20060834 Ver 1_401 Application_20060518

6Zuible
Quible & Associates, P.C.
ENGINEERING • ENVIRONMENTAL SCIENCES • PLANNING • SURVEYING
SINCE 1959
May 10, 2006
Mr. John R. Dorney ~_ Q o
Water Quality Certification Program
NC Division of Water Quality
4401 Reedy Creek Road
Raleigh, NC 27607
Re: Lot 11, Holiday Shores, Rodanthe, Dare County, NC
BKS Enterprises Corp. (Attn. Mary Kelley)
Nationwide #18 and #14/ 401 Water Quality Cert. Permit Application Package
Dear Mr. Dorney:
P.O. Drawer 870
Kitty Hawk, NC 27949
Phone:[phone]
Fax:[phone]
PRINCIPALS
Sean C. Boyle, P.E.
Joseph S. Lassiter, C.E.P.
Eduardo J. Valdivieso, P.E.
ASSOCIATES
/1 Joseph J. Anlauf, P.E.
`t KaTherine C. Marchello, P.L.S.
The purpose of this correspondence is for Quible & Associates, P.C. to provide NCDENR, Division of Water
Quality a Nationwide #18 and #14/401 Water Quality Cert. Permit application submitted by our firm on behalf of
BKS Enterprises Corp. (Attn: Mary Kelley). The site plan accurately shows the confirmed wetlands line as well as
the proposed residential construction.
Proposed work includes backfill and grading of approximately 0.11 acres (4,827 SF) of section 404 wetlands as
shown on the accompanying site plan. This backfill is necessary to provide adequate space for the residential
construction as proposed. The fill area includes 0.1 acres of wetlands under a proposed Nationwide #18 and 0.01
acres under a Nationwide #14. The area covered under a Nationwide #14 would be the driveway. There is an
existing Health Department improvement permit for the septic system that is depicted on the site plan.
A copy of this package has been submitted to US Army Corps of Engineers (USAGE).
Enclosed are seven copies of the following:
• 8.5" x 14" Site Plan indicating wetlands, proposed fill and proposed improvements
• 8.5" x 14" Wetland Delineation Plat
• Signed copies of the Pre-Construction Application
• Authorization letter from Mary Kelley
• USGS topographic location map
• 2002 Aerial Photo of the project location
• Dare County Soils Survey
• Photocopies of the $200 processing fee check to NCDENR and original check
• County of Dare Improvement Permit and Associated Plat
Thank you for your attention to this information. If you have questions regarding this matter please contact me at
252-261-3300.
Sincerely,
Quible & Associates, P.C.
~'Vl ~~\
Brian Rubino
cc: Tom Steffens, USAGE
Mary Kelley
C~~~d ~ ~
D~
M Ay ~ S ioo6
OENK~SS~~TERDRN~'H
Y~~

6~uible
Quible & Associates, P.C.
ENGINEERING • ENVIRONMENTAL SCIENCES • PLANNING • SURVEYING
SINCE 1959
May 10, 2006
Mr. Thomas Steffens
US Army Corps. of Engineers
P.O. Box 1000
Washington, NC 27889
Re: Lot 11, Holiday Shores, Rodanthe, Dare County, NC
BKS Enterprises Corp. (Attn: Mary Kelley)
Nationwide #18 and #14/ 401 Water Quality Cert. Permit Application Package
Dear Mr. Steffens:
P.O. Drawer 870
Kitty Hawk, NC 27949
Phone: [phone]
Fax:[phone]
PRINCIPALS
Sean C. Boyle, P.E.
Joseph S. Lassiter, C.E.P.
Eduardo J. Valdivieso, P.E.
ASSOCIATES
Joseph J. Anlauf, P.E.
Katherine C. Marchello, P.L.S.
The purpose of this correspondence is for Quible & Associates, P.C. to provide USACE and NCDENR, Division of
Water Quality a Nationwide #18 and #14/401 Water Quali[y Cert. Permit application submitted by our firm on
behalf of BKS Enterprises Corp (Attn: Mary Kelley). The site plan accurately shows the confirmed wetlands line as
well as the proposed residential construction.
Proposed work includes backfill and grading of approximately 0.11 acres (4,827 SF) of section 404 wetlands as
shown on the accompanying site plan. This backfill is necessary to provide adequate space for the residential
construction as proposed. The fill area includes 0.1 acres of wetlands under a proposed Nationwide #18 and 0.01
acres under a Nationwide #14. The area covered under a Nationwide #14 would be the driveway. There is an
existing Health Department improvement permit for the septic system that is depicted on the site plan.
Seven copies of this package have been submitted to NCDENR, DWQ.
Enclosed are the following:
• 8.5" x 14" Site Plan indicating wetlands, proposed fill and proposed improvements
• 8.5" x 14" Wetland Delineation Plat
• Signed copies of the Pre-Construction Application
• Authorization letter from Alfred L. Jackson
• USGS topographic location map
• 2002 Aerial Photo of the project location
• Dare County Soils Survey
• Photocopies of the $200 processing fee check to NCDENR and original check
• County of Dare Improvement Permit and Associated Plat
Thank you for your attention to this information. If you have questions regarding this matter please contact me at
252-261-3300.
Sincerely,
Quible & Associates, P.C.
~vl ~~
Brian Rubino
cc: John Dorney, DWQ
Mary Kelley

