20030587 Ver 1_COMPLETE FILE_20030512

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DWQ Project No.: J-3 County: (-4-uwticZe'n
Applicant:
Project Name: ?o ?3 ,mac©??'S ?.Y - ? > e""?5 c-
Date of Issuance of 401 Water Quality Certification:
Certificate of Completion
Upon completion of all work approved within the 40.1 Water Quality Certification and Buffer Rules,'and any
subsequent modifications, the applicant is required to return this certificate to the 401/Wetlands Unit, North
Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC, 27699-1621. This form may be
returned to DWQ by the applicant, the applicant's authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
Appllcant's Certlflcat/on
I, C'r, Q , hereby state that, to the best of my abilities, due care and
diligen s used in the observation of the construction such that the construction was observed to be-bull t
within substantial' compliance and Intent of the 401 Water Quality Certification and Buffer Rules, the
.
approved plans and spectfl t s, and other supporting materials..
-
Signature: Date:
.
Agent's Certification
I, , hereby state that, to the best of my abilities, due care and
diligence was used In the observation of the construction such that the construction was observed to be built
within substantial compliance and Intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials. WETLANDS/ 401 GROU0
Signature:
if this protect was designed by a Certified Professlonal
Date: APH 2.2004
vimwsatts r. "Ways %avvtniwt
William Q. Roes Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
WATER QUALITY SECTION
I, as a duly registered Professional (i.e.,
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized to
observe (periodically, weekly, full time) the construction of the project, for the Permittee hereby state that, to
the best of my abilities, due'care and diligence was used in the observation of the construction such that the
construction was observed to be built within substantial compliance and Intent of the 401 Water.Quality
Certification and Buffer Rules, the-approved plans and specifications, and other supporting materials.
Signature:
Registration No.
Date

N. C. Division of Water Quality, 401 Wetlands Certification Unit,
1860 Mall Service Center, Raleigh, NO 27899.1650 (Malling Address)
2321 Crabtree Blvd., Raleigh, NO 27804-2260 (Location)
[phone] (phone), 919-733-8893 (fax), (httpJ/h2o.enr.state.no.uatnewetlands
United States Department of the Interior
FISH AND WILDLIFE SERVICE
Raleigh Field Office
Post Office Box 93726
Raleigh, North Carolina 27636.9726
April 18, 2003 APR 4 ?003
Mr. William Wescott
U. S. Army Corps of Engineers
Washington Regulatory Field Office
P. O. Box 1000
Washington, North Carolina 27889-1000
Subject: ID No. 200310492, J. G. Winslow, Camden County, North Carolina
Dear Mr. Wescott:
This letter provides the comments of the U. S. Fish and Wildlife Service (Service) on the subject
Pre-Construction Notification (PCN), dated April 1, 2003. The applicant, Mr. Jay Garnett
Winslow, has submitted an application for a Department of the Army (DA) Nationwide Permit to
fill a 0.1-acre area of forested wetlands on Lot 73 within the Dances Grant subdivision, Camden
County, North Carolina. The permit is requested to achieve the desired location for a house with
a detached garage. These comments are submitted in accordance with the Fish and Wildlife
Coordination Act (48 Stat. 401, as amended; 16 U.S.C. 661-667d) and section 7 of the
Endangered Species Act (ESA) of 1973, as amended (16 U.S.C. 1531-1543). They are to be
used in your determination of compliance with 404(b)(1) guidelines (40 CFR 230) and in your
public interest review (33 CFR 320.4) as they relate to protection of fish and wildlife resources.
According to information in the PCN and supplied verbally by you, the existing lot is entirely
forested and adjacent to Ameuse Creek which flows into the Pasquotank River and Albemarle
Sound. The Service considers such riparian forests to have high value for fish and wildlife
resources. Such forests on the coastal plain provide a host of ecological functions. They
improve water quality by controlling erosion and removing nutrients which would otherwise
cause unwanted enrichment of downstream estuaries. They also remove suspended sediment,
retain stormwater runoff, and recharge groundwater. They serve as buffers for inland areas
against the impacts of storms. Wetlands, such as those along Arneuse Creek, provide valuable
nesting, roosting, and foraging habitat for resident and migratory waterfowl, hawks, owls, wading
birds, and songbirds, including neotropical migrant birds, many of which have shown population
declines in recent years. Resident wildlife species include numerous small mammals, game
animals, reptiles and amphibians.
The wetlands in the project area are especially important to aquatic organisms and contribute to
the production of recreationally and commercially important fisheries and shellfisheries. The
organic matter lifted by flood waters from the floodplain and carried downstream is an important
part of the estuarine food chain. Such nutrient inputs are valuable in maintaining the biological

