20080594 Ver 1_Application_20080331

En~7ronmental Lo,~rc, Inc.
1215 Low Gap Itaad, Ha}resville, NC 28904 828189-3609
March 28, 2008
NC DENR
Division of Water Quality
401/Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
'08 0594
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RE: USACE Action ID. Number 2008-00205 NW Permit Number 18
Pipe Placement in Buckner Branch
Tusquittee Township, Hiwassee River Basin
Clay County, North Carolina
Dear DWQ;
Please find with this letter, five copies of the PNC application for a Nationwide Permit with area
description maps and calculations for a proposed pipe placement in Buckner Branch, a tributary to Tusquittee
Creek in Clay County, NC.
Ms Darlene Dickerson, the property owner, is sending a check to you for $240.00 as directed, from her
location with the USACE reference numbers included.
Ms Dickerson was miss-informed about the designated stream buffer width, prior to constructing a
permanent structure along Buckner Branch. The Clay County authorities informed her of the buffer violation
and required that the condition must be corrected. In an effort to restore a 30 ft. buffer with the least impact,
Clay County ruled that one restoration option can be to pipe the stream irr the affected area.
We have previously forwarded multiple duplicate copies of this package to Ms Lori Beckwith with The
USACE, to Mr. David McHenry with the NC Wildlife Resources Commission, to Mr. Jim Reid in the Asheville
office of NC DENR DWQ and to Clay County. I have included the NC Wildlife Resources Commission
response and The USACE permit number and designation as assigned by Ms Beckwith.
I have helped Ms Dickerson with the preparation of the included package. If you have questions,
please contact me at the address or telephone number above or at krugerlogic yahoo.com or at 828-557-
9255. Ms Dickerson can be reached at the contact addresses included on page 5 of the application or 770-
456-8918, or through me. Thank you.
Sincerely.
~!'S?,ca...,
Brian Kruger C ESC
CC: Darlene Dickerson

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT ~ 8 4 5 4
Action ID. 2008-00205 County: Clav
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property Owner /Authorized Agent: Ms. Darlene Dickerson
Address: $21 Dallas Hwv
Villa Rica. Georgia 30180
Telephone No.: (770) 456-$91$
Size and location of property (water body, road name/number, town, etc.): The proiect area is located
an a 2.81-acre tract of land on Quarterhorse Drive near Havesville. CIav County, North Carolina.
Coordinates for the site are 35.0756 north and 83.7967 west.
Description of projects area and activity: The permittee is authorized to permanently impact (culvert)
90 linear feet of Buckner Branch on the property.
Applicable Law: ® Section 404 (Clean Water Act, 33 USC 1344)
Section I O (Rivers and Harbors Aci, 33 USC 403)
Authorization: Regional General Pernut Number:
Nationwide Permit Number: 18
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the
attached conditions, the conditions in the attached letter from the North Carolina Wildlife Resources Commission
(NCWRC), and your submitted plans. Amone the comments from the NCWRC, the following condition is
emphasized: construction must not occur from January I" to April I5" of any veer in order to avoid possible
harm to trout spawning. Any violation of the attached conditions or deviation from your submitted plans may
subject the permittee to a stop work order, a restoration order and/or appropriate legal action.
This verification will remain valid until. the expiration date identified below unless tbe nationwide authorization
is modified, suspended or revoked. If, prior to the expiration date identified below, the nationwide permit
authorization is reissued and/or modified, this verification will remain valid until the expiration date identified
below, provided it complies with ail requirements of the modified nationwide permit. If the nationwide permit
authorization expires or is suspended, revoked, or is modified, such that the activity would no longer comply with
the terms and conditions of the nationwide permit, activities which have commenced (i.e., are under construction) or
are under contract to commence in reliance upon the nationwide permit, will remain authorized provided the activity
is completed within twelve months of the data of the narionwide permit's expiration, modification or revocation,
unless discretionary authority has been exercised on a case-by-case basis to modify, suspend or revoke the
3uthorizatian.
Activities subject to Section 404 (as indicated above) may also require an individual Section 401 Water Quality
Certification. You should contact the NC Division of Water Quality (telephone [phone]) to determine
Section 401 requirements.
For activities occurring within the twenty coastal counties subject to regulation under the Coastal Area
Management Act (CAMA), prior to beginning work you must contact the N.C_ Division of Coastal Management.
This Department of the Army verification does not relieve the permittee of the responsibility to obtain any other
required Federal, State or local approvals/permits.
If there are any questions regarding this verification, any of the conditions of the Permit, or the Corps of
Engineers regulatory program, please contact Lori Beckwith at 828-271-7980.
Corps Regulatory Official: Lori Beckwith ~ _ Date: March S, 2008
Expiration Date of Verification: March 5.2010

