20120511 Ver 1_401 Application_20120512

Dennison, Laurie
From Homewood Sue
Sent Thursday May 24 2012 9 09 AM
To Dennison Laurie
Subject RE courtesy copy
Thx 111 go add the location
The USACE gave them that application in person
Sue Homewood
NC DENR Winston Salem Regional Office
Division of Water Quality
585 Waughtown Street
Winston Salem NC 27107
Voice (336) 7714964
FAX [phone]
E mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties
From Dennison Laurie
Sent Thursday, May 24, 2012 8 05 AM
To Homewood, Sue
Subject RE courtesy copy
DWQ 12 0511
Old PCN form I Tsk tsk
Also there are 9 Yadkin River entries to choose from in BIMs & without Lat /Long I don t know which entry to select
From Homewood, Sue
Sent Wednesday May 23, 2012 4 52 PM
To Dennison Laurie, Strickland, Bev
Subject courtesy copy
Sue Homewood
NC DENR Winston Salem Regional Office
Division of Water Quality
585 Waughtown Street
Winston Salem NC 27107
Voice (336) 7714964
FAX [phone]
E mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties
1

Office Use Only
USACE Action ID No
No
20 1205 1 1
Form Version May 2002
(If any particular item is not applicable to this project please enter Not Applicable or N/A )
Processing " ,
✓ 1 Ch ck all of the approval(s) requested for this protect F ��
Section 404 Permit C� sit- ❑ Rtparian or Buffer Rules
Section 10 Permit ❑ Isolated Wetland Permit from DWQ
9 401 Water Quality Certification /NCDIuGi
2 Nationwide, Regional or General Permit Number(s) Requested X&I .q
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 (verify availability with NCWRP prior to submittal of PCN) complete
section VIII and check here ❑
0( 5 If your protect is located in any of North Carolma'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 ❑
II Applicant Information
.� 1 Owner /Ap c
Name
Mailing Address
Telephone Number tJ� L3 Fax Number
E mail Address 4/ a c� v 4 C a �.
Agent /Consultant 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

III Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns rivers, and roads Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties Both the vicinity map
and site plan must include a scale and north arrow The specific footprints of all buildings,
impervious surfaces, or other facilities must be included If possible the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined Plan drawings, or other maps may be included at the applicant's discretion
so long as the property is clearly defined For administrative and distribution purposes the
USACE requires information to be submitted on sheets no larger than 11 by 17 inch format
however DWQ may accept paperwork of any size DWQ prefers full size construction
drawings rather than a sequential sheet version of the full size plans If full size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decgherable maps are provided
1 Name of project S
TIP Project Number or State Project Number (NCI)OT Only)
3 Property Identification Number (Tax PIN) .sg a DDDa 17 7
r
4 Location , Q
County Vaz i 1k,, k i Nearest Town etrS :1
Subdivisi n name (include phase/lot number)
Directions to site (include road numbers, landmarks, etc)
f5) Site coordinates if available (UTM or Lat/Lon
(Note — If project is linear, such as a road or utility line, attdch a sheet that separately lists the
coordinates for each crossing of a distinct waterbody )
6 Property size (acres)
7 Nearest body of water (stream/river /sound/ocean/lake)
vG8ti�l�° kl ' ir4 ie�i-
River Basin �
(Note — this st be one of North Garolma's seventeen designated major river basins
River Basin map is available at http //h2o enr state nc us /admin/ma12 )
MITI
9 Describe the existing conditions on the site and general land use in the -vicinity of the project
at the time of this application
Page 6 of 12

