20080340 Ver 1_Shoreline Stabilization_20080222

DUKE ENERGY LAKE SERVICES
EC12-Q
P O BOX 1006
CHARLOTTE, NC 28201-1006
704-382-1567 or TOLL FREE 1400-443-5193
APPLICATION FOR PERMIT TO STABILIZE THE SHORELINE IN NORTH CAROLINA
Please type or print and fill in all blanks. If information is not applicable, so indicate by placing N/A in blank. PLEASE
SUBMIT APPLICATION AND APPROPRIATE DUKE ENERGY FILING FEE, PAYABLE TO DUKE ENERGY,
TO ABOVE ADDRESS.
L Applicant Information
A. Name j
B. Mailing Address
IL
C. Telephone:- ?} -q ?j - `?7j Tom=
Location of
A.
B.
D.
E.
F.
G.
H.
Lake 1VDman
Street Address _
CountyCity, town, community or la
Section Lot #
08-0340
IIL Description of Project ii
A. Length of wall 1
B. Material
C. Distance from property line/shoreline +? !'
?01
IV. Intended Use of Project Area
A. Private
B. Commercial _
V. Applicant Signature
Date 0// A
PLEASE NOTE THE FOLLOWING:
• A COPY OF THE COMPLETED APPLICATION WITH A ROAD MAP SHOWING LOCATION OF THE PROPERTY
MUST BE SUBMITTED TO: US ARMY CORPS OF ENGINEERS, 151 PATTONAVE. - ROOM 208,
ASHEVILLE, NC 28801-5006
• 2 COPIES OF THE "DUKE ENERGY APPLICATION FOR PERMIT TO STABILIZE THE SHORELINE IN NORTH
CAROLINA", PHOTOGRAPHS OF THE SHORELINE TO BE STABILIZED, AND FIVE (5) COPIES OF THE
COMPLETED "NC DIVISION OF WATER QUALITY PRE-CONSTRUCTION NOTIFICATION APPLICATION"
MUST BE SUBMITTED WITH THE DIVISION OF WATER QUALITY APPLICATION FEE TO:
NC DIVISION OF WA TER QUALITY
ATTENTION. CYNDI KAROLY
PARKP7NWBLDG., 2321 CRABTREEBLVD
.
RALEIGH, NC 27604
919-733-1786
GALAnMGMTPackage InfonmtionWC Shoreline Stabilization Amlication.&c
8
Please submit a map showing the coordinates or a detailed J
exact location of the project site. map (USGS quad map, city map, etc.) showing the
ProJ (NOTE: Latitude/ longitude coordinates can be found on internet site,
www.mapsonus.com. Directions: Don't register, click "Maps", enter address, draw
Clicking Will...", select "Lat/Long", click map) map' select "map
-Or-
Sh or2Li ne. 5?ub? l i?a?-r Ck1

IN4 VA'
Brian S1sson
I ('b "agp- (^-,rrovc re
Romp- sviIfe, IV C.
2?)tn

Forth 398578 (5-06)
LAKE DUKE ENERGY LAKE SERVICES DUKE ENERGY PERMIT NO.
PRIVATE FACILITIES PROGRAM
COU NTY PREVIOUS PERMIT NO.
PERMIT APPLICATION FORM
BUILDING PERMIT NO.

o First MI Last Signature (Required) Date
4
4

Street Street

a City State Zip City T State Zip

Phone Cell / E-Mail / Other Development Lot No.
+

Company Name Phone / E-Mail / Etc.

