20071713 Ver 2_More Info Received_20080408

Office Use Only:
Telephone Number:
E-mail Address: S k
USAGE Action ID No DWQ No ~ 7'' ~ ~ C ~ ~~~
(If any particular item is not applicable to this project. please enter "Not Applicable" or "N/A".)
I. Processing ,~~ t, ~~ ~ `{- t G'~ `~~ ~1.~1 ~ ~~ J J .F' c `~" L ~ - (~1 1 ~ ~,~ ~-
1. Check all of the approval(s) requested for this oject:
r~ ~ ~ ~~~;~,- 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 40 i 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 V[II,
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. A licant Information ~ ~ ~ ~ ~~
PP ~ .
1. Owner/Applicant Information
Name: l-1 .~- r'~-1~
Mailing Address: i u'
Fonn Version March OS
APRs z00g
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 ownerlapplicant.)
Name:
Company Affi{iation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page S of 1 Z

IX. Environmental Documentation (required by DWQ)
1. 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 aNEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ^ No ^
If yes, has the document review been finalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SEPA final approval letter. Yes ^ No ^
X. Proposed Impacts on Riparian and Watershed Buffers (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
(Neuse), I SA NCAC 2B .0259 (Tar-Pamlico), I SA NCAC 02B .0243 (Catawba) I SA NCAC
2B .0250 (Randleman Rules and Water Su ly Buffer Requirements), or other (please
identify )? Yes Ns~- /U~%~
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* Impact
( ware feet) Multiplier Required
Miti anon
1 ") ;J 3 (2 for Catawba)

Total ` '7 C7
* 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 of Zone 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 appropriate information as identified
within 15A NCAC 2B .0242 or .0244, or .0260.
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