-2-
Determination of Jurisdiction:
A. ^ Based on preliminary information, there appear to be waters of the US including wetlands within the above
described project area. This preliminary determination is not an appealable action under the Regulatory
Program Administrative Appeal Process {Reference 33 CFR Part 331).
B. ^ There are Navigable Waters of the United States within the above described project area subject to the
permit requirements of Section 10 of the Rivers and Harbors Act and Section 404 of the Clean Water Act.
Unless there is a change in the law or our published regulations, this determination may be relied upon for a
period not to exceed five years from the date of this notification.
C. ®There are waters of the US and/or wetlands within the above described project area subject to the permit
requirements of Section 404 of the Clean V~ater Act (CWAx33 USC § i 344). Unless there is a change in the
law or our published regulations, this determination may be relied upon for a period not to exceed five years
from the date of this notification.
D. ^ The jurisdictional areas within the above described project area have been identified under a previous action.
Please reference jurisdictional determination issued - Action ID
Basis of Jurisdictional Determination: The stream channel on the property is Buckner Branch which flows into
the Hiwassee River, then into the Tennessee River. The Tennessee River is a Section 10 water.
Appeals Information: (This information does not apply to preliminary determinations as indicated by paragraph A.
above).
Attached to this verification is an approved jurisdictional determination. If you aze not in agreement v`rith that
approved jurisdictional determination. you can make an administrative appeal under 33 CFR 331. Enclosed you will
find a Notification of Appeal Process (NAP) fact sheet and request for appeal (RFA) form. If you request to appeal
this determination you must subnut a completed RFA form to the following address:
District Engineer, Wilmington Regulatory Program
Attn: Lori Beckwith, Project Manager
151 Patton Avenue, Room 208
Asheville, North Carolina 28801
In order for an RFA to be accepted by the Corps, the Corps must determine that it is complete, that it meets the
criteria for appeal under 33 CFR Hart 331.6, and that it has been received by the Division Office within 60 days of
the date of the NAP. Should you decide to submit an RFA form, it must be received at the above address within 60
days from the Issue Date below.
**It is not necessary to submit an RFA form to the Division Office if you do not object to the determination in this
correspondence. **
Corps Regulatory Official: Lori Beckwith
Issue Date: March 5.2008 Expiration Date: Five years from Issue Date
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT PLANS, ETC.,
MUST BE ATTACHED TO THE FII.E COPY OF THIS FORM, IF REQUIRED OR AVAILABLE.
Copy Furnished: Environmental Logic, Inc., Attn: Mr. Brian Kruger, 1215 Low Gap Road, Hayesville,
NC' 28904
The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we
continue to do so, please visit http:/lregtzlatory.usacesurvey.com/ to complete the survey online.

Permit Number: 2008-00205
Permit Type: NW 18
Name of County: Clay
Name of Permittee: Ms. Darlene Dickerson
Date of Issuance: March 5, 2008
Project Manager: Lori Beckurith
Upan completion of the activity authorized by this. permit and any mitigation required by the
permit, sign this certification and return it to the following address:
U.S. Army Carps of Engineers
Attention: CESAW-RG-A
151 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
Please note that your permitted activity is subject to a compliance inspection by an U.S. Army
Corps of Engineers representative. If you fail to comply with this permit you are subject to
permit suspension, modification, or revocation.
I hereby certify that the work authorized by the above referenced permit has been completed in
accordance with the terms and conditions of the said permit, and required mitigation was
completed in accordance with the permit conditions.
Signature of Permittee
Date

