20071920 Ver 1_401 Application_20071107

Office LJse Only:
USA.CE Action ID No.
DWQ No.
Form Version March OS
07-1924
(lf any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. Processing
1. Check all of the approval(s) requested for this project:
~ection 404 Permit ^ Riparian or Watershed Buffer Rules
Section 10 Permit ^ Isolated Wetland Permit from DWQ
401 Water Quality Certification ^ Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested:` -t~"
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 Concet7i (see the top of page 2 for further details), c~h~ec~lc he ~ 1~ 1~~~
II. Applicant Information Ol
h~~ ~ ~, ZG
1. ClwncrlApplicant Information ~ ~~~~.w~T~~~~, ~~~~c~
Name: ~i ~ ~ ~-,yt s.
_ ~ .~ ~...
Mailing Address: D y ' L ru
Telephone Number: 3 3 (t ~',5-~ ~'~ Fax Number: 5 ~~n E-
E-mail Address: m i z Z c~ ~t. -fi ~~t ~'r5 ~ ~C;1' Gtc~m ~ ~ e h~ -/-
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the A ent has signatory authority for the owner/applicant.)
Name: j-C' ~ ~~
Company Affiliati n: Qi'- c; -'a ~'~s ~n e
Mailing Address: 7 ~ .L C~c?
~. X,h y-, C a q,
Telephone Number: ;~'
E-mail Address: ~`'
J "t~ Fax Number:
rv ~ t7-~t~ C .n~f
PanaGnfl7

III. Project Information
5
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 sru-rounding properties. Botb the vicinity map
and site plan must include a scale and north arro4v. 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 def ned. 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 hill-size construction
drawings rather than a sequential sheet version of the full-size plans. If frill-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: ~ dGti'rl S
2. T.LP. Project Number or State Project Number (NCDOT Only): ~/~
3. Property Identification Number (Tax PIN): ~~ ~(~~ - d 3 ~- ~3 "~~~r°
4. Location
County: ~~U, ~~'~ ~'i Nearest Town:
Subdivision name (include phase/lot number): ~~ t-d: e~.:f ~Cs~e ~ - - ~ ~ ~~ -Z
Directions to site (include road numbers/names, landmarks, etc.): ~ - .Z'~5- .k~- $el~ne~-~
'br1 ~x;-~ . 1Z' L•nu:c~~~~/-Sc~~~,rr,c~-~ ~c~ l=Z- 't~,;ue~v;ew ~
m ~ I ~ S 1-t. - ~ ~ n (o K,~ i' / ~ t.w Kit ,
Site coordinates (For linear projects, such as a road or utility line,
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum): ~ ~} °N
6. Property size (acres):
7. Name of nearest receiving body of water: 1 ~1 CT ~, ~ G C k~ ~P SPA U O i r
8. River Basin: ~2 ~~r`Yl ~~z ~c ~
(Note -this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at 1~~://h2o.enr.state.nc.us/adrnin/maps/.}
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: ~Z+ i m D're ale, u.i2-~v ~~Y-~~~ t u'h ~ ~
attach a sheet that
aW
Pao (, of 17

10. Describe the overact
IV. Prior Project History
if jw•isdictional 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
buffo impacts, along with associated mitigation (where applicable). If this is a NCD~T project,
list and describe permits issued for prior segments of the same T.LP. project, along with
construction schedules. 17 [)v1 ~
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.
n one
VI. Pf•oposed 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. All proposed impacts,
pern~anent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all 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 descriptil/on oflthe proposed impacts: f ~lt ~_~l~~/, [,G~f ~ ~ ~ °`~ ~'
f~ Yl l~ 1 rYl ~rj G +.S 7v ve l~ p _, Gl.'T/^~"1 Q:~ d- i~~? /Qv1 G~S
ha oP 7 of t ~
nrnu~r•t in rlr tail in~lttriinu the tune of eauinmE:nt to be used:

2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drail~age, etc. For dams,
.,r~l,. l:r.f- , nic ring in l,nth cfrnrtnrP. ~nrl flnnrlinsr

Wetland Impact

Site Nu-nber
(indicate on map)
--r-- -

ype of Impact
"rope of Wetland

(e.g., forested, marsh,
herbaceous, bog, etc.) LOCated Wllhln

100-year ~
I'loodplain
(yes/no) r)15taI1Ce t0

Nearest
Stream
(linear feet) AI'ea Ot

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 walls, rip-rap, crib
walls, 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
,.,r L." ;,,nl,,.ia.l Tn nnln„l~tn arrPann mnltfnly lenai"h X Wldth then divide by 43.560.
Stream Impact ~
Number
(indicate on ma) ~
Stream Name v
Type of Impact j ~ v
Peremiial o~
Internuttent' Average
Stream Width
Before Im act Impact
Length
linear feet Area of
Impact
acres
(~' ,/~ ~