$
Address
Check the appropriate box. Stationary Pier Slip Style Dock Platform Style Boat Ramp or FACILITY SQUARE
(Fig. 1) (Fig. 3 & 4) Dock (Fig. 2 & 5 Marine Railway FOOTAGE
Use: Stationary Surface Area:
1 Individual 2 Common 0102 0102 0102 0 1 0 2
FF
Status: Floating Surface Area:
1 Existing 1 Proposed 13 1 0 2 ? 1? 2 13 1 13 2 13 1 F F

Total Surface Area:
Type of Facility:

1 Stationary 2 Floating 3 Combi
nation ` ? 1 ? 1 ? 2 ? 3 ? 1 ? 2 ? 3 ? 1
FTZ
?

W
T T

? Check box if uncovered dock. ? Check box if uncovered dock. U-See attached.
FIG. 1 FIG. 2 FIG. 3 FIG. 4 FIG. 5 FIG. 6 (other)
If application is for a common use facility, additional waterfront property owners using the facility appoint the individual(s). Listed in
the applicant information section of this form as the agent applying for permit. All parties using the facility for permanent mooring
must be waterfront property owners (i.e., eligible for individ ilities) and must sign below: (use additional sheet if needed).
-
V
)
Name _Jddresf ?f Date`
f
Name Address Date

Condition of Pier: ? Good ? Fair ? Poor Permitted: ? Yes ? No ? Denied
Final Inspection Completed: Date, Initial
°' Comments:

The following is an abbreviated application form for those applying for a 401 Water
Quality Certification to impact FERC (Federal Energy Regulatory Commission)
regulated lake shore or bottom under the U.S. Army Corps of Engineers Permit
GP30. This Application cannot be used for wetland or stream impacts. Please
provide seven (7) copies of this application and supporting information as well as a
non-refundable application fee to the Division of Water Quality of $200.00 for
impacts of to lake bottom of less than 1 acre and $475.00 for impacts to lake bottom
of greater or equal to 1 acre.
O S- 0 s o
Applications should be sent to: p
Division of Water Quality Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
1. Applicant information
1. Ow
Telephone Number: r10 - 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 signpryA authority 'of the owneriapplicanI I r
Company Aftllftal
Mailing Address:
Telephone Number: - Fax Number:
E-mail Address: ,,t 2? . ? • ce?r?t
II. 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. You may use the diagram below to make a hand sketch of
your project. Also, see the example below for guidance. Both the vicinity map and
site plan must include a scale and north arrow. The footprints of all buildings,
impervious surfaces, or other facilities must be included.
1. Location
County. Nearest Town: q)cpytS V . N C'.
Subdivision name or site address (include phase/lot number): 10) Cis n e Girnvp Lam,
Directions to site please include road numbers, landmarks, etc. (This is not
necessary if,an adequat-t map_ is ini lull: e-tflirYli'1 *,
2. Describe the
or condition of the site at the time of
3. Property size (acres):-
4. Nearest body of water (stream/river/sound/ocean/lake):
5. Describe the purpose of the proposed work: Io (111d ??t r r !
6. List the type of Nuipment to be used to construct the project: 1. 'tom ' GICT
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the normal pool lake level in square feet or acres: hl Cn
a. Amount of impact (including all clearing, back fill, excavation, rip rap,
retaining walls, etc.) above the normal pool lake level and 50 feet land-ward in
['r P S
square feet or acres: 1!1
b. Please describe vegetation above the normal pool laIX level and 50 feet land-
ward to be impacted (number of trees for instance): ?wy11 ??

Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

Please approximately sketch the following information on this plan
(please provide dimensions for each item, such as 40 ft. x 100 ft):
1) All proposed vegetation dearing (provide dimensions).
2y Location of rip rap or fill to be placed above the Fug Pond?elevation
3) Location of rip rap or fill to be placed below the Fu0 Fond elevation
4) The location of any proposed sqmlures such as buildings, retaining
walls, docks, etc.
5) The location of any excavation or edging below the Full Fond
elevation.
6) Location of construction access corridors.
NUKE ENERGY DIRECTIONS BY ROAD FORM
Lake Use Permit Applicants and Contractors: Ease of locating the proposed project site can Gave a bie
iulpact on permit processing time. Please complete this form and return it along ?Vitlt your completed
perrrut appli(:?Itlon to
DUKE ENERGY
C/O LAKE SERVICES - EC 12 Q
PO BOX 1006
CRARLOTTE. NC 28201-1006
1-800-443-5193 or Option 5
Applicant's Name kv__5??
Sheet Address (at lake).
Labe Name -??
Subdivision Nance
Property Section: _ Lot #
City: ` C Co.:
?.ree
i
State: Zip:
Telephone: _ rW ' m'' pw ??
i?
Directions (from major road or highway). 4orn Nay w - oe a:--n N`J rA 'ib F(j 1 3
Wi111aK9-J%n 0--W W 40 'PrdWkySd1W1
e all -Ae 'W -40 6 r d e 4, te A 'k W( L/ ?I o r&U SL61 -kuY n R ?us?aj.rarc?
Descriptive Structure(s) on Property (i.e. brick garage, white fence, mobile home, etc):
`Note: Please use the back of this form if desired to draft us a map to the site.
gpaVLAKEMGMT/Pwkage tnformationM reetions by Road Formdoc
August l8, 2006
Map of Cottage Grove Ln, Mooresville, NC 28117 - YELLOWPAGES.COM Page 1 of 1
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usability or expeditiousness. User assumes all risk of use. YELLOWPAGES.COM and its suppliers assume no responsibility for any loss or delay resulting
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Part of the new AM
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Q 2008 AT&T Intellectual Property. All rights reserved. AT&T, AT&T logo and all other marks contained herein are trademarks of AT&T Intellectual Property and/or AT&T
affiliated companies.
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l+4fr?•/I?:nirav vA??n?:marrae ne?m/mor?e7aiirirace=:Prfrnm=Rranrlinrr mar+ mar+ ?/?/?nnQ
Welcome to Redi-Rock Retaining Walls rage i of i
is fast and easy using the following guidelines.

i;
1. Level and compact a solid base for the bottom layer of blocks to sit on. (It may be necessary to place 6-8" of
compacted gravel to create a solid base)
2. When placing the first row of blocks, it is important to make sure that the blocks are level. Bottom blocks should
be used for the first row to create stability, unless only one row is being placed.
3. Middle blocks can then be placed over the bottom row such that they interlock two bottom blocks. As this
system continues, the entire wall will be interlocked.
4. The retaining wall can be tied back into the backfill material with occasional deadmen or fabric layers.
5. Top blocks are then used to create a top row which is recessed to allow for topsoil placement.
6. Topsoil can then be placed to within 4" of the block face.
7. Color applications can be applied if desired.

Steps to Install Blocks
#,
r

Iredell County
ZONING PERMIT
227 South Center St. PO Box 788 Statesville, NC 28687 Phone [phone]
Call Sanitarian between 8 a.m. & 9 a.m. Statesville 704-878-5305 Mooresville 704-664-5281
Permit #: 146859ZO Subdivision:
Proposed Use: Pier Township: 1800 Meck Neck
Location of Property: 108 COTTAGE GROVE LN MOORESVILLE NC 28117
Parcel #: 4624166607.000 Zoning: R20
Lot #: 207 Size: 0.734 Flood Plain: No Watershed:
Applicant: BD Professional Marine Construction Owner. BRIAN P & PATRICIA P SISSON
Address: 4790 Hot Rod Road Address: 108 COTTAGE GROVE LANE
Catawba NC 28609 MOORESVILLE, NC 281170000
Phone: [phone] Phone:
Property Recorded: Yes Site Plan Reviewed: Community Water: No Community Sewer:
If permitted the following minimum requirements must be met, unless Health Department requires more land area, or other
qualifications are indicated in the comments.
Min. Lot Area: Min. Front Yard: Min. Left Side Yard:
Min. Lot Width: Min: Rear Yard: Min: Right Side Yard:
Min. Number Parking Spaces: Max. Built Upon Area:
Comments:
Directions:
brawley sch, right on tuskorora, right on cottage grove on corner
FEES
Zoning Permit/Inspection Fee 0 $45.00
Site Plan Review Fee Q $0.00
Environmental Health New System Q $0.00
Environmental Health Existing System $0.00
Total Fees: $45.00
I certify that all statements made in this application and any attached documents are true, complete, and correct to the best of my knowledge and belief and are
made in good faith. I understand that informs ' may be gro s for rejection of this application. Authorized Health Department and Planning &
Enforcement Representatives are right of to ey a ions or inspections and to release information upon public request
rV 116
0 15 7
Applicant:
IkV41's-2 Date:
V A non=reffindable fee of $45.00 is charged on all permit applications.
ALAINA DILLARD Printed: It/15f2007
(Page 1 of 1)

