20041488 Ver 1_401 Application_20040825

i

Transmittal

STEWART-PROCTOR PLLC
ENGINEERING & SURVEYING

319 CHAPANOKE ROAD
SUITE 106
RALEIGH, NC 27603
PHONE: (919) 779-1855 0 4 1 4 8 8
FAX.- (919) 779-1661

Date:

Attention: WETLANDS 1401 GROUP

From: -To i4,-) --,5 F L, AUG 2 5 2004

No. of pages; WATER QUALITY SECTION
(Including this cover)

Comment(s):

~ ~O~a~T C,Q ~~S i G 7 ~ ~ oiE s n ,c

Reply requested: _ Yes _ No

( SPOILS
X711 EA FILL EA _ 67 00
k
66 00
Em-

,,T--~ SF 41i6 252004

100' NEUSE RIVER RIPARIAN BUFFER QljklrYSILL
FlAREA ARE MEASURED 50' FROM CREEK ~rcr/
BANK,ON BOTH SIDES.
PM STA - 64+50 PLAN VIEW FOR L 1
FM EMV = 226.00
A.D. - &06
K = 7.14

to
m
W
m + 4
m
r, a
~m
W W
A _
6 /
Z /
~ 3a
a
\ 1 BACKWA
= 231.0 ~
\ f
PIPE AO

Iq In m n ® m n
ri
N N N
63+00 64+00 65+00 66+00 67+-
PROFILE VIEW FOR L 1

START /
CONSTR CTION

5' 50'x6 #57 WAS
GR VEL ONSTRUCTION AN

1 CT ,

o ?
?

g

L
SPR

s

L

R ARI ? F
50' ROM CRE
)N B TH SID

s,
a

~ O
a
0
L

GARNER-QUADRANGLE
{ O
• • NORTH CAROLINA
7.5-NIINLTfE SERIES (TOPOGRAPHIC)
'
,
b t '51
o er
50 •u
o - J
10
3s ~ r II B
5
2
II
, 11 ~
O - 56 s b pl •50
•4 ~ I ~ 40 r
ya~~ NWRW c CH
0 I SI a u
0 o II
n+u N49
E14
C .7.. u

1•
356 11 O

1\ ..a
1 ~
,e
alp
50
1! -1 II ~ r I ~
11 11 it „ p
r o N p ~a
1 ` a
11 a ~ Tr
hIl ~~u /1 ~ o ' I
'47
. / t 111 ~
G O- XI66 /

'462'N

O zso o
ti L
11 0 '
• ~ - ° 37'30'
'22 32'30' '23 4 '25 '26_'E 78 ° i30'
NTERIOR- GEOLOGICAL SURVEY, RESTON. VIRGINIA. IYGY
ROAD CLASSIFICATION
2000 Primary highway Light-duty road, hard or

Pre-Construction Notification (PC N-) Application Form

For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules

This form- is to be used for projects qualifying for- any of the U.S. Army Corps of Engineers' (USACB)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an individual 404 Permit or Individual 401
Water Quality Certification. The USACE IridiVidual Permit application form is available online at
htV://www.saw.usace,anny.miVwetlatids/Perth gpp,htm.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at hM://www.saw.usace.army.mil/wetlands/re our.htm, or contact one of the field
offices listed on page 3 of this application. The website also lists the responsible project manager for
each county in North Carolina and provides additional information regarding the identification and
regulation of wetlands and waters of the U.S.

The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 40UWetlands Unit website at
htta://h2o.enr.state.nc.us/ncwetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for General Certifications is not required, provided
that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet should
contact DWQ's Central Office in Raleigh at [phone].-
trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
(NCWRC) is required for projects occurring in any o North Carolina's twenty-five
Commission
counties that contain trout waters. In such cases,. the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on page 4 of this application) prior to submittal of the application-.

Page 1 of 11

Coastal Area Management Act (CAMA) Coordination - If the project occurs in any of North Carolina's
twenty coastal counties (listed on page 4) the applicant should contact the North Carolina Division of
Coastal Management (DCM). DCM will determine whether or not the project is within a designated
Area of Environmental Concern, in which case DCM will act as the lead permitting agency. In such
cases, DCM will require a CAMA Permit and will coordinate the 404/401 Permits-.
The applicant may also choose to coordinate with the United States Fish and Wildlife Service to ensure
that the proposed project will have no impact upon any endangered or threatened species or critical
habitat as regulated by the Endangered Species Act; and the State Historic Preservation Office, North
Carolina Department of Cultural Resources to ensure that the proposed project will have no impact upon
any properties listed or eligible for listing on the National Register of Historic Places. Compliance with
these regulations is required to be eligible for any Department of the Army permit. The addresses for
both agencies are listed on page 3 of this application.

USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office. Upon receipt of an application, the
USACE will determine if the application is complete as soon as possible, not to exceed 30 days. This
PCN form is designed for the convenience of the applicant to address information needs for all USACE
Nationwide, Regional or General permits, as well as information required for State authorizations,
certifications, and coordination. Fully providing the information requested on this form will result in a
complete application for any of the US°ACE Nationwide, Regional or General permits. To review the
minimum amount of information that must be provided for a complete PCN for each USACE
Nationwide permit, see Condition 13, 65 Fed. Reg. 12893 (March 9, 2000), available at
htip://www.saw.usace.army.miVwetlands/nwpfinalFedReg.pdf. Processing times vary by permit and
begin once the application has been determined to be complete. Please contact the appropriate
regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water- Quality, 401/Wetlands Unit, 1-650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at http://h2o.ehnr.state.nc.us/newetlands/fees.htmi. The fee must be
attached with the application unless the applicant is a federal- agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 461 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.

Page 2 of 12

US Army Corps Of Engineers Field Offices and County Coverage

,heville Regulatory Field Office Alexander Caldwell Haywood McDowell Swain
Army Corps of Engineers Alteghany Catawba Henderson Mecklenburg Transylvania
1 Patton Avenue Ashe Cherokee Iredell Mitchell Union
rom 208 Avery Clay Jackson Polk Watauga
Neville, NC 28801-5006 Buncombe Cleveland Lincoln Rowan Yancey
lephone: [phone] Burke Gaston Macon Rutherford
x: [phone] Cabamus Graham Madison Stanley
neigh Regulatory Field Office Alamu= Franklin Nash Sutry
3 Army Corps Of Engineers Caswell Forsyth Nordmmpton Vance
08 Falls of the Neuse Road Chatham Granville Orange Wake
cite 120 Davidson Guilford Person Warren
sleigh, NC 27615 Davie Halifax Randolph Wilkes
Jephone: [phone] Durham Johnston Rockingham' Wilson
x: [phone] Edgecombe Lee Stokes Yadkin
ashington Regulatory Field Office Beaufort Currituck Jones Pitt
3 Army Corps Of Engineers Bertie Dare Lenoir Tyrrell
1st Office Box 1000 Camden Gates Martin Washington
ashington, NC 27889-1000 Carteret* Green Pamlico Wayne
gephone: [phone] Chowan Hertford Pasquotank-
uc [phone] Craven Hyde Perquimans *Croatan National Forest Only
'ilmingtonRegulatory Field Office Anson Duplin Onslow
5 Army Corps Of Engineers Bladen Harnett Pender
ist Office Box 1890 Brunswick Hoke Richmond
'ilmington, NC 28402-1890 Carteret Montgomery Robeson
lephone: [phone] Columbus Moore Sampson
?x: [phone] Cumberland New Hanover Scotland
North Carolina State Agencies
ivision of Water Quality Division of Water Quality State Historic Preservation Office
)1 Wetlands Unit Wetlands Restoration Prb&m Department Of Cultural Resources
i50 Mail Service Center 1619 Mail Service Center 4617 Mail Service Center
aleigh, NC 276994650 Raleigh, NC 27699-1619 Raleigh, NC 27699-4617
elephone: [phone] Telephone: [phone] Telephone: [phone]
ax: [phone] Fax: [phone] Fax: [phone]

US Fish and Wildlife Service / National Marine Fisheries Service

S Fish and Wildlife Service US Fish and Wildlife Service National Marine Fisheries Service
aleigh Field Office Asheville Field Office Habitat Conservation Division
ost Office Box 33726 160 Ziilicoa Street Pivers Island
aleigh, NC 27636-3726 Asheville, NC 28801 Beaufort, NC 28516
elephone: [phone] Telephone: (82S) 258-3939 Telephone: [phone]

Page 3 of 12

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
Section 10 Permit ? Isolated Wetland Permit from DWQ
[3d 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: (S
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: ?