10 De ribe the overall project i detail, includ-ing the type o equipment to be used
B
11 Explain the purpose of the proposed work �i � 6 /1 Z
/ Prior Project History
If ,jurisdictional determinations and/or permits have been requested and /or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain Include
the USACE Action ID Number, DWQ Project Number, application date and date permits and
certifications were issued or withdrawn Provide photocopies of previously issued permits,
certifications or other useful information Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable) If this is a NCDOT project,
list and describe permits issued for prior segments of the same T I P project, along with
construction schedules
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 unpact in Section VIII below If additional space is needed for
listing or description please attach a separate sheet
Page 7 of 12

a written deacript� of the proposed impacts % `iq (. b� Ile t, -t --cr '
it-e/r► cry[' `I'K' -al A, I..,
(k Individually list wetland impacts below
Wetland Impact
Site Number
indicate on ma
Type of Impact*
Area of
Impact
acres
Located within
100 yearFloodplatn **
es /no
Distance to
Nearest Stream
linear feet
Type of Wetland * **
11
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* List each impact separately
and identify temporary impacts
Impacts include but are not limited to mechanized clearing grading fill
excavation, flooding ditchmg/dramage etc For dams separately list impacts due to both structure and flooding
** 100 Year floodplams 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 htta. / /www fema gov
* ** List a wetland type that best describes wetland to be impacted (e g freshwater /saltwater marsh forested wetland, beaver pond
Carolina Bay bog etc ) 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 ma
Type of Impact*
Length of
Impact
linear feet
Stream Name **
Average Width
of Stream
Before Impact
Perennial or
Intermittent?
leasespecify)
11
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* List each impact separately and identify temporary impacts Impacts include but are not limited to culverts and associated rip rap
dams (separately list unpacts due to both structure and flooding) relocation (include linear feet before and after and net loss /gam)
stabilization activities (cement wall np-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) tb the naarest
downstream named stream into which it flows USGS maps are available through the USGS at 1 800 358 9616 or online at
www usgs.aov Several intemet sites also allow direct download and printing of USGS maps (e g www topozone com .
www mapguest.com, etc)
Cumulative impacts (linear distance in feet) to all streams on site / yr
Page 8 of 12

XIndividually 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 p licabblele) Wat)
(if app
Type of Waterbody
(lake pond estuary sound
bay, ocean etc
* List each 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 ap lication
Pond to be created in (check all that apply) ❑ uplands stream ❑ wetlands
Describe the method of construction (e g, dam/embankment, excavation, installation of
draw down, valve or gpillway, etc ) &'XC4v Gk. P41- 13t4/1a' .34,
A r4 W =4Z a Glih d a J
Proposed use or purpose of pond (e g vestock watering, irri ation, aesth tic, trout pond,
local stormwater requirement, etc ) _ to C )-,c �= 16 1- a / 9- A rk"
Size of watershed draining to pond 0*- I d dGwf Expected pond surface area 1 a cv c--
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 foll wed during construction to red a impacts LDur --� w
' A 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 /stnngide html
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/lmear 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
Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program ( NCWRP) Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN For additional information regarding the application process for the
NCWRP, check the NCWRP websrte at http / /h2o enr state nc us /wm /mdex htm If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information
Amount of stream mitigation requested (Imear feet)
Amount of buffer mitigation requested (square feet)
Amount of Riparian wetland mitigation requested (acres)
Amount of Non riparian wetland mitigation requested (acres)
Amount of Coastal wetland mitigation requested (acres)
Page 10 of 12

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Environmental Documentation (required by DWQ)
Does the project involve, an expenditure of public (federal/state) funds or the use I of public
(federal /state) land?
Yes ❑ No FZ
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 K!
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 (required by DWQ)
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 wlthm 15A NCAC 2B 0233
(Meuse), 15A NCAC 2B 0259 (Tar Pamlico), 15A NCAC 2B 0250 (Randleman Rules and
Water Suppl Buffer Requirements), or other (please identify, )?
Yes [] No 14 If you answered "yes ", provide the following information
Identify the square feet and acreage of unpact to each zone of the riparian buffers If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers
Zone*
(square afe t
Multiplier
1Required
1
3
2
15
Total
Zone 1 extends out30 feet perpendicular from 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 2B 0242 or 0260
XI Stormwater (required by DWQ)
Describe unpervious 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
XH Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non discharge or discharge) of
wastewater generated from the proposed protect or available capacity of the subject facility
NM Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H 0500) or any Buffer Rules?
Yes ❑ No R
Is this an after the fact permit application?
Yes ❑ No 2
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 signature is valid only if an authorization letter from the applicant is provided)
Page 12 of 12