20090723 Ver 1_401 Application_20090609

?1!?LMG .De"° 72 3
LAND MANAGEMENT GROUP INC.
Environmental Consultants COURTESY
Copy
June 18, 2009 JUN 2 4 2009
TO: Ms. Kimberly Garvey
U.S. Army Corps of Engineers
69 Darlington Avenue
Wilmington, NC 28403
RE: After-Action Restoration Plan
Brunswick County, NC
Action ID# SAW-2009-00925
Dear Kim:
DENR - WATER QUAUrr
VOW= MD ST ftMTER 8WW.A
& NWP 18 & 33 Application for 7219 Island View Place SW;
Enclosed is an After-Action Restoration Plan & Nationwide Permit 18 & 33 Application for your
review. This report and application is submitted on behalf of Mr. Robert Pope for his property at 7219
Island View Place SW in Ocean Isle Beach, NC. The applicant is proposing to construct a 20' wide
shallow meandering stream shaped to a 1:100 slope (1%) through existing fill material located in waters
of the US. The construction of this stream will restore the area back to its natural state prior to the ponds
excavation, will minimize waters and/or wetland impacts, and will bring the project out of violation with
the Clean Water Act. The applicant proposes temporary impacts to approximately 0.157 acres of waters
of the US during the stream construction. Once the stream is intact, approximately 0.082 acres of riparian
wetlands will be restored along with approximately 250 LF of ephemeral stream channel. Total
permanent impacts will equal 0.075 acre of waters of the US. The constructed ephemeral stream and
riparian areas will provide for greater wetland functions than the existing stagnant pond and will be used
to mitigate the small loss of waters of the US.
Please review this restoration plan and permit application and contact me if you have any
questions. Thank you for your assistance with this project.
Sincerely,
'W ?e,.-?-? i4 • ?o-?
Wes Fryar
Environmental Scientist
Encl.
Cc: Mr. Robert Pope
Mr. Chad Coburn, DWQ
Mr. Ian McMillan, DWQ
www.lmgroup.net • [e-mail] • Phone: [phone] • Fax: [phone]
3805 Wrightsville Ave., Suite 15, Wilmington, NC 28403 • P.O. Box 2522, Wilmington, NC 28402
LMG
LAND MANAGEMENT GROUP INC.
Environmental Consultants
W
June 18, 2009
TO: Mr. Chad Coburn
NC Division of Water Quality
127 Cardinal Drive Extension
Wilmington, NC 28405
RE: After-Action Restoration Plan & Courtesy Copy of NWP 18 & 33 Application for 7219 Island
View Place SW; Brunswick County, NC
COE Action ID# SAW-2009-00925
Dear Chad:
Enclosed is an After-Action Restoration Plan & Courtesy copy of a Nationwide Permit 18 & 33
Application for your review. This report and application is submitted on behalf of Mr. Robert Pope for his
property at 7219 Island View Place SW in Ocean Isle Beach, NC. The applicant is proposing to construct
a 20' wide shallow meandering stream shaped to a 1:100 slope (I%) through existing fill material located
in waters of the US. The construction of this stream will restore the area back to its natural state prior to
the ponds excavation, will minimize waters and/or wetland impacts, and will bring the project out of
violation with the Clean Water Act. The applicant proposes temporary impacts to approximately 0.157
acres of waters of the US during the stream construction. Once the stream is intact, approximately 0.082
acres of riparian wetlands will be restored along with approximately 250 LF of ephemeral stream channel.
Total permanent impacts will equal 0.075 acre of waters of the US. The constructed ephemeral stream and
riparian areas will provide for greater wetland functions than the existing stagnant pond and will be used
to mitigate the small loss of waters of the US.
Please review this revised permit application and contact me if you have any questions. Thank
you for your assistance with this project.
Sincerely,
Wes Fryar
Environmental Scientist
Encl.