productivity of wetland and aquatic habitats in lower portion of the Pasquotank River and farther
downstream in Albemarle Sound.
These swamp forests are important nursery areas for anadromous fish such as striped bass
(Morone saxatilis). In late winter and early spring, adult fish may feed in flooded bottomland
hardwood forests. These forests slow the flow of freshwater during flood stages and thereby
protect estuarine fish and shellfish nurseries from harmful changes in salinity. The North
Carolina Division of Marine Fisheries estimates that North Carolina has already lost 34 percent
of its coastal wetlands which are important fish habitat. One of several activities responsible for
these losses is filling of coastal wetlands.
In light of both the ecological and economic values of the wetlands in the project area, adequate
compensatory mitigation for unavoidable losses is essential. The Service advocates that wetland
compensation consist of two components. First, there should be a minimum of one-to-one
restoration of wetlands with a strong emphasis on in-kind replacement near the area of impacts.
The second component should consist of either one additional acre of wetland restoration, two
acres of enhancement, three acres of creation, or five acres of wetland preservation. This two-
tiered approach is necessary to ensure that there is no net loss of these wetlands and fully account
for the extended time lag required for the restored wetlands to become fully functional. This is
especially critical for forested wetlands which may require decades to completely replace the fish
and wildlife habitats lost.
The PCN states that the applicant is willing to participate in the wetland mitigation program
available to residential landowners. We believe this offer refers to the North Carolina Wetland
Restoration Program (WRP). If the Corps determines that wetland impacts have been minimized
to maximum extent possible, the Service recommends acceptance of this form mitigation as the
restoration component of compensation plan.
The PCN also states that the applicant is willing to preserve the remaining wetlands on the lot
through a deed restriction. There would be approximately 1.5 acres of wetlands that would not
be impacted by the proposed work. The Service strongly supports preserving the existing
forested wetlands on the lot as the second component of compensatory mitigation. The
preservation of the forested wetlands could be accomplished by establishing a conservation
easement on the remaining wetlands within the applicant's property. This conservation easement
should include all the prohibited and restrictive activities given in Article II of the Corps' model
conservation easement (available at http://www.saw.usace.army.miI/wetlands/Permits.htm),
revised in October 2002. The I 1 restrictive activities include (Sections A-K) measures to
prevent the introduction of non-native plants (A); construction of paved surfaces or utility poles
(B); any cutting of trees, shrubs, or other vegetation (E); any change in topography (H); certain
changes to drainage patterns (I); and, the operation of mechanized vehicles (K). These prohibited
and restrictive activities within mitigation streams and wetlands should be part of the permit
conditions and become part of the property deed.
Currently, the only Federally listed species known to occur in Camden County is the red-
cockaded woodpecker (Picoides borealis). This species inhabits mature, upland pine forests and
is not likely to occur in the project area. The American alligator (Alligator mississippiensis) has
also been reported in Camden County, but is only list due to similarity of appearance and is not
subject to section 7 consultation. Therefore, the proposed action is not likely to adversely affect
any Federally-listed endangered or threatened species under our jurisdiction and that the Corps'
requirements under section 7(a)(2) of the ESA would be satisfied. We remind you that
obligations under section 7 consultation must be reconsidered if: (1) new information reveals
impacts of this identified action that may affect listed species or critical habitat in a manner not
previously considered; (2) this action is subsequently modified in a manner that was not
considered in this review; or, (3) a new species is listed or critical habitat determined that may be
affected by the identified action.
Overall, the Service does not oppose issuance of the requested DA permit if the Corps has
determined that all feasible measures have been taken to avoid and minimize wetland impacts.
However, we do request that complete and adequate compensatory mitigation be required by the
Corps for the unavoidable wetland losses. We also request that all elements of a compensatory
mitigation plan, including any formal conservation easement or deed restrictions, be established
prior to the issuance of the DA permit.
We appreciate the opportunity to provide these comments for the protection and enhancement of
fish and wildlife resources. Please advise us of any action taken by the Wilmington Corps
District. If you have questions regarding these comments, please contact Howard Hall at 919-
856-4520 (Ext. 27) or by e-mail at [e-mail].
Sincerely,

