20061448 Ver 1_401 Application_20060906

Office Use Only: Form Versi~~a March o5
2 0 (1 61 4 4 8
L'5ACE Action ID No. DW'Q No.
(If any particular item is not applicable to this project. please enter "dot Applicable" or "iii/~". i
I. Processing
1. Check all of the approval(s) requested for this project:
(Section 404 Permit ^ Riparian or Watershed Buffer Rules
^ Section 10 Permit ^ Isolated Wetland Permit from DWQ
^ 40I Water Quality Certification ^ Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: N~~~ ~~~~ ~tYW-:~' ~~-~'
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 Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, 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 fiirther~ils), check here: ~ ~ ~~
~. rho ~ D
II. Applicant Information
~ ~ ~oX aka 5 F P 7 2006
l . Owner/ApplicarJ,~ ormation ~ ~~ 5~ ~~y~
Name: J~ 8 i1ENFt-+NF~I'ERQUALI7Y
Mailing Address: / c AT~R BRANCH
7
Telephone Number.// ~/'~ /~/ 3f, ~ .?icy Fax Number: c'a~/ '~ /a/ 3s3 /~33
E-mail Address:
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attachgd if the Agent has signatory authority for the owner/applicant.)
Company
Mailing A
Telephone Number: 33t, ~fb -SY/Cv Fax Number. ~3(~ -~~f(o -O(S`Z
E-mail Address: ~In.>~~_s ~ S,F . ~n r,-,
Updated 1 I/1/2005
Page S of 12

III. Project Information
Attach a vicinity map clearly shativing 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. Bath 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_~c .(,~/2
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIl~: ~/°T ~ 90~--~~
4. Location Q
County: ~~ Nearest Town: ~^t~1
Subdivision name ' Jude phasellot number):_~C ,~u. /.~ .~.6-~s
Directions to site (include road. numbers/names, landmarks, etc.): ~,-o,.,, ,goon, e, 3~
-rO:vQ. tsv :., ~ t~ / iP ,scJii J
t~:
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
sepazately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum):~oy.~r5"- °N ,1.~/S~3~ 5~ °W
6. Properly size (acres): ~1, ~7',T /~~°c 5
7. Name of nearest receiving body of water_ -~a ~.n,~ _~,~~.z~~.~,
8. River Basin: ~t~.~ ~. ~ ~~~ 2
(Note -this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at httpJ~o_enr_state.nc.us/adminlmansl.)
9. Describe the existing conditions on the site and general land use in the vicinity of the
at the time oftl}is application: f.t~c~$~ lJY}~, ,,,..(~ -h Ic n.c~- ~~~#'~. r-~
Updated 11/l2W5
Page 6 of 12

10. Describe the/ o~ gall projeect 1/n detail~j in1c-lulling the rope of equipcm~ent to be
r ~.~,r. ~~ ~ .~r~.46Crri'd rdPltX T~ S~ YiTQ., ~ ~ ~Jv~~~,"J is
11. E:tplainp the purfase of the proposed work: -~~ ro4~ -~c~ ~~r~e- ~ryr >C.~vl
~c~-d1~s2i.S~Du - -
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 subdi~7sion) 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 issu~/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. Each impact must be
listed separately in the tables below (e.g., culvert installation should be Listed separately from
riprap dissipater pads}. Be sure to indicate if an impact is temporary. AlI proposed impacts,
permanent and temporary, must be listed, and must be Iabeied and clearly identifiable on an
accompanying site plan_ All wetlands and waters, and ali streams (intermittent and perennial)
should 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.
1. Provide a written description of the
r-
1J,pdated l l/l/24(!5
Pa>;e 7 of 12

Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized crearing, grading, fill, excavation, flooding, ditehing/drainaae, etc. For dams,
cPnaratPly lief imnac.Lc due tC both Structure and flOOdilla.
w v...~
Wetland Impact
Site Number

(indicate on map) .....J ~~.._ -W __ __ - --

Type of Impact - - -
T;rpe of ~Vetland
(e.g., forested, marsh,
herbaceous. bo etc.
g' )
Located within
1(30-year
Floodplain
(es/no)
Distance to
Nearest
Stream
(linear feet)
Area of
Impact
{acres)