Cc: Mr. Robert Pope
Mr. Ian McMillan, DWQ
Ms. Kim Garvey, USACE
www.lmgroup.net • infoglmgroup.net • Phone: [phone] • Fax: [phone]
3805 Wrightsville Ave., Suite 15, Wilmington, NC 28403 • P.O. Box 2522, Wilmington, NC 28402
AGENT DISCLOSURE FORM
TO WHOM IT MAY CONCERN:
I/we, the undersigned, hereby authorize Land Management Croup, Inc. to act as our agent in the
preparation and representation of information submitted within the 401/404 and/or CAMA
applications and/or septic permits for the'41.19 %66J V ?fw Rye SVJ site. All questions in
regards to this project should be directed to Land Management Group, Inc.
Sincerely,
Applicant Signature
Print Name
bate
After-Action Report
7219 Island View Place SW
Bob Pope Pond
Ocean Isle Beach
Brunswick County, North Carolina
Action ID# SAW-2009-00925
Prepared by:
Land Management Group, Inc.
P.O. Box 2522
Wilmington, NC
28402
Prepared for:
U.S. Army Corps of Engineers
Job# 01-09-099
June 15, 2009
Table of Contents
1.0 Introduction .............................................................................................................................3
2.0 Site Description .......................................................................................................................3
3.0 Area of Disturbance ................................................................................................................4
4.0 Restoration ...............................................................................................................................4
List of Figures & Appendices
Figure 1. Vicinity map
Figure 2. USGS Topographic map
Figure 3. Soils Map
Figure 4. Aerial Photograph
Figure 5. Site Plan showing `Existing Conditions' of Project Area
Figure 6. Site Plan showing `Proposed Restoration'
Figure 7. `Zoom In' of Restoration Area
Figure 8. `Top View' Schematic of Restoration Area with Elevation Readings
Figure 9. Existing Conditions Cross-Section with Proposed Grade
Figure 10. Final Proposed Conditions Cross-Section with Proposed Grade
Appendix A. Photographs of Site
2
1.0 Introduction
On May 12t' (2009), Ms. Kimberly Garvey and Ms. Teresa Russell from the Wilmington Regional
Office of the United States Corps of Engineers (USACE), and Ms. Stacie Craddock of the U.S.
Environmental Protection Agency (EPA) conducted a site inspection in regards to a complaint from a
neighbor regarding the unauthorized discharge of dredged and/or fill material into waters of the
United States, including wetlands adjacent to the Atlantic Intracoastal Waterway (AIWW). These
inspections revealed that the subject property was in violation of Section 301 of the Clean Water Act
(33 USC 1311) for the measurable discharge of fill material into approximately 0.25 acres of
jurisdictional waters of the US and/or wetlands. Specifically, they stated the presence of fill material
in a pond and wetlands on the property. As stated in a phone conversation on June 15th (2009) by
Ms. Kimberly Garvey of the USAGE, an After-the-fact Nationwide 18 & 33 permit application
(ATF) will be submitted along with this restoration plan for unauthorized activities in jurisdictional
waters of the US and/or wetlands and for the restoration of a stream channel in the impacted waters
of the US and/or wetlands area. Pursuant to the notice of unauthorized activity, the following `after-
action' report identifies appropriate steps to be taken for the correction of unauthorized disturbances
to wetlands and restoration of the small ephemeral stream.
2.0 Site Description
The site is located on the west side of Hideaway Road SW and Island View Place SW in Ocean Isle
Beach, Brunswick County, NC (refer to Figures 1 through 3). The violation area is located along the
northern side of the property in a pond which connects to an unnamed ephemeral tributary to the
Atlantic Intracoastal Waterway (AIWW) through a small dike and 6" pipe culvert (Figure 5, 8, and
Appendix A). The pond was dug out of high ground by Mr. Pope in the early 1970's and was
connected to the tributary of the AIWW through the 6" overflow pipe. Much of the site consists of
upland soils mapped by the Natural Resource Conservation Service (NRCS) as Wando fine sand
(Figure 3). The wetland soils that exist on site consist of Bohicket silty clay loam and are composed
almost entirely of Coastal Marsh. Most of the upland vegetation present consists of characteristic
species such as live oak (Quercus virginiana), wax myrtle (Morelia cerifera), yaupon holly (Ilex
vomitoria), common greenbrier (Smilax rotundifolia), and muscadine grape (Vitis rotundifolia).
Wetland vegetation on the property consists of characteristic species such as black needlerush
(Juncus roemerianus), wool