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BRIAN SISSION
108 COTTAGE GROVE LN.
MOORESVILLE, NC 28117
PIER 3'X 30'
TR. ROUND PILINGS
TR 2 X 6 X-BRACING W13M" GALV. LAG BOLTS
TR 2 X 8 CROSSHEADS BOLTED TO PILINGS W112" GALV.
CARRIAGE BOLTS.
TR. 2 X 8 JOISTS 16" ON CENTER
VINYL HANDRAILS BOLTED TO PIER FRAME W112" GALV. BOLTS
VINYL DECKING
STAIRWAY TO SUNDECK
TR 2 X 12 STAIR STRINGERS, 16" ON CENTER
VINYL HANDRAILS, VINYL DECKING
STAIR LANDING 3 X 3
TR. ROUND PILINGS, 2 X 8 CROSSHEADS
2 X 8 JOISTS, 16" ON CENTER
RAMP 3X20
HINGED RAMP
TR. 2 X 10 JOISTS 16" ON CENTER
TR. 2 X 6 UNDER RAMP BRACING. GALV. STEEL HINGES FOR
STATIONERY PIER CONNECTION
PLASTIC SKID PLATES UNDER RAMP ON THE FLOATING DOCK
VINYL HANDRAILS BOLTED TO RAMP FRAME WITH 12" GALV
BOLTS. VINYL DECKING
FLOATING BOAT SLIP
TR. 2 X 8 LUMBER DOUBLED AROUND PERIMETER L1-J
BOLTED WITH 12" GALV. BOLTS. k-3,-
TR. 2 X 8 JOISTS 16" ON CENTER
TR 2X6 ATTACHED UNDERNEATH FOR FLOTATION
INSTALLATION
BLACK ENCAPSULATED FLOTATION. LAG BOLTED TO BOAT SLIP FRAME.
VINYL DECKING
SUNDECK
BUILT ON TREATED ROUND PILINGS DRIVEN INTO LAKE BED, THRU BOAT SLIP
FRAME. TR. 2X8 JOISTS 16" ON CENTER BOLTED TO SUNDECK PILINGS. GALV.
COMMERCIAL ROOF PANS SCREWED TO JOISTS. VINYL DECKING
INSTALLED ON TOP OF ROOF PANS
VINYL PICKET HANDRAILS BOLTED AROUND ENTIRE PERIMETER OF SUNDECK
GUSSETS BOLTED TO ALL CORNER PILINGS AND SUNDECK FRAME
'%01419111121
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6' 0.. _- _ 4'0'-1
BRIAN SISSION
108 COTTAGE GROVE LN.
MOORESVILLE, NC 28117
11'-0.
PIER 3'X 30'
i
TR. ROUND PILINGS -
TR 2X 6 X-BRACING WIM" GALV LAG BOLTS
TR 2 X 8 CROSSHEADS BOLTED TO PILINGS W1112"GALV
CARRIAGE BOLTS.
TR. 2 X 8 JOISTS 16" ON CENTER
VINYL HANDRAILS BOLTED TO PIER FRAME W1112" GALV. BOLTS -
VINYL DECKING
STAIRWAY TO SUNDECK
TR 2 X 12 STAIR STRINGERS, 16" ON CENTER 3 034Rx
VINYL HANDRAILS, VINYL DECKING

