FEMA Map Service Center at 1-800-358.4616, or
online at httr,//www,fema.%1
••• List a wetland type that best describes wodand to be impacted freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be mado by USACE only).
List the total acreage (estimated) of all existing wetlands on the property:
Total area of wetland impact proposed:_
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Sitc Number
(indicate on map)
Type of Impact" Length of
Impact
(linear feat
Stream Name" Average Widtlt
of stream
Before Impact I'ertnnial or
Intermittent?
(please specify)

List, caert impact separaioty ana tacxttiry tcmporury tmpuezs. impacts; mcwae, out act: not umat:.o to: cu;vQns arts assocnacr, rip-rap.
dams (separately Hat impacts due to both structure and flooding), relocation (include linear fat before and after, and net toss/gain,),
stabilization activities (ccmcnt will, rip-rap, crib will, gabions, etc.), excavation, ditching/straightening, cte. 1f stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must ba included.
Stream narttcs enact 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, USES maps are available through the USGS at 1-800-358-9616, or online at
wwwmsujoy. Several intcrnet sites also allow direct download and printing of USGS maps (c,g,, www.tor.K)Zone.wrn,
www_,x,lsirnl:e?6e?.xn, etc.),
Cumulative impacts (linear distance in feet) to all streams on site:
Page 8 of 12
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i ' EP
4'
\< / oNost
9• \ E1P
N +? /. i AO EIP NOTE'
\ 4 Lots 29 Th
33 / l on M. B.
19
°S current 5 t
/ 1.19 AC. , hereon, as
ti (32 County Sub
Sp'••? /•'? kg pk VP /• ?? sar / Instrument,
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C'1 \ EIPtiA? sG ; A'Qo? ?taP AoA?o R/
/
1 o ?'E` 4ty, ti, I 1 `.0 3r 0.
.0 3r.
SP lp
70
' s. 2.26 AC. A, /
I I ,(? m 3r1 _ _ NIP
%
O I i ?? tis S/ F 0 P S A? \ (!S, dog/ r
O % `f0 ?1? 1 J?$ 7 ?0 ?9C NgCF "i{/
I ?/y % 9\??, Q ?e SNIP",
ySiDF?SF /%
4&
4q4;." 29- EIP
\ 601. (A) 41
O
I I J410' "N, NIP
I " ? CONTROL '? rJ ?,p?k p0tih
I S CORNER
41,
in Conc.. ?Q
CONTROL <?k
rr CORNER
C/L CURVE DATA NOTE'
NUMBER DELTA CHO. BEARING TANGT. RADIUS LENGTH NON - r
C11 673454" S76'55'28"E BUILDABLE.
C 12 20'00'00" 153.92 230.00 255.83
S52'5654"E 86.54 500.00 170.54 - - - LOT 29 TO BE USED FOR SEPTIC
C13 04'26'14" N4238'51E 30.99 600.00 61.94 TANK DRAIN FIELD LINES FOR LOTS 32 AND 33,
BLOCK A.
AG,yAL?"

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 map)
a of Impact*
?'P Area of
Impact

(acres)
Name of Watle)

(if applicable) Type of Waterbody
i
(lake, pond, estuary, sound,
bay, ocean, etc.
i

List cacti impact separately Hnd identify tempOrtuy impacts. Impacts include, but are not limited to, till, excavation, dredging,
flooding, drainage, bulkht:ads, etc.
5. 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 F-1 stream [] wetlands
Describe the method of construction (e.g., dandembankment, excavation, installation of
draw-down. valve or spillway, etc.):
Proposed use or purpose of pond (e.g., 1'vestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): ?>r -
Size of watershed draining to pond:___,_ Expected pond surface area:
VIZ. 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 red ce impacts.
01 e
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
EITVOIt0'd 089y# 03d 7YE ZnV2n. £7Rtiy;.A616 ?.rtai

