20051144 Ver 2_Application_20081211

Office Use Only: --- -- - - I-orm Version March 05
USACE Action Ill No. UWQ No.
(If any particular item is not applicable to this project. please enter "Not Applicable" or "N/A".)
I. Processing
1. Ch k all of the approval(s) requested for this project:
(Section 404 Permit Riparian or Watershed Buffer Rules
V ection 10 Permit ? Isolated Wetland Permit from DWQ
01 Water Quality Certification L] Fxpress 401 Water Quality Certification
2. Nationwide, Regional or General Permit Ntunber(s) Requested: U
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: D
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts. attach the acceptance letter from NCI:EP, complete section VIII,
and check here: []
5, If your project is located in any of North Carolina's txNenty 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:
V19@90162 B
II. Applicant Information
,,, DEC 1 1 2008
1. Owner/Ap licant Information
Name: C? L------ l-You DENR-wATFrrnUALITY
. WETLANDS AND STORMWATER BRANCH
Mailing Addres
-s 31*
C?
-clephone Number:-a,? Fax Number: -_-?
f-mail Address: q:7(??.+cnf? nGr C°?rrt
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority liar the owner/applicant:)
Name:
Company Affiliation------- -------_-? ------
Mailing Address:
Telephone Number: - 1=ax Number:
E-mail Address:
Pa-c 5 ail, 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 arro?k. 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 I7-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-sire construction
drawings rather than a sequential sleet 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:.- C\ Yy-
2. T.I.P. Project Number or State Project Number (NCDO'f Only):
3. Property Identification Number ('fax PIN): 08OC.116 0 ;,Z131
4. Location
County: Nearest Town:?Af- ? l
Subdivision name (in lude phase/lot ntunber):______
Directions to site (include road numbers/names. landmarks, etc.):
Site coordinates (For linear pro.'ccts. such as a road or utility line.
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum):
6. Property size (acres): _ye-
7. Name of nearest receiving body of water:
River Basin: / refvc4 &41GJ
(Note --- this must be one of North C'arolina's seventeen designated major river basins. The
River Basin map is available at IOU)._._Ii ,idnrin m?if??%.}
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: ki 60144 0W I A44(, re=
attach a sheet that
OW
Page 6 of 12
10. Describe the overall project in detail, including the type ofequipment to be used:
W ? It SOnAlk ci,cc ?salw ?6 he-vrv4 e- A19 Ct r-4V C1 I rr-e-K. -ri orn 5 2cl-w'.
11. Explain the purpose ofthe proposed work:__ It-"% Ck 4A;e-?
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 11) 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. pr 'ect, along with
construction schedules. ' kjS ./4rtA WN% P y rCJ 1 ? IWe? 11CWk^J LA"0
_
zo-C )
V. Future Project Plans
Are any future permit requests anticipated for this project? I1' so. describe the anticipated work,
and provide justification for the exclusion ofthis vNork I'rom the current application,
ni u
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)
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 Vlll below. If additional
space is needed for listing or description. please attach a separate sheet.
Provide a written description of the proposed impacts:
Page 7 of 12
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
- - - - - - - - , - - - - - -- -
A
i I ocated %Nithin Distance to rea of
Wetland Impact l %pe of 1? etland
100-scar Nearest Impact
Site \umber 1 ape of Impact I (c.g.. 6 rested, marsh.
I loodplain Stream (acres)
(indicate on map) I herhaceous. h0c. ctC. t c, no (linear teed i
i I
3. List the total acreage (estimated) of all existing v?ctlands on the property:
4. Individually list all intermittent and perennial stream impacts. Be sure to identiffi 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. I o calculate acreage. nuuu t tengul n wiatn, inen utvtae ny UV.
Stream Impact Perennial (it- A\crage Impact Area of
1
Number Stream Name I lie of Impact ) Stream Width Length Impact
IntcrmittcnC'
indicate on ma) Belpre Impact (linear feet) (acres)
t a v p?- S ---- - - -- -
Total Stream Impact (h\ length and acreage)- - --
5. Individually list all open skater impacts (including Iakcs, ponds. estuaries, sounds. Atlantic
Ocean and any other water of the I;.S.). Open ?xater impacts include, but are not limited to
F.rt nvr oaotinn rtrPi-loino flnridino drainage. httlkheads- etc.
Open Water Impact l\ pc of WaterbodY
Namcof Watcrbod?
' Area of
Site Number linpact (take. pond. cstuar\. sound, bay.