NOTIFICATJON OF ADMIlti~IS'TRATIVE APPEAL OP'FIQNS AND PROCESS A?vD
~REQI7EST FOR,APPEA~ ~ _ _ __ . _- _ ~ ~ -- > ~ .- , ; _ -- _ - .: _ ~ .
A licant: Ms. Darlene Dickerson File Number: 2008-00205 Date: Mazch 5, 2008
Attached is: See Section below
INITIAL PROFFERED PERMIT (Standard Permit or Letter of A
ermission
PROFFERED PERMIT Standard Permit or Letter of ermission} B
PERMIT DENIAL C
X APPROVED JURISDICTIONAL DETERMINATION D
PRELIMINARY JURISDICTIONAL DETERMINATION E
SECTION I -The following identifies your rights and options regarding an administrative appeal of the above
decision. Additional information maybe found at http://www.usace.army.miUinet/functions/cw/cecwo/ret; or
Go s re latior-s at 33 CFR Part 33I.
_. _
A: INITIAL PROFFERED PERMIT: You may accept ar object to the permit.
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your signature
on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all rights to appeal the
permit, including its terms and conditions, and approved jurisdictional determinations associated with the permit.
• OBJECT: If you object to the permit {Standard or LOP) because of certain terms and conditions therein, you may request that the
pernut be modified accordingly. You must complete Section II of this form and return the form to the district engineer. Your
objections must be received by the district engineer within 60 days of the date of this notice, or you will forfeit your right to appeal
the permit in the future. Upon receipt of your letter, the district engineer will evaluate your objections and may: (a) modify the
permit to address all of your concerns, {b) modify the permit to address some of your objections, or {c} not modify the permit
having deiermi4ed that the perrt,.it sha~.!ld be issued as previetLly written. After evaluating your objections, the district engineer
will send you a proffered pemrit for your reconsideration, as indicated in Section B below.
B: PROFFERED PERMIT: You may accept or appeal the permit
• ACCEPT: If you received a Standard Perrut, you may sign the permit document and rerun it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your signature
an the Standard Permit ar acceptance of the LOP means that you accept the permit in its entirety, and waive all rights to appeal the
permit, including its terms and conditions, and approved jurisdictional determinations associated with the permit.
• APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of certain terms and conditions therein, you
may appeal the declined permit under the Corps of Engineers Administrative Appeal Process by completing Section II of this form
and sending the form to the division engineer. This form must be received by the division engineer within. b0 days of the date of
this notice.
C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of Engineers Administrative Appeal Process by
completing Section II of this form and sending the form to the division engineer. This form must be received by the division engineer
within 60 days of the date of this notice.
D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or
provide new information.
• ACCEPT: You do not need to notify the Carps to accept an approved JD. Failure to notify the Corps within 60 days of the date of
this notice, means that you accept the approved JD in its entirety, and waive all rights to appeal the approved JD.
• APPEAL: If you disagree ~~ith the approved JD, you may appeal the approved JD under the Corps of Engineers Administrative
Appeal Process by completing Section Ii of this farm and sending the form fa the division engineer. Tltls form must be received by
the division engineer within 60 days of the date of this notice.