H. Applicant Information

1. Owner/Applicant Information
Name: AtraiE. ,s1-,ep4gw,,.S
Mailing Address: 314 6!APPA0oKE QoAD
R h u:A. N , O .L. 2.760

Telephone Number: -771-/,q SS Fax Number: 779 /~6/
E-mail Address:
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: fCaArr-PrevGro / ligg" .rT liA T
Company Affiliation: x-Ajg i i,er¢l u
Mailing Address: 3 1 1 C N APA a oke eoA D
7 71, 1) 3

`telephone Number: Fax Number: -779-1661
E-mail Address: S r~cjA27' dL

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 I I 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. Nameofproject: LJwsTolJ OolAjT6

2. T.I.P. Project Number or State Project Number (NCDOT Only): a /k

3. Property Identification Number (Tax PIN):_ 1(4 a

4. Location
County: J'phoz ro,,J Nearest Town: Toi+J or- CLAyTor)
Subdivision name (include phase/lot number): W to s-re.LJ PO/AJTG
Directions to site (include road numbers, landmarks, etc.): 7co T1+E _joe-rA from
TAE ?TERSEcT/a~J of G AA)AUIS ROAD AJD LJVSToa! &AA
CJr-r- &.4,- a/(.J 5T orb oR D

5. Site coordinates, if available (UTM or Lat/Long):
(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): 13 33. 7 2 A c_
7. Nearest body of water (stream/river/sound/oceatt/lake): V 141 rE va?. c 2 a

8. River Basin: ~.J 1ruSE
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at httn://h2o.enr.state.nc.us/admin/mays/.)

9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: t,10o D rA * CA L L o0

Page 6 of 12

10. Describe the overall project in detail, including the type of equipment to be used:

AJo vSE P2OPOSMO rO 151< MR-O"TEAL . TYPE
of Qwy ~.~T ro /~tCvOE 4yGL ObZE,e GeAo
DAL) A i eAGK Mnt,

11. Explain the purpose of the proposed work: To BAS/.y AREA o~
- / oPos~'~ Qr~aD

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 USAGE 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.
Noa F

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.
7-H496 k/ ,OF 4P rHE4 49124flV6 Za -Ir_
Y'?ld~C a?T rW- Ou ye t n~'oyf ii/A t /1f~? ~ IVIA 1 _
IJFJ F Q I ?E,e av FG ~ ~r. aq~j
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

I . Provide a written description of the proposed impacts: Pg,~ynfj.JrLA L 2 o A bt ?R
L 20-s-.4 1,; G , -7 2" 2G P /0

2. Individually list wetland impacts below:

Wetland Impact Area of Located within Distance to
Site Number Type of Impact* Impact IWyear Floodplain** Nearest Stream Type of Wetland***
(indicate on ma acres (es/no linear feet

* 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. ov.
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: 11-r. 2S &c
Total area of wetland impact proposed: (A
3. Individually list all intermittent and perennial stream impacts below:

Stream Impact Length of Average Width Perennial or
Site Number Type of Impact* Impact Stream Name** of Stream Intermittent?
indicate on ma linear feet Before impact lease specify)
I uT ro wglr OAK MW 3. 57 k

* 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 loWgain),
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 he founts 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 USES at 1-800-358-9616, or online at
www.usgs.eov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.tooozone.com,
www.mapquest.com, 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 Area of Type of Waterbody
Site Number T 5 "g of ~ - ot* I Name of Waterbody
YPmpact (if applicable} 0" Pte, sound,
indicate on map) (acres) bay, ocean, etc.

' List each impact separately and identify temporary impacts. 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.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.):

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
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
L -Iek 1'2,4v92sED A,uAOS.S Geox,64 AoO zAo.5.0-14
/L4A~1LJ / vA rn!/~2E1~ I~ EL~L~.~ 1.11Lf~' l~2DU~11~
To rl/yl rt /tom 11"Ogt r Z12DS-41AJC 1-JAS -4f-7- ArT A,
90b
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

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
htti)://h2o.enr.state.nc.us/ncwetlands/strmgide.html.

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 httL)://h2o.enr.state.ne.us/wry/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. 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 ?

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 213 .0233
(Neuse), 15A NCAC 213 .0259 (Tar-Pamlico), 15A NCAC 213 .0250 (Randleman Rules and
Water Suppl Buffer Requirements), or other (please identify PWSf
Yes V 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.
* Impact Required
Zone*
(square feet Multiplier Miti on
1 d S ~
2 2 SU 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 I:

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.
Ark/STI,y & e_nP rT71 is 4w-WW6 - Pappas E /s /174 LDTS - S 1rC /S
4001TAO 6Y N4-0Ea2 S1100r1WATE2 tEGyLA7/ -5.

XH. 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.
Tbc,)J o GL 27y~ SEw64

XH1. Violations (required by DWQ)

Is this site in violation of DWQ Wetland Rules (15A NCAC 211.0500) or any Buffer Rules?
Yes ? No

Is this an after-the-fact permit application?
Yes El 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, ari 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).

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

Page 12 of 12