Garland B. Pardue, Ph.D.
Ecological Services Supervisor
cc: Kathy Matthews, USEPA, Athens, GA
Ron Sechler, NOAA/Fisheries, Beaufort, NC
David McHenry, NCWRC, Washington, NC
John Dorney, NCDWQ, Raleigh, NC
Sara Winslow, NCDMF, Elizabeth City, NC
VVA
O 9 Michael F. Easley, Uovernor
H
Q William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
`O
G
r Alan W. Klimek, P.E. Director
>_ y Division of Water Quality
0
June 11, 2003
DWQ# 03-0587
Camden County
Mr. Jay Garrett Winslow
135 Perkins Rd.
Camden, NC, 27921
APPROVAL of 401 Water Quality Certification with Additional Condition
Dear Mr. Winslow:
You have our approval, In accordance with the attached conditions, to place fill in 0.099 acre of wetlands in order to construct a
residence on your lot in Camden County, as described in your application received by the Division of Water Quality on May 12, 2003.
After reviewing your application, we have decided that this fill Is covered by General Water Quality Certification Number 3402, which can
be viewed on our web site at htta:Hh2o.enr.state.nc.us/ncwetlands . This Certification allows you to use Nationwide Permit Number 18
when issued by the U.S. Army Corps of Engineers. In addition, you should get any other federal, state or local permits before you go
ahead with your project Including (but not limited to) Sediment and Erosion Control, Coastal Stormwater, Non-Discharge and Water
Supply Watershed regulations. Also this approval will expire when the accompanying 404 permit expires unless otherwise specified in the
General Certification.
This approval is only valid for the purpose and design that you described in your application. If you change your project, you must
notify us in writing and you may be required to send us a new application for a new certification. If the property is sold, the new owner
must be given a copy of the Certification and approval letter and is thereby responsible for complying with all conditions. If total wetland
fills for this project (now or in the future) exceed one acre, compensatory mitigation may be required as described in 15A NCAC 2H .0506
(h). For this approval to be valid, you must follow the conditions listed in the attached certification and the additional conditions listed
below:
1. Upon completion of the project, the Applicant shall complete and return the enclosed "Certificate of Completion" form
to notify NCDWQ when all work included in the 401 Certification has been completed. The responsible party shall
complete the attached form and return it to the 401/Wetlands Unit of the INC Division of Water Quality upon
completion of the project.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must act within 60 days
of the date that you receive this letter. To ask for a hearing, send a written petition which conforms to Chapter 150B of the North Carolina
General Statutes to the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its
conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If you have any
questions, please telephone Tom Steffens in our Washington Regional Office at 252-946-6481 or Cyndi Karoly in our Central Office at
919-733-9721.
Sincerely,
Alan W. Klimek, P.E.
AW K/cbk
Attachments
cc: Corps of Engineers Washington Regulatory Field Office
Washington DWQ Regional Office
Central Files
File Copy
030587
NCDM
N.
C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone] Customer Service
1 800 623-7748
MEMORANDUM
TO: John Dorney Regional Contact: tom steffens
Non-Discharge Branch WO Supervisor: Roger Thorne
Date:
SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS
Facility Name Jay Garrett Winslow County Camden
Project Number 03 0587 County2
Recvd From APP Region Washington
Received Date 5/12/03 Recvd By Region
Project Type residential
Certificates Stream Stream Impacts (ft.)
Permit Wetland Wetland Wetland Stream Class Acres Feet
Type Type Impact Score Index Prim. Supp. Basin Req. Req. ME
F18 OTH F770 N 30-3-13-(2) SB 30,150. 0.10 F F-
Mitigation Wetland
MltigationType Type Acres Feet
F- r F_
Is Wetland Rating Sheet Attached? Q Y O N Did you request more Info? Q Y O N
Have Project Changes/Conditions Been Discussed With Applicant? Q Y O N
Is Mitigation required? p Y Q N Recommendation: Q Issue O Issue/fond O Deny
Provided by Region: Latitude (ddmmss) Longitude (ddmmss)
Comments:
Issue n/c
cc: Regional Office
Central Office Page Number 1
i