E: PRELIMINARY JURISDICTIONAL DETERMINATION: You do not need to respond to the Corps
regarding the preliminary JIa. The Preliminary JD is not appealable. If you wish, you may request an approved
JD (which may be appealed), by contacting the Corps district for fiirther instruction. Also you may provide new
information for further consideration by the Corps to reevaluate the JD.
SECTION II - RE UEST FOR APPEAL or OBJECTIONS TO AN INITIAL PROFFERED PERMIT
REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your
objections to an initial proffered permit in cleaz concise statements. You may attach additional information to
this form to clarify where your reasons or ob}ections are addressed in the administrative record.)
ADDITIONAL INFORMATION: The appeal is limited. to a review of the administrative record, the Corps
memorandum for the record of the appeal conference or meeting, and any supplemental information that the
review officer has determined is needed to clarify the administrative record. Neither the appellant nor the Corps
may add new information or analyses to the record. However, you may provide additional information to clarify
the location of information that is already in the administrative record.
POINT OF CONTACT FQR UESTIO'tiISOR INNI~`ORMATIt3N:
If you have questions regarding this decision andlor the If you only have questions regarding the appeal process
appeal process you may contact: you may also contact:
Lori Beckwith, Project Manager Mr. Michael F. Bell,
USACE, Asheville Regulatory Field Office Administrative Appeal Review Officer
i ~ i Paitun Ave, Room 208 CESAD-ET-CO-R
Asheville, NC 28806 U.S. Army Corps of Engineers, South Atlantic Division
828-271-7980 60 Forsyth Street, Room 9M15
Atlanta, Geor is 30303-8801
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel, and any
government consultants, to conduct investigations of the project site during the course of the appeal process. You
will be provided a IS day notice of any site investigation, and will have the opportunity to participate in all site
investigations_
Date: Telephone number:
Signature of appellant or agent.
For appeals on Initial Proffered Permits and approved Jurisdictional Determinations send
this form to:
District Engineer, Wilmington Regulatory Division, Attn:Lori Beckwith, Project Manager,
Asheville Regulatory Field Office,151 Patton Avenue, Room 208, Asheville, NC 28801.
For Permit denials and Proffered Permits send this form to:
Division Engineer, Commander, U.S. Army Engineer Division, South Atlantic, Attn: Mr.
Mike Bell, Administrative Appeal Officer, CESAD-ET-CO-R, 60 Forsyth Street, Room
9M15, Atlanta, Georgia 30303-8$01

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® North Carolina Wildlife Resources Commission
December 31, 2007
Ms. Loretta Beckwith
U.S. Army Corps of Engineers, Regulatory Branch
151 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
SUBJECT: Nationwide Permit Application for Darlene Dickerson
Culvert in tributary to Tusquitee Creek, Glay County
Dear Ms. Beckwith:
Ms. Darlene Dickerson requested a letter of concurrence from the North Carolina Wildlife Resources
Commission {Commission) fora 404 Permit from the U.S. Army Corps of Engineers (ACOE). The project
involves placing 90 feet of culvert in a tributary to Tusquitee Creek near Hayesville because a newly built
garage is within the trout buffer. Comments from the Commission are provided under provisions of the Clean
Water Act of 1977 (33 U.S.C. 466 et. seq.) and the Fish and Wildlife Coordination Act (48 Stat. 401, as
amended; 16 U.S.C. b61-667d}.
Tusquitee Creek is stocked with trout and supports wild rainbow trout. It also supports sensitive aquatic life like
hellbenders. The proposed culvert installation has the potential to harm trout spawning because of proximity to
Tusquitee Creek.
Placement of the culvert would reduce the contribution of sediment and other non-point pollution the stream
receives from the surrounding area. However, it would also constitute a permanent loss of stream habitat and
possibly impede aquatic life movements. Therefore, the Commission recommends planting native trees and
shn~bs (e.g., silky dogwood, rhododendron, dog hobble, red maple, silky willow, tag alder, black willow,
sycamore...) between the garage and stream rather than addressing the trout buffer violation by piping the
stream. Storm water from the garage and parking should be routed diffusely through the established buffer.
Ground cover, but not tall fescue, should be used to stabilize any disturbed soils here and elsewhere on the
property.
However, if the project is permitted and pursed, then the Commission can concur if:
1. The Nationwide and Final Regional conditions are adhered to. This includes partial burial of the culvert in the
stream bed as stipulated in Final Regional Condition 3.6. Final Regional Condition 1.2 can be modified to
avoiding construction of the project from January 1 to April 15.
2. Sediment and erosion control measures are used and maintained. Exposed soils along the stream are
covered with erosion control matting and seeded as soon as possible following culvert placement.
Mailing Address: Division of Inland Fisheries 1721 Mail Service Center Raleigh, NC 27699-1721
Telephone: [phone] Fax: [phone]
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Dickerson Page 2 December 3I, 20Q7
Ciav
Thank you for the opportunity to review and comment on this project. T'he Commission may inspect the work
site during or after construction. If there are any questions regarding these comments, please contact me at
[phone] extension 24.
Sincerely,
~~ .
Dave McHenry
Mountain Region Coordinator, Habitat Consen~ation Program
cc: Ms. Darlene Dickerson