Total Stream Impact (by length and acreage}
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
F; 11 avnovoti~,n rlrarlnfntr flnnrlinv l1PAlYlAQA hnikheadc_ etc"
Open Water Impact
Site Number Name of Waterbody
Type of Impact Type of Waterbody
(lake, pond, estuary, sound, bay, Im act
p

(indicate on map) (if applicable)
ocean, etc.)
acres)
i ~ 1 U~ b`" ~~ !!~~
t•f-'~ '~OC ~ F ~r U~ ~

Total Open Water Impact (acres)
Page 8 of 12

6
List the cul.~ulative impact to all Waters of the U.S. resulting from the project:
r----- --- ---- - --~
Stream Impact: (acres): ------~
------
Wetland Impact (acres): D
_
Open Water Impact (acres}:
Total Impact to Waters of the U.S. (acres) ,,~ '
~T_otal Stream Impact (linear feet):
7. Isolated Waters
Do any isolated waters exist on the property? ^ Yes [~'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.
local stormwater requirement, etc.):
Current land use in the vicinity of the pond:
Size of watershed draining to pond:
Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
iuch-ded 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 conshuction (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,
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. We/k -~U-%~. ~~
er-~~~ ~. h~ -- ~( ~xC'c~ucc7~b~-- w- l I b~ ' ,- ~r~~ tea.. ~
1'r~ C4, ~ ~' ~ cc~1 G ,e r~~fi ~~ -f 'vC o jX~GtL~cL~1 C/rr-~- Lt%i
,tom. l~C( U,~~~ -~ PyG /.~` a M i ~~S C2 i,c/l-L~ ~~r~-' t,G.' // bc? n U ``~n7/94 c~- C~.~
~ ~ ~ ~ 4.tc 3c Q~ L GC clct t-r L /Q~f' `~ H` . ,Q, ~ZP ~~~''/G r
VIII. Mitigation i~ny ~~st~ h d%~ a ~ ~ ~' ~-~ /
~/~ GL~l1 rl( GL~Gi~'6r ~ L"L'`~ ~C! L~~ ! DCU ~~'(.~E~ ~.$ ! ~'1
DW ~ In accordance with 15A NCAC ~2H .0500, mitigation may be required by the NC
Q
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.
P~vP 9 of 1

+. ~SACE - In aCCOi'dallCC with the Final Notice of Issuance and Modification of Nationwide
Pel'nllts, published in the Federal Register on January 15, ?00~, mitigation will. be required ;vhen
t~ecessal•v i.o ensures that adverse effects to the aquatic cnvironinent are minimal. Factors
includinf; size and type of proposed impact and function ar~d 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 sire of the project; estahlishing 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
timctions and values, preferabic 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 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
Di•aIl Technical Guide for Stream Work in North Carolina, available at
htit~:/ih2c~.eni- _state.nc.us!Itcwetlandsistrm~`ide.hhnl.
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 sep_ crate sheet if more space is needed.
N~n~~ ___
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 htt}~•//h2a.enr.state.nc.us/wrp/index.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 : CU
Amount ofNon-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Pane 1 n of 1 ~

I;~. Environniet~t.~l ©ocuinentatiou (required by DWQ)
~. Does the hrojcct involve an expenditure of public (federal; state/local) funds or the use of
public (f~cleral/state) land? 1'es ^ No [1~
2. 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 (919) 73 -5083 to review current thresholds for environmental documentation.
Yes ^ No [~
3. If yes, has the document review been finalized by the State Clearinghouse? f so, please
attach a copy of the NEPA or SEPA Cnal 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.
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
{Neese), 15A NCAC 2B .0259 (Tar-Pamlico), ISA NCAC 02B .0243 (Catawba) 15A 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.
* Impact Required
Zone ,_______ ~__,. Multiplier ,,,~;+;~„t;~„
1 - ~ N~~ I 3 (2 for Catawba) I NI ~ I
2 1.5
Total I ~ ~ ~
Zone I extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge oFZone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration /Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all ap ropriate information as identified
within 15A NCAC 2B .0242 or .0244, or .0260. N
Pave 1 1 of 1 ~