NOTES:
- REFfI?ENGE MB B, f'6 /l.
- FIRM ZONE AE (8)
PA1~L 375348 61630 E
(MAP REVism /2/2o/a~)
- AREA = 11,3/3.6 SF BY
GGVRDlN,4TE METHOD
-SURVEY DATE 04/06/616.
"VERTICAL DA71A~f
IVAVD B8, t3ASt:U ON
R7K 6P5 SURVEYlN6,
O.l' AGGUiZ4GY.
~ ~~~u~~ xrrxmHrd.vn
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MAY ~ 8 ZOOg - -
OEMR - WAl'Ek L; ..., : v ~ S~A~I¢
~~ NAIL 3 ~ s~ BRANCH
O - EXISTlN6 /RG'N ROD
O - FXlSTlN6 /RON Plf'E ~ ~
• - GALGULATID POINT
~ - l1dETLA1VD FLA6 VlGINITY MAP
PROPOSED SECTION 404 h~TLAN05 FILL TOTAL = 4,827 ssqq ft. M'S'
(4,3/4 scj.ft./O.IO AG I/SlN6 NATIONWIDE l8; 5/3 sq.ft./O.OI AG.~ U5/N6 NATIONl11/DE l4)
DRIVEWAY FILL I/S/Ak5 A NATIONWIDE /4
567 sc~.ft.
NORTH HOL117,4 y BL VD.
(60' R/yyJ
577°0900'E
LOT lO
LOT 2/
PlN 0658-09-17-0/3.~ ~
24242 N. HOLlDr4Y BLVb
ROD~4NTHE, NG
PROJECT
06066 COPYRIGHT © 2008
OUIEILE ~ ASSOCIATES, P.C.
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RIGHTS ARE RESERVED. ANY RI
CAD REF PRODUCTION OF THIS OR POSSE.'
. WITHOUT PRIOR PERMISSION C
06060 OUIBLE do ASSOCATES, PC WILL
CONSTITUTE VIOLATION OF COPYRI
LAWS. VIOLATION WILL BE SUE3JE
DATE TO LEGAL ACTION
4/28/06
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LINE TABLE
LINE LENGTH BEARING
L38 3,99 S05.42'02'E
L39 11,86 S05'42'02'E
L40 15,85 S73'49'03'E
L41 16,16 N63'S2'S5'E
L42 8.08 N89'S7'31'E
L43 59,09 S13'46'18'W
L44 21.72 N86'00'34'W
L45 24,63 S64'30'32'W
L46 29.55 Sll'32'07'W
L47 5,53 Sll'32'07'W
NATIONWIDB 18 AND 14 S1TB PLAN
LOT ll HOLIDAY SHORES
BKS SNTBR.PRISES CORP.
KINNAKEET TOWNSHIP DARE COUNTY
NORTH CAROLINA
0 2U 40
GRAPHIC SCALE IN FEET 1'=20
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Quible S,N~E 1959
~ Associates, P.C.
ENGINEERING ^ CONSULTING • PLANNING
ENVIRONMENTAL SCIENCES ^ SURVEYING
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NOTES:
- REFE7?6MGE 1~ 8, P6 /l.
- FIRM ZG9~' AE (8)
PAl1~. 375398 61530 E
(MAP REVD l2/20/Gl~,
- AREA = N,3/3.6 SF BY
GGtDRD/MATE h1EThbD
- 5fiRVEY DATE 04/O~/Gt5
'`VERY/GAL DATIA~a
N,4VD '88, BASED GMr
RTK GP5 51A?VEYII~K
O.l' AGGUI?AGY.
LOT lO
LEGEND:
D - I°~ NAIL
O - EX15nnrG IRON ROD
O - Exisnn~ IRON P/PE
• - GALGGLArED POINT
~ - hETLAND FLAG
NORTH HOLlD~4Y BL 1/D.
(60' /~Y1
O
LINE TABLE
LINE LENGTH BEARING
L38 3.99 SOS°42'02'E
L39 11.86 S05°42'02'E
L40 15.85 S73°49'03'E
L41 16.16 N63°52'S5'E
L42 8.08 N89°57'31'E
L43 59.09 S13°46'18'W
L44 21.72 N86°00'34`W
L45 24.63 S64°30'32'W
L46 29.55 Sll'32'07'W
L47 5.53 Sll°32'07'W
N hl7LIDAYp.VD 11
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INTENDED FOR REGORD.4TlON
OR GONYEYANGE.
P/N 0x658-09-17-0/35
24242 N. HOLIDAY BLYD
RODANTHE, NG
PROJECT
02055 COPYRIONT © 2006
om6L,E ~ AssocuTES. P.c.
DRAWN
KCM THIS oOCUMENT IS THE PROPERTY Of
ouIBLE e< ASSOCWTES. Pc. ALL