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Office Use Only: Form Version March OS
USACE Action ID No. DWQ No. ~ ~ $ 0 5 9 d
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
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
[~ 401 Water Quality Certification ^ Express 401 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 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 further details), check here: ^
II. Applicant Information [- ~-'.i,~ r~ {
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1. Owner/Applicant Information

Name: Darlene Dickerson
Mailing Address: 821 Dallas Hwy !- ~ '" ~~'~~ ~ ~ ""~`''
Villa Rica GA 30180 ~~~~~~ ~~T ~~'~!^
Telephone Number: 770-456-8918 Fax Number: 770-456-8919
E-mail Address: meadowcreeklands(a,bellsouth.net
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name: Brian Kruger
Company Affiliation: Environmental Logic, Inc.
Mailing Address: 1215 Low Ga~Road
Hayesville, NC 28904
Telephone Number: 828-557-9255 Fax Number: 828-389-3609
E-mail Address: krugerlogic~a~yahoo.com
PaOP. 5 of 1 Z

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: Dickerson Homesite
2. T.LP. Project Number or State Project Number (NCDOT Only): N/A
3. Property Identification Number (Tax PIN): 556100560627
4. Location
County: Clay Nearest Town: Hayesville Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers/names, landmarks, etc.):From downtown Hayesville
take Tusquittee Rd. (SR1307~ north 3.7 miles to Bristol Rd. (SR1319). Turn left (west) on
Bristol Rd., proceed 0.9 miles to Quarterhorse Dr. (a private road) Turn left on Quarterhorse
Drive and proceed approx. 0.1 mile to the end at the structure and tributary.
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum): 35 04.473 °N 83 47.855 °W
6. Property size (acres): 2.81
7. Name of nearest receiving body of water: Tusquittee Creek/Buchner Branch
8. River Basin: Hiwassee
(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 on the site and general land use in the vicinity of the project
at the time of this application: There are several (5) other houses in the immediate vicinity
and more being constructed. There are lawns, gardens and pasture areas in the ad'al cent
bottomland sections. The remaining areas in the upstream watershed draining to the site are
wooded, heavily wooded, or residential wooded.
Pa4P F, of 1 ~

10. Describe the overall project in detail, including the type of equipment to be used:The area is
rural residential. A permanent 24ft.X28ft.structure, to be used as a garage was constructed
near a corner of the lot. The owner had been told by a Realtor that the structure could be
built a minimum of 15ft, from the branch, which is the case along non-trout waters. Later as
a home was being constructed, a Clams County building inspector saw the structure and
informed the owner of the violation of the Trout Stream/Water Supply Watershed 30ft.
minimum buffer. The miss-informed owner, desiring compliance but not able to move the
structure, asked Clay County what options to consider. The County determined if the owner
obtains the required permit(s~from the US ACE, the NC DENR DWQ, the WRC or others as
applicable, the owner could either move or pipe the stream (Buckner Branch at the adjacent
violation area, to re-establish the buffer. To minimize the impact to the stream, the owner
has_ chosen to request permission to install 85ft. of 48in. dia. corrugated metal pipe.
Equipment to be used will include track and/or rubber-tired backhoe, a "Bobcat", and dump
truck(sl.
11. Explain the purpose of the proposed work: To re-establish a buffer, to minimize any future
impacts, and to protect the trout-water in Buckner Branch. Pipe placement in the branch will
increase shade to reduce water temperatures and helmsprevent future potential contamination
from residential runoff.
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. No other USACE or DWQ or other permit exists. There are local
building permits for adjacent residential structures.
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.
No future permit requests are anticipated.
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. All proposed impacts,
permanent 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)
PaQP. 7 ~f 1 ~

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.
Provide a written description of the proposed impacts: Placement of 85ft. of 48"dia.
corru ag ted galvanized metal arch pipe "ovalized" (actual dimensions 3$" high X 57" wide).
The pipe will be placed on the stream bed grade (2% slope), covered with 18" of high quality
fill, and the area seeded and mulched with combinations of natural grasses and other native
vegetation. (see ve etg ation plan
2. Individually list wetland impacts. Types of 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.
Wetland Impact
Site Number
(indicate on map)
Type of Impact Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.) Located within
100-year
Floodplain
es/no Distance to
Nearest
Stream
linear feet Area of
Impact
(acres)
N/A Yes

Total Wetland Impact (acres)
3. List the total acreage (estimated) of all existing wetlands on the property: 0 acres
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
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
Intermittent? Average
Stream Width
Before Im act Impact
Length
linear feet Area of
Impact
acres
#lA Buckner Branch Pipe & RipRap Perennial 30 in. 90 ft. 0.021ac.