~;1, Storm~vater (required by DWQ)
,ribe im pervious acreage (existing alld proposed) versus total acreage on the site. Discuss
Desc, 1
stonn~a~ ater controls proposed in order to protect surfaceed~ a>~~ ~al~ lease p ovldelr calculat oIl
the property. if percent Impervious surface exce
demonstrating total proposed impervious level.
XII. Sewage Disposal (required by DWQ)
detail the ultimate treatment methods and disposition (not - olf th e s bjeo tfac lrty e) °f
Clearly ` Io ect, or available capacl y
wastewater generated from the proposed p' j
~ .' a 11
XIII. Violations (required by DWQ) Buffer Rules?
Is this site in violation of DW . Wetland Rules (1 SA NCAC 2H .0500) or any
Yes ^ No [~
No [~
Is this an after-the-fact permit applicatioli? Yes ^
XIV. Cumulative Impacts (required by DWQ)
ro~ect based on past and reasonably anticipated future~mpYeS)a tilt N adder onal
Will this p J ( U
development, which could impact noTaruan t vercu nt lative impact analysis in accordance with
If yes, please submit a qualitative Q olic osted on our website at
the most recent North Carolina Division ° leaseterovQ~idela short narrative description:_______
hit ://h2o.em•.state.nc.ush1cwetlands. If no, p p
XV. Other Circumstances (Optional):
lication sufficiently in advance of desired
It is the applicant's responsibility to submit the app p licant may
construction dates to allow processing time for these permits. However, an a o e limits on
choose to list constraints associated with construcl~eS rdates Basso g ated wit (Endangered and
work schedules {e.g., draw-down schedules for ,
reatened S ecies, accessibility problems, or other issues outside of the applicant's control).
Th p
~ ~h
~ ' , ~-- ~~ 7 Leo
f ~' ~~' Date
pplicant/Agent's Sig iature p licant is rovided.)
(Agent's signature is valid only if an authorization letter from the a p P
n...-~ i ~ „f 1 ~

~~
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Page 1 of 1
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Driving Directions from Raleigh, NC to 2206 Riverview Rd, Lexington, NC Page 2 of 2
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Subject to License/Copyright
rights reserved, Use
All
_
.
These directions are informational only. No representation is made or warranty given as to their content, road conditions or
route usability or expeditiousness. User assumes all risk of use. MapQuest and its suppliers assume no responsibility for any
loss or delay resulting from such use.
http://www.mapquest.com/directions/main.adp?go=1 &do~w&rmm=1 &un=m&cI=EN&q... 11 /5/2007

Llriving Directions from Raleigh, NC to 220b Riverview Rd, Lexington, NC
Sorry! When printing directly from the browser your map may be incorrectly cropped. To print the
y~,~ entire map, try clicking the "Prier-Friendly" link at the top of your results page.

Raleigh, NC US
Total Est. Time:
2 hours, 11 minutes
2206 Riverview Rd
Lexington, NC 27292-1751, US
Total Est. Distance:
125.76 miles
Page 1 of Z
Maneuvers Distance
1: Start out going EAST on E SOUTH ST toward S WILMINGTON ST. 0.1 miles
2: Tum RIGHT onto S BLOUNT ST. 0.6 mites
/~\ 3: S BLOUNT ST becomes HAMMOND RD. 0.3 miles
a~ ~ 4: Take the I-440 /INNER BELTLINE ramp toward CARY /DURHAM. 0.4 miles
.,
5: Merge onto I-40 W.
71.6 miles
6: Take I-85 S toward CHARLOTTE. 41.1 miles
Q~ 7: Take the NC-8 exit- EXIT 91- toward SOUTHMONT. 0.4 miles

O 8: Tum LEFT onto COTTON GROVE RD / NC-8. Continue to follow NC-8. 7.9 miles
O 9: Turn RIGHT onto WALL RD. 0.2 miles
O 10: Tum RIGHT onto LINWOOD SOUTHMONT RD. 0.7 miles
11: Turn LEFT onto RIVERHOUSE RD. 1.2 miles
O 12: Turn RIGHT onto RIVERVIEW RD. 0.7 miles
13: End at 2206 Riverview Rd
Lexington, NC 27292-1751, US
Total Est. Time: 2 hours, 11 minutes Total Est. Distance: 125.76 miles
http://www.mapquest.com/directions/main.adp?go=1 &do-nw&rmm=1 &un=m&c1=EN&q... 11 /5/2007

November 6, 2007
Jimmy Adams
106 Comanche Trail
Lexington, NC 27295
To Whom It May Concern:
I would like to appoint Lee Yarboro as my consultant for the excavation project within
2206 Riverview Road, Lexington, NC. I hereby give Lee Yarboro authority to sign off
on this project.
Sincerely,
~! l
Jimmy Adams