US
necessarS7-to ensure that 'a
inciudpj?.4-iae and type of
mitig s d. Exf
but are not limited to: re
and/or upland vegetated ba.
aquatic resource functions
functions and values, prefer,
li mitigation is required for
for USAC or DWQ to c
lacking a iced mitigal
incomple . . a -cant m
in DWO ' r-eMuzu
1.
the Final Notice
I Registry on h
?r effects the
o ed i act and
dete r 'n
Ales of miti t a
the srze the
•s to a
i values;Ati
in thersh
IS projee a py i
,ides th applicatio
r plan r P
also ch s
Guide for S.tre
1N4-Jst asknh r f.
W
e prop9kSe'it Oi
as-mmen rrtormauo o?si nc
and/or map, if offsite), ii!Y?Fted stre
of mitigation proposed (restoration,
preservation mechanism (e.g., deg
description of the current site co
a ;1?,r to sheet if more space i
tion n n must be attached in r or
for ocessing. Any appli ea
nee all be placed on hold as
snt gui elines for stream restoration
in N` th Carolina. available at
S?

plan. 7h description should provide
Cited to; s e location (attach directions
type and amount (acreageilinear fret)
cation, o .. preservation), a plan vie
onservati n. easement, etc.), ;an+jr-A
method of construction. Pleas4 xr.aq
r.
_ - - `_ Q

4L
2. Mitigation may also he made by payment into the North C" olina Wetlands Restorati
Program (NCWRP). Please note it is the applicant's responsibil.ty to contact the NC! W
[phone] to determine availability and to request written approval of mitigation pri
to submittal of a PCN. F6r additional information regarding application process for t
NCWRP, check the NCWRP website at Irttp:i/h2o.enr.state.nc. is,!,.-,r 'irrdex.htm. If use
the NCWRP is proposed, !please check the appropriate box o `+ page three and provi
following information:
Amount of stream mitigation requested (linear feet): AM
Amount of buffer mitigation requested (square feet):T
Amount of Riparian wetland mitigation requested (acres) _
Amount of Non-riparian wetland mitigation requested

rssuance and; o'' `o `ationwide
91 2000; m'•'' tIon wt eduire en
ratic e : orYt gent are minimal. a:•?tori
O and re tive value of the im of the aete
fob al+iiity appropriate and practicablc
ray . appro Late and practicable inqadt,
estahlish1 g and maintaining wt4akyd
s ch as str, )s; and replacing lossd -ef
:!;ring, eft rcing, or preserving sinriiar
IX.
i
?
i
Environmental Documentation (required. by DWQ)
Does the project involve an! expenditure of public (federal/state) I
(federal/state) land? j .____..?..
Ycs ? NoI .??
If yes, does the project req} ire preparation o envirotun . tal
requirements of the National or North Carolina ironnaeial P
Note: _ a whether a NIEPA/ A document is
coordl r t 9 "5083o review Curren resholds for en
(-i No?f-1 i n.
If yo,ke-dbwaaep,.
copy f th NEPA or SEPA
0
X.
Proposed Impacts on Rip
It is the applicant's (or agen
required state and local buff,
justification for these impacts
and must kdiqcre y identifiab
map, whof impact,
Regional ma inc;
applic:ant'Will roje ct impact pZ
(Neus ' ' 460:
Water Supply Buffer Requii
Yes [] No 0
and
s)
I Sectio VII ab
on the
are pro 0
:9ed as, ppromi
Identify the square feet and acreage
mitigation is required calculate t14
multipliers.
i
uiwt rC."JT, !,, ;P,
use of public
pursuant to the
tKSPA/S EPA)?
call the SEPA
Clearinghouse? If so, please attach a
(required by DWQ)
ne, delineate and map all impac
,ct. The applicant must also, pr ' e 0
roposed impacts must be listed hv•n,
plan. All buffers must be shown on a
rs. Correspondence from the DWQ
)graphs may also be included at the