Total Stream Impact (by length and acreage) 90 ~~ 0.021ac.
Paaa R of 1't

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, dredging, flooding, drainage, bulkheads, etc.
Open Water Impact

Site Number
indicate on ma
Name of Waterbody
(if applicable)

Type of Impact Type of Waterbody

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

Impact
acres
N/A

Total Open Water Impact (acres) 0
6. List the cumulative im act to all Waters of the U.S. resultin from the ro~ect:
Stream Im act (acres : 0.021ac.
Wetland Impact (acres):
O en Water Im act acres
Total Im act to Waters of the U. S. (acres) 0.021 ac.
Total Stream Im act (linear feet): 90 ft.
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.
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 watering, 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 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
Papa 9 of 1 2

were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts. The owner on finally asked
what buffers widths should be observed and was misinformed. The permanent structure can not
be moved. The proposed dine-placement impact is being considered the most environmentally
protective option and having the least long-term affect on the stream. There will be verb! little
future activityadjacent to the stream. There will be no vehicle crossing. The impacted area will
have natural protective permanent vegetation.
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 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 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
Draft Technical Guide for Stream Work in North Carolina, available at
http: //h2 0. enr.state. nc. us/ncwetlands/strm Bide. 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 more space is needed.
N/A
PaoP ~ n c,f i ~

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 willing 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:J/h2o.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):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ^ No
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 NEPAJSEPA 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 finalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SEPA final approval letter. Yes ^ No ^
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify )? Yes ^ No ~,
PaaP 11 of i't

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 ~^^Impact^+` I Multiplier ( Required
1 ~ ~ 3 (2 for Catawba)
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2
additiona120 feet from the edge of Zone 1.
extends an
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 appropriate information as identified
within 15A NCAC 2B .0242 or .0244, or .0260. N/A
XL 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 provide calculations demonstrating total proposed
impervious level. There is currently no impervious acreage. Driveways may be paved later but the
impervious surface area will not approach or ever exceed 20%, the site acreage is 2.81 acres. Proposed
disturbed areas on-site are minimal (less than '/2 acre). Typical erosion and sediment control measures
including but not limited to silt fence, seedin mulching, RipRap or gavel stabilization, rolled erosion
control products RECP) may be used to prevent erosion and eliminate sedimentation. The site is nearly
flat.
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.
The proposed pipe placement proiect will not generate or discharge wastewater. Elsewhere on
the site the home construction will have a permitted septic system and all construction will
comply with local building codes. ,
XIII. Violations (required by DWQ)
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 ^
Paor 1 ~ of 13

I. Cstmalative Impacts (rcquitYd by DWQ)
Will tbas project (ba,9ed on past and reasonably anticipated future impacts} result
iu addztaooal development, wl~icla evuld inspect ~asby dowrssbrearn waoGx quality?
No
Ifyes, please submit a qualitative or quatxtitati~-e cwaulative impact arsalys~s in
accordance with the most rocent North Carol'ma Division of Water Quality policy
posted oar aw website at http://h2o.caar_statc.nc.ushacwetlands. If no, please
provide a Short nan~ative description:,,
II. Other Circomstauces (Optional}:
Tt is the, applicant's respcrosibility ~oo submit the application sufficientlX in advance
of desired con.~tnu~tion dates to allow processing time for these permits.
I~oweve~t, an applicant may clxoose to list crnastraiats associated wit~t construction
or sequencing that may impose limits on work schedules (e.g., dtavr-cbwn
schedules for lakes, dales assoaated, w,Kh Endangered and Tb~zeeatened Species,
accessibility problems, or other issues outside of the applicant's control).

AppGcaadAgent's Signatsu~e ~ "ri,
(Agents sig~o~ature is valid only if an authorization letter from the applicant is
provided.)

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