a
Pre-Construction Notification (PCN) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality CertiFic:atious, aad Riparian Buffer and 'watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form-iS6uld not be used if you are requesting an Individual 404 Permit or Individual401
Water Quality Certification. The USACE Individual Permit application form is available online at
htt-P://www.saw.usace.army.mil/wetlands/Peim app htm.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at http://www.saw.usace.arrny.mil/wetlands/relatotir.htm, or contact one of the field
offices listed on page 3 of this application. The website also lists the responsible project manager for
each county in North Carolina and provides additional information regarding the identification and
regulation of wetlands and waters of the U.S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://h2o.enr.state.nc.us/ncwetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for General Certifications is not required, provided
that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet should
contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is required for projects occurring in North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant sh ? ate NCWRC
regional coordinator (listed by county on page 4 of this application):
MAY 1 2 2003
Page 1 of 12 WATE r QUALITVSECTtQA?
l?l I?
Coastal Area Management Act (CAMA) Coordination - If the project occurs in any of North Carolina's
twenty coastal counties (listed on page 4) the applicant should contact the North Carolina Division of
,. Coastal Management (DCM). DCM will determine whether or not the project is within a designated
Area of Environmental Concern, in which case DCM will act as the lead permitting agency. In such
cases, DCM will require a CAMA Permit and will coordinate the 404/401 Permits.
The applicant may also choose to coordinate with the United States Fish and Wildlife Service to ensure
that the proposed project will have no impact upon any endangered or threatened species or critical
habitat as regulated by the Endangered Species Act, and the State Historic Preservation Office, North
Carolina Department of Cultural Resources to ensure that the proposed project will have no impact upon
any properties listed or eligible for listing on the National Register of Historic Places. Compliance with
these regulations is required to be eligible for any Department of the Army permit. The addresses for
both agencies are listed on page 3 of this application.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office. Upon receipt of an application, the
USACE will determine if the application is complete as soon as possible, not to exceed 30 days. This
PCN form is designed for the convenience of the applicant to address information needs for all USACE
Nationwide, Regional or General permits, as well as information required for State authorizations,
certifications, and coordination. Fully providing the information requested on this form will result in a
complete application for any of the USACE Nationwide, Regional or General permits. To review the
minimum amount of information that must be provided for a complete PCN for each USACE
Nationwide permit, see Condition 13, 65 Fed. Reg. 12893 (March 9, 2000), available at
N!, 1-ittp://www.saw.usace.army.mil/wetlands/nyMfinalFedReg.-Pdf Processing times vary by permit and
begin once the application has been determined to be complete. Please contact the appropriate
regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at http://h2o.ehnr.state.nc.us/ncwetlands/fees.htrnl. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water. Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 12
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Caldwell Haywood McDowell Swai

US Army Corps of Engineers
151 Patton Avenue
Alleghany
Catawba
Henderson
Mecklenburg n
Transylvania

Room 208 Ashe Cherokee Iredell Mitchell Union

Asheville, NC 28801-5006 Avery
Buncombe Clay
Cleveland Jackson
Lincoln Polk
R Watauga

Telephone: [phone]
Burke
Gaston
Macon owan
Rutherford Yancey
Fax: [phone] Cabarrus Graham Madison Stanley
Raleigh Regulatory Field Office Alamance Franklin Nash Surry
US Army Corps Of Engineers Caswell Forsyth Northampton Vance
6508 Falls of the Neuse Road Chatham Granville Orange Wake
Suite 120
Raleigh
NC 27615 Davidson Guilford Person Warren
,
Telephone: [phone] Davie
Durham Halifax
Johnston Randolph
Rockingham Wilkes
Wilson
Fax: [phone] Edgecombe Lee Stokes Yadkin
Washington Regulatory Field Office
US Army Corps Of Engineers Beaufort
Bertie Currituck
Dare Jones
Le
i Pitt

P
t Off
B no
r Tyrrell
os
ice
ox 1000
Washington
NC 27889-1000 Camden

C Gates Martin Washington
,
Telephone: [phone] arteret
Chowan Green
Hertford Pamlico
Pasquotank Wayne
Fax: [phone] Craven Hyde Perquimans *Croatan National Forest Only
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
US Fig
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
h and Wildlife Service / National N
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 27699-4617
Telephone: [phone]
Fax: [phone]
larine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivers Island
Beaufort, NC 28516
Telephone: [phone]
Page 3 of 12
CAMA and NC Coastal Counties
Division of Coastal Management
1638 Mail Service Center
Raleigh, NC 27699-1638
Telephone: [phone]
Fax: [phone]
Beaufort Chowan
Bertie Craven
Brunswick Currituck
Camden Dare
Carteret Gates
Hertford Pasquotank
Hyde Pender
New Hanover Perquimans
Onslow Tyrrell
Pamlico Washington
Western Piedmont Region Coordinator
3855 Idlewild Road
Kernersville, NC 27284-9180
Telephone: [phone]
Mountain Region Coordinator
20830 Great Smoky Mtn. Expressway
Waynesville, NC 28786
Telephone: [phone]
Fax: [phone]
NCWRC and NC Trout Counties
Alleghany Caldwell
Ashe Mitchell
Avery Stokes
Burke Surry
Buncombe Henderson
Cherokee Jackson
Clay Macon
Graham Madison
Haywood McDowell
Watauga
Wilkes
Polk
Rutherford
Swain
Transylvania
Yancey
APPLICATION FORM BEGINS ON PAGE 5. PLEASE DO NOT SUBMIT PAGES 1 - 4.
Page 4 of 12
Office Use Only: Form Version February 2002
USACE Action ID No. gi ?j `-' ?o'q2 DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1.
IT.
Processing
1. Check all of the approval(s) requested for this project:
ection 404 Permit
? Section 10 Permit
? 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested:
7