0
nparsf )u tl •rs tified "Rhin 15A NCAC 2B .0233
-Pam • , 1 0 AC 2B .0250 (Randleman Rules and
o er p ide tify_ )?
If you ??{{-e s", provide the following information:
ch zone of the riparian buffers. If r
amount of mitigation by applying the of

Zone i Impact
4quare feet)
Multiplier Required
Mitigation 11
I ' 3
2 1.5
Total
V ?CP
C
lone I extends out 30 fast pupendicular from near bank of chamci; Zone 2 extcnds an
additional 20 feat from the edge of 7one t-

j
I
I
Page 1 I of 12
£T01Z:0'd 08954 egd Zl+d 211isa £Z8S9L86T6 C7:9T ZOOZ,47'Z%i

i

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 BuOer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 20.0242 or.0260. I - -
XI. Stormwater (required by
Discuss
from the
Y11. Sewage Disposal (required b,
Clearly detail the ultimate tre
wastewater generated from the
X1II. Violations by
Is this site in vio a ' f
existing a proposed) ver total acreage on
sed i orde6oj?pro surface waters and
V
M -ds *d' ition (non-discharge or disc f
d r r at capacity of the subject fae iyrl
0
2H .0500) or any Buffer Rules?
Is this it aplic 'on? 00 0
Yes ? No 00
XIV. Other Circumstances (Optio"l):
It is the applicant's responsibility t e application sufficiently in advance of desired
construction dates to allow plbcessing time for these permits. However, an applicant may
choose to list constraints associated with constriction or sequencing that may impose limits on
work schedules (e,g,, draw-dokvn schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's contro ----?`
Applicant/Agent's Sigdature Date
(.Agant's signature is valid only Sfan authorization letter from the applicant is provided.)
Page 12 of 12
C
C
o C
C? 0
i0!£i0'?T OE+a5# S31d Z" SOYSn CUS9LS616 vl*-OT
O?O? W AT "IRpG
r
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 Quaffty
August 1, 2002 _
Frankie Faithful
2685 South Old Carriage Rd.
Rocky Mount, NC 27803
Dear Mr. Faithful: ?S
JJ
-<- On 08/01/02, your application for 401 Water Quality Certification for the construction of a bulkhead on
Lot # 32 in the Wind Chase Subdivision located in Nash County.
-eemrtyr Please note that beginning January 1, 1999, the N.C. General Assembly passed legislation requiring
payment of a fee for all 401 applications, as indicated on page two of the PCN application form. Your
application is being returned since no payment was received with the package, nor was the application signed.
The fee for applications is $200 for projects impacting less than an acre of wetland and less than 150 linear feet
of streams. For projects impacting one or more acres of wetland or 150 or more feet of streams, the fee is $475.
In order for DWQ to review and process your request, you must send a check in the appropriate amount made
payable to the N.C. Division of Water Quality attached to your application.
Please note that this information has been sent to the Raleigh Regional Office for a site review to be conducted.
This site review is for the compliance of the Tar- Pamlico Buffer Rules.
-<- Please call me at 919-733-3575 or visit our web site at http://h2o.enr.state.nc.us/ncwetlands if you have
any questions regarding this fee.
Enclosure or Attachments
CC:
Sincerely,
Michael Horan
Environmental Tech.
,/ham. db rc?.r? ?,1 G-?@ Q-
aA& 6.0- o, ire ce,.-? Cuj
l i--2 r"Q?.
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone]
Customer Service
1 800 623-7748
.
p A
l
L'i 44 3 Z
fe.. ti b w?-
??t?or ?rvL ?'LR S s', /A
194
ro.JL? A ;,*If / $??P, rHowf'
?i 4eeef 4^ 61(AFF AeeJs 4t' mdae uf[
W ArF
V R Michael F. Easley, Governor
O?
pG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
\
?- Alan W. Klimek, P.E. Director
> Division of Water Quality
o ?