Total Wetland Impact (acres)
3. List the total acreage (estimated} of all existing wetlands on the property:
4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement wails, rip-rap, crib
walls, gabions, etc.), excavation, ditchinglstraightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
must be included. To calculate acreage, multiply length X width, then divide by 43,560.
Stream Impact
Number
indicate on ma
Stream Name
Type of Impact
Perennial or
IntermittenE? Average
Stream Width
Before I act Impact
Length
l
i
n
ea
r feet Area of
Impact
acres
'V ~ ~
j
~
~
'7~~J f~~

Total Stream Impact (by length and acreage) ~$~ ..00
5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S_). Open water impacts include, but are not limited to
fill, excavation, ~ , floodin ,drains e, bulkheads, etc.
Open Water Impact

Site Number
indicate on
Name of Waterbody
(if applicable)

Type of Impact Type of Waterbody

(lake, pond, estuary, sound, bay,
ocean, etc. Area of

Impact
acres

Total Open Water Impact (acres)
upaated t utrzoos
Page 8 of 12

6. Lis: tl~~e cumulative i~~pact to all Watery of the U.S. resultin:? from the project:
Stream ImFac f acres): t . ~~f ~¢e.
~~~'etland Impact (acres): p
j Open Water Im act (acres): Q
Total Impact to Waters of the U_S. (acres) roof ~L j
f Tc taI Stream
7. Isolated Waters
Do any isolated waters exist on the property? ^ Yes Q~No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.
8. 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 v~~atering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Current Land use in the vicinity of the pond:
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically descn~be 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 a ''~~ Iic ble discuss constnzetion
techniques to be followed during construction to reduce impacts. ~~t -~o _~~
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 I50 linear feet of total impacts to perennial
streams.
Updated L 1/1RW5
Paee 9 of 12

USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on January 15, 2002, 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 far 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 NCEEP 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:/1h2o.enr.state.nc.us/newetlands/strm~ide.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/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 mare space is needed.
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at http:/lh2o.enr.state.nc.us/wrplindex.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five 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 ofNon-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Updated I 1/1/2005
Paee 10 of 12

IX.
X.
Environmental Documentation (required by;Jl~'Q)
Uotrs the project involve an e~cpenditure of public (fvderaUstateilocal) fi:ltds or the use of
public (federaL`state) land? Yes ^ No ~''
2. I* yes, does the proj-~ ct requir? preparation of an environmental document pursuant to the
r:;quirements of the rational 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 ^
3. If yes, has the document review been f nalized by the State Clearinghouse? if so, please
attach a copy of the NEPA or SEPA final approval letter. Yes ^ No ^
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
justif cation 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.
I. Will the project impact protected riparian buffers identified within ISA NCAC 2B .0233
(Meuse), 1 SA NCAC 2B _0259 {Tar-Pamlico), 1 SA NCAC 02B .0243 (Catawba) 1 SA NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify )? Yes ^ No
2. If "yes", 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* I reA~PaFt }l I Multiplier I Required
3 (2 for Catawba)
i.5
Total
Zone 1 extends out 30 feet pecpendicu
additiona120 feet from the edge of Zone 1.
from the top of the near bank of channel; Zone 2 extends an
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Suffer Restoration /Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 1 SA NCAC 2B .0242 or .0244, or .0260. ___
Updated 11/I/2W5
Page 11 of 12

XI. Stormwater (required by DWQ)
Describe impervious acreage (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. If percent impervious surface exceeds 20%, please pr ~zde calculategns
c~emon~trati~g total proposed impervious level., An _ ~,rns;or,_~-(-~ro~ bra n c~ <<(
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wa~sstewater generated from the proposed project, or available capacity of the subject facility.
u l ~ /~-F~ -fin L..,..~~ _ ~ ~: u,~ ~ C~r~ _ -7aHl~s ~i.-~12 .~: c%(l /„~c-
XIII. Violations (required by DWQ)
Is this site in violation of DW etland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ^ No [[
Is this anafter-the-fact permit application? Yes ^ No
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additi al
development, which could impact nearby downstream water quality? Yes ^ No
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
http://h2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description:
XV. 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).
~/3
`~ App~ant/Agent's Signature Da~ ~
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
u~,aacea ~ i~irzoos
Page I2 of l2

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