CAD REF RIGHTS ARE RESERVED. ANY RE-
PROOUCTroN of TNIS oR PossESSIOI
. WRHOUT PRIOR PERMISSION OF
~~ ouIBLE a Assocu-TES. Pc wILL
c~NSmuTE vlou-noN of coPrRIGHr
LAWS. VIOLATION WILL BE SUBJECT
DATE TO LEGAL ACTION
04/24/06
N79°5500°lN
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LOT 20
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404 GERTIFIGATE
naffs GERnFiES rtrAr Wars GOPY of Wars PLAT AGGURArELY
DEPiGrs rHE BarAVDARY OF ~ .ueisDicnav of s,EGnoly
4~ of rnrE GLEAN IKArBe AGr I~VDee rtaE ~RESENr LAW AND
RE6uAL noncs AS DErE,~In~D BY n~ 1nvDeesIGNED oN Wars
:DATE. UYLFSS TITRE /5 A GHAN6E /N 71~ LAW OR GY/R
`r~llsraED RE~tArloNS, r+ws DErBeM/NAnoN OF SEGnoN
~ .~wsDrcnoN Mar BE R~rED /~olv FOR A PBeioD Nor
TO EXGEED 5 YEARS FROM THIS DATA THlS DETERM/NATION
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:DATE
WL~TLAND3 LOCATION
LOT $
HOLIDAY SHORES
KINNAKEET TOWNSHIP DARE COUNTY
NORTH CAROLINA
0 20 40
GRAPHIC SCALE IN FEET 1'=20
~uible ~,~f ,9ss
& Associates, P.C.
ENGINEERING * CONSULTING * PLANNING
ENVIRONMENTAL SCIENCES * SURVEYING
Phone: [phone]
Fax: [phone]
E-Moil: quibleOea~Fllink.nel
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Office Use Only: Form Version October 2001
~'~ Q 80 83 4
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
,~ : ~-
~. i
,~ _ : ,_.
I. Processing ~ ~, .,; . _',~-~
Check all of the approval(s) requested for this project:
® Section 404 Permit
^ Section 10 Permit
® 401 Water Quality Certification
^ Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: Nationwide 18 and lyationwide 14
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:
II. Applicant Information ~ ~ ~ ~ ~ "
1. Owner/Applicant Information MAY ~ ~ 20Q~
Name: BKS Enterprises Corp (Attn: Mary Kelley) D~NR - WATE~~~et Win'
Mailing Address: P.O. Box 2103 wEt~08NrD~0~-TFADRANCH
Manteo, NC 27954
Telephone Number: [phone] Fax Number:
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: Brian Rubino
Company Affiliation: Quible & Associates, P.C.
Mailing Address: P.O. Drawer 870
Kitty Hawk, NC 27949
Telephone Number: 252-261-3300 Fax Number: 252-261-1260
E-mail Address: [e-mail]
Page 5 of 12