3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII -Mitigation), check here: ?
Applicant Information
1. Owner/Applicant Information
Name:
Mailing Address: ?? ?'?rk'M s QJ
,
-1
Telephone Number: Fax Number: zsz - _-? = yid
E-mail Address:
2. Agent Information (A signed and dated copy of the Agent Authorization letter must be
attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
Page 5 of 12
III. Project Information
Attach a vicinity map clearly showing the location of the, property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be inc ded at the- applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable snaps are provided.
Name of project: '
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN) :
4. Location
County: Nearest Town: F E
Subdivision name (include phase/lot number): ' ' -
Directions to site (include road numbers, landmarks, etc.)LL: 34? Sawk, ??
...5. Site coordinates, if available (UTM or Lat/Long
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application:
7. Property size (acres):
8
9. River Basin:
Nearest body of water (stream/river/sound/ocean/lake):
(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/aclmin/maT)s/.)
Page 6 of 12
v 10. Describe the purpose of the proposed work:

11. List the type of equipment to be used to construct the project: % 77>o z
12. Describe the land use in the vicinity of this project: Rt'_ --,?-c(1 Q?
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 usefiil 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 7 of 12
I Provide a brief written description of the proposed impacts
/ p
J aiC-, ?.-. e•_.C': C'? ? t,{ t.?..JJ (?, ?,G ? ^i?.-?P C?y'I" r` f.. ?"' a .?`F"''f.`': ?e-? -? l"_ ? f nee f ( ("' fi !°r l
6^ ,
2. Individually list wetland impacts below:
Wetland Impact
Site Number
indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet)
Type of Wetland***
r7- i « }?;? ; awe

* T : _L
?u . i"IpauL Soparateiy anQ iaennry Temporary impacts. impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at htti)://www.fema.!zov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of all existing wetlands on the property:
Total area of wetland impact proposed: y?ro,??
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
(linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)

List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.uses.eov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.coni,
www.mapguest com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.

h T L
LIbL cacti impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
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 included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond)
local stormwater requirement, etc.):

Size of watershed draining to pond:
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 constriction
techniques to be followed during construction to reduce impacts.
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Expected pond surface area:

VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http ://h2o. enr. state.nc.us/ncwetlands/strmgide. html.
J 1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
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14
X' ??F.° A "w y?A ,C'"?^11Y?' E r R/^ INMpti PS..P r...
C°t.r!"•? My ,,6rt'??? c9??A ?" F"'l .".1. r"'.O CE^ P'T.".<'?? ??'? c5E• " > , i s*t? ...r+. ,.,,
p? f f'f' f.. !' e`c _,?. ?`('. ? ?' t, ?? ;?'?' ? ??(.?•r : °.F.,.?, _d:'? ?„? ,ran k w, ?
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration J
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be Irv
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants' o
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at http://h2o.enr.state.nc.us/wrp/index.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide,
the following information: V4,.
Al
'K Sw
Amount o stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet): ' wY
Amount of Riparian wetland mitigation requested (acres): V 1 r., ?, a W
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
r
Y ~3
Page 10 of 12 `'?
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ? No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No] If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(T square feet Multiplier Required
Mitigation
1 3
2 1.5
Total
-ut; emenus our )v ieei perpenarcuiar trom near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 11 of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 213.0242 or.0260.
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
XII. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
F
f' t? 1 y ?+ 9 ?"?. A
"3+.t_ Y1 V{ CAS ?XIII. Violations (DWQ Only)

Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No 0
Is this an after-the-fact permit application?
Yes ? No ?]
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).

(Agent's
plicant/Agent's Signature Date
is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
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Triage Check List
late: S , `I - ° 3 Project Name:
To: ? ARO Mike Parker
? FRO Ken Averitte
? MRO Alan Johnson
? RRO Steve Mitchell
From: Q Lt.
DWQ#: 0`2, - ()5,5 7
County: (f' QvyNje h
WaRO Tom Steffens
? WiRO Noelle Lutheran
? WSRO Cyndi Karoly (Central Office)
Telephone : (919) 7 3 3 ° 7 ?- G
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

;omments: A? kA Uinn tR 5