I ape ol
(if applicable) Impact
(indicate on ma) ocean. etc.) (acres)
i
t

Total Open Water impact (acres)
I
Paec 8 of 12
6. List the cumulative im
to all Waters of the U.S, resulting from the
Stream Impact (acres):
Wetland hnpact (acres):
Open Water Impact (acres):-
Total Impact to Waters ofthc U.S. (acre)
"l otal Stream Impact (I 1-ncarfeet):
ect:
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
11' construction ol' a pond is proposed. associated N\-ctland 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.): T_ _
Current land use in the vicinity ofthe pond:--
Size of watershed draining to pond:-- __ Expected pond surlace 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. _?f; (2
61
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VIII. Mitigation 4}v 'lLt
DWQ - In accordance with 15A NCAC 21-1 .0500. mitigation may be required by the NC
Division of Water Quality fi>r 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.
Pa 9 o f 12
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 ma% be appropriate and practicable include,
but are not limited to: reducing the site of the project. establishing and maintaining wetland
and/or upland ccgetated buffers to pt'Otcct open eaters such as streams: and replacing losses of
aquatic resource functions and ? aluc h\ ;treating. restoring. enhancing. or preser\ ing similar
functions and \ aloes. preferable in the same \\ atcrshcd.
If mitigation is required for this project. a copy of' the mitigation plan must be attached in order
for USACE or D\VQ to consider the application complete for processing. Any application
lacking a required mitigation plan or WI _IT concurrence shall be placcd on hold as incomplete.
An applicant ma\ also choose to rep ie?\ the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Strcam Work in North Carolina. mailable at
htt :!ih?o,?lll ltatl'.nl=.U,nlll?ll?il'il -.Bill Ili ' r '?
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., decd 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 Ecos,,stern Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability. and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
websitc at litto: -1- .?rcu? r (;.,._u:, i> _ IRICN i1tm. If use of the NCEEP is proposed, please
check the appropriate box on page f ivc and provide the follox% ing 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):
Pau 10 of 12
IX. Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of public (federal/sta /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 l;nvironmcntal Policy Act (NIPA/SEPA)?
Note: If you are not sure whether a NI'TA%SI•:PA docurncnl is required, call the SEPA
coordinator at (919) 7:33-5083 to review current thresholds for environmental documentation.
Yes ? No ?
3. If yes, has the docllmellt review been finalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SFI)A 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 buflers 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 bllffel's must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Oftice 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
(Neese), 15A NCAC 213 .0259 ('far-Pamlico). 15A NC AC 0213 .0243 (Catawba) 15A NCAC
213 .0250 (Randleman Rules and Watcr Supply 131-111er Requirements), or other (please
identify _)'? Yes ? No ?
2. It' "yes", identify the square feet and acreage of impact to each ions of the riparian buffers.
If buffer mitigation is required calculate the required amount of mitigation by applying the
buffer multipliers.
r - ------ _ ' - - --
%unc I Impact 1 RCyuired
Multi het
-- - lsyuare ICCI.I -- ---- --Mitt uion
l 3 (2 I'OrCalao,ha)
2 1.5
Total ---- -- ---- - --- ------
Zone 1 extends out 30 Icet perpendicular fFom the top of the near bunk of channel: Zone 2 cstends an
additional 20 Ices f -om the edge ofZone I.
3. It' buffer mitigation is required, please discuss what type of' mitigation is proposed (i.e.,
Donation of Propert). Riparian Buffer Restoration 1:11hancement.. or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 213 .0242 or .0244, or .0260.
Page I I of 12
XI. Stormwater (required by DWQ)
Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss
stortmvater 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.-- !Y0 L-4 -iti1c.-? t?3n'
XII. Sewage Disposal (required by I)NN'Q)
Clcarl? detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater genterc d from the propt)scd projectl„or available capacit of he suhject faeility.
TIs3A ?1 AC, a,J t AS?1_a<,1 ?l:t? d1iR.L?trr
XIII. Violations (required by DWQ)
Is this site in violation of DW') Wetland Rules (I 5A NCAC 21-1 .0500) or any Buffer Rules?
Yes ? No V
Is this an after-the-Iact permit application? Yes ? No EL
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development. which could impact ncarbv downstream water quality`.' Yes ? No ?
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our \cebsite at
htt?:i?h?o.??i:r.,talr.nc.usiil???rtf Ifno. please provide a short narrative description:
XV. Other Circumstances (Optional):
It is the applicant's responsibility to suhmit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. Ilo\vever. an applicant may
choose to list constraints associated with Construction or sequencing that maN impose limits on
work schedules (c.g., draw-do\\ n schedules for lakes. dates associated with Endangered and
Threatened Species. accessibility problems. or other issues outside of the applicant's control).
Applicant/A nt'snature at
(Agent's signature is alid only ifan authorisation letter from the applicant is provided.)
Page 1 ? cal 12