III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 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: Lot 11 Holiday Shores
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): 065809170135
4. Location
County: Dare Nearest Town: Rodanthe
Subdivision name (include phase/lot number): Holiday Shores Revised
Directions to site (include road numbers, landmarks, etc.): NC 12 South to Rodanthe on
Hatteras Island; turn left (east) on North Holiday Blvd., just to the north of Rodanthe fishing
pier; the lot is located at 24242 North Holiday Blvd. on the south side of the right-of-way
5. Site coordinates, if available (UTM or Lat/Long): 35°35'12"N, 75°27'50"W
(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:
Undeveloped grassy with maintained herbaceous-type vegetation• total lot area is 0.26 ac•
non-wetland 00.07 ac); Section 404 wetland 00.19 ac)
7. Property size (acres): 0.26 ac
8. Nearest body of water (stream/river/sound/ocean/lake):
The Pamlico Sound and Atlantic Ocean are similar distances away in opposite directions• this
is a relatively narrow portion of the island. There is a drainage ditch located 426 ft to the
west of the nearest portion of posed wetland impact.
9. River Basin: Pasquotank
Page 6 of 12

l
(Note -this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
10. Describe the purpose of the proposed work: To provide sufficient area for the placement of
a septic system, house, pool and driveway. The proposed septic system location has been
approved by the Dare County Health Dept. (Improvement Permit enclosed).
11. List the type of equipment to be used to construct the project:
Backhoe, dump truck and other rg ading equipment
12. Describe the land use in the vicinity of this project: residential
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
A jurisdictional determination of the delineated Section 404 wetlands has been requested. The
delineation was performed by Quible and was verified in the field by USACE on 4-11-06.
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:
There will be a future buildingpermit request to Dare County.
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
Page 7 of 12

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.
1. Wetland Impacts
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***
Nat. 18 Area Fill, Grading .1 ac. yes 426 If to ditch Section 404, grassy wetland
Nat. 14 Area Fill, Grading .Ol ac. yes 466 if to ditch Section 404, grassy wetland

* List each impact separately and identify 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 aze available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://www.fcma.eov.
*** 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 existing wetlands on the property: 0.19 ac.
Total area of wetland impact proposed: 0.11 AC (4,827 ft2)
2. Stream Impacts, including all intermittent and perennial streams N/A
Stream Impact
Site Number
(indicate on ma)
Type of Impact* Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Im act Perennial or
Intermittent?
(leases ecif )

* List each impact sepazately and identify temporazy 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.usgs.~ov. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapguest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
Page 8 of 12

Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S. N/A
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,
ba ,ocean, etc.)

List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
4. Pond Creation N/A
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: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
The posed residential construction plan requires the proposed fill as shown. As an attempt to
minimize wetland impacts, a retaining wall will be constructed around the proposed pool area,
adjacent to the wetlands, so that a fill slope in additional areas of wetlands is not necessary. This
layout that has been permitted by the Dare County Health Department is achievable under a
Nationwide 18 and a Nationwide 14, with 0.11 acres of Section 404 wetland fill. The
Nationwide 14 component is necessary for the driveway to access the building footprint, since
the_total fill area proposed slightly exceeds 0.1 acres. There is no proposed fill within the Area
of Environmental Concern (AEC).
Page 9 of 12

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.
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.
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.
Proposed mitigation includes payment into the NC EEP at a 2:1 mitigation to fill ratio in
accordance with the 7/22/03 MOA between USACE and NC DOT.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at ht~:~/h2o.enr.state.nc.us~wrp~;ndex.htm. If
Page 10 of 12

use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres): 0.25 acres
Amount of Coastal wetland mitigation requested (acres):
IX. Environmental Documentation (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
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
(Neuse), 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
(s ware feet) Multiplier Required
Miti ation
1 3
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 (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.
No existing impervious coverage;
Proposed new impervious: 3,011 ft2 (residential structure footprint driveway and pool)
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.
On-site septic treatment system to be constructed as a conventional bed-type system The
permitted position of this system is shown on the site plan
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ^ No
Is this an after-the-fact permit application?
Yes ^ No
XIV. Other Circumstances (Optional): N/A
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
* "Lone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.

__ -
04l2812006 11:49 2524733822 MCCOWN & MCCOWN PAGE 02!04
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3. F.I.R.M. ZONE: AE (EL 8')
4. PIN NO.: 15 085$09 17 0135
5. RECORDED REFERENCE; M8 8, PG 11
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5. RECORDED REFERENCE: MB 8, PG 11
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