STAIR LANDING 3 X 3
TR. ROUND PILINGS, 2 X 8 CROSSHEADS
2 X 8 JOISTS, 16" ON CENTER
RAMP 3X20

HINGED RAMP
TR. 2 X 10 JOISTS 16" ON CENTER
TR. 2X 6 UNDER RAMP BRACING. GALV. STEEL HINGES FOR
STATIONERY PIER CONNECTION j
PLASTIC SKID PLATES UNDER RAMP ON THE FLOATING DOCK j
VINYL HANDRAILS BOLTED TO RAMP FRAME WITH 12" GALV
BOLTS. VINYL DECKING
FLOATING BOAT SLIP
TR. 2 X 8 LUMBER DOUBLED AROUND PERIMETER
BOLTED WITH 12" GALV. BOLTS. ?X?0'
TR. 2 X 8 JOISTS 16" ON CENTER
TR 2 X 6 ATTACHED UNDERNEATH FOR FLOTATION
INSTALLATION
BLACK ENCAPSULATED FLOTATION. LAG BOLTED TO BOAT SLIP FRAME.
VINYL DECKING
SUNDECK
0titt ttt„..
BUILT ON TREATED ROUND PILINGS DRIVEN INTO LAKE BED, THRU BOAT SL i
IP
' ?'
a r ys®
FRAME. TR. 2X8 JOISTS 16" ON CENTER BOLTED TO SUNDECK PILINGS. GALV. ??
COMMERCIAL ROOF PANS SCREWED TO JOISTS. VINYL DECKING w
INSTALLED ON TOP OF ROOF PANS
VINYL PICKET HANDRAILS BOLTED AROUND ENTIRE PERIMETER OF SUND
GUSSETS BOLTED TO ALL CORNER PILINGS AND SUNDECK FRAME .. =
• a .• !b

Office Use Only: Form Version May 2002
USACE Action ID No. DWQ No.
(If 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:
? Section 404 Permit ? Riparian or Watershed Buffer Rules
? ySection 10 Permit ? Isolated Wetland Permit from DWQ
21101 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested:
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: ?
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 further details), check here: ?
II. Applicant Information ® +?ti ?:! D
1. Owner/A licant Information B, h 20n8
Name: bl i 6W 5i S.
Mailing Address: 1 p72 Q OLun b i L ' ' ' E rvr? ova WgSERB1tAR?
it , .1, - 9 7 A d -41, r) ) " a-e „ ?nl 8TOBN?-
Telephone Number: 7C (?J r' Fax Number:
E-mail Address:
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be if the Agent has ignatory &Wfi( ority for the owner/applicant.)
Name: attached ? yl)*%,it oC t?1Ci'?..{1bJ6 LL L
Com pany Affiliation:
Mailing Address: L- ` w V
Telephone Number:
E-mail Address:
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 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 I1 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
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN):
4. Location
County: Nearest Town:
Subdivision name (include phase/lot number): illf
DirecticAs to site (include road numbers, landmarks, etc.):-

_f"A& KA51 W'r r&1 -Mrrt & MT -Ae qr WE- Vwc "V-se, av? r?vt-f
5. Site coordinates, if available (UTM or Lat/Lori
(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. Property size (acres): ,I ?- Uk fic `;
7. Nearest body of water (stream/river/sound/ocean/lake): L II N f'm n
8. River Basin: e4414?
(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/.)
9. Describe the existing conditions n the site and general land u 4e in the vicinity of the
at the time of this a?pplica ion: Ill ??f 'fill M ? Q - IV) 61
Pn,n a, .:1J?. .a ert? :.n A v% A I . n ^1P., 1. f 1
Page 6 of 12
10. Describe the overall nroiect in
-I
11. Explain the purpos/ of the
including the type of equipment to be used:
sed work:_ (< tf?i 111 i?1
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.
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
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***

* 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 are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://www.fema.izov.
*** 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: to
3. Individually list all intermittent and perennial stream impacts below: 1 A
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.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., wvw.topozone.com,
www.ma uestcom 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
(if Name p Waterbody
applicable) Type of Waterbody

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

wct+er- ? 5

List each impact separately and identifyltemporar? impa . 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.., tn/embankmen, , excav do installatio of
dray-dovyq valve or spillway, etc.):_ 92a )h; (, ?( ((?M M Y
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): w1J&
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
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
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
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.htmi.
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.
2. 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 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:
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):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX.
X.
Environmental Documentation (required by DWQ)
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 ?
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 within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Require nts), 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
(square feet Multiplier Required
Mitigation
1 3
2 1.5
Total
Zone 1 extends out 30 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 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 (required by DWQ)
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.
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 an after-the-fact permit ap ation?
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).
ales,
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12