August 1, 2002 J2 E'
Frankie Faithful
2685 South Old Carriage Rd.
Rocky Mount, NC 27803
Dear Mr. Faithful:
On 08/01/02, your application for 401 Water Quality Certification was received by the Department of Water
Quality for the construction of a bulkhead on Lot # 32 in the Wind Chase Subdivision located in Nash County.
Please note that beginning January 1, 1999, the N.C. General Assembly passed legislation requiring payment of
a fee for all 401 applications, as indicated on page two of the PCN application form. Your application is being
returned since no payment was received with the package, nor was the application signed. The fee for
applications is $200 for projects impacting less than an acre of wetland and less than 150 linear feet of streams.
For projects impacting one or more acres of wetland or 150 or more feet of streams, the fee is $475. In order
for DWQ to review and process your request, you must send a check in the appropriate amount made payable to
the N.C. Division of Water Quality attached to your application.
Please note that this information has been sent to the Raleigh Regional Office for a site review to be conducted.
This site review is for the compliance of the Tar- Pamlico Buffer Rules.
Please call me at 919-733-3575 or visit our web site at http://h2o.enr.state.nc.us/ncwetlands if you have any
questions regarding this fee.
Sincerely,

Michael Horan
Environmental Tech .
Enclosure or Attachments
CC:
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone]
OEN-R
Customer Service
1 800 623-7748
UNITED STATES POSTAL SERVICE

• Sender: Please print your name, address, ahd ZIP+4 in this box •
NC DFNR Division of Water Quality
Wetlands/401 Certification Unit
2321 Crabtree Boulevard, Suite 250
Raleigh, NC 27604
First-Class Mall
Postage & Fees Paid
USPS
Permit No. G-10

¦ Complete Items 1, 2, and 3. Also complete
Item 4 if Restricted Delivery Is desired.
¦ Print your name and address on the reverse
so that we can return the card to ynu.
¦ Attach this card to the back of the mallpiece,
or on the front if space permits.
1. Article Addressed to:
Mike Arrington
306 18t" Street
Butner, NC 27509
DWQ# 02-1368 - Granville
2. Article Number
Monsfer from service lab& _
P3 Form 3811, August 2001
A. Sign ure
X
B. Repeived by (
D. Is delivery address Ifferent froItem 1? ? Yes
If YES, enter delivery address Blow: ? No
3. S Ice Type
a"c rtifled Mall ? ExI
C Registered m'Rel
? Insured Mail ? c.C
4. Restricted Delivery? (Extra
7002 2410 0003 0275 1529
Domestic Return Receipt
mail
ecelpt for Merchandise
? Yes
102686.02-M•164
UNITED STATES POSTAL SERVICE

• Sender: Please print your name, address, and ZIP+4 in this box •
NC DENR Division of Water Quality
Wetlands/401 Certification Unit
2321 Crabtree Boulevard, Suite 250
Raleigh, NC 27604
First-Class Mail
Postage & Fees Paid
LISPS
Permit No. G-10

¦ Complete items 1, 2, and 3. Also complete
Item 4 If Restricted Ceiivery is desired.
¦ Print your name and address on the reverse
so that we can return the card to you.
¦ Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
Michael Chappell
306 18"' Street
Butner, NC 27509
DWQ# 02-1368 - Granville
2. Article Number
(Ransfer from service label) -
PS Form 3811, August 2001
A. Signature
B. Received by (
? Agent
C. Date of
D. Is delivery address different frog Item 1? 0 Yes
If YES, enter delivery address below: ? No
3. Se ce Type
ECertified mail ?
Ex;
? Registered ?
l7 Rel
? Insured Mall ? C.C
4. Restricted Delivery? (Extra
I Mail'
Receipt for Merchandis
7002 3150 0004 9315 2769
Domestic Return Receipt
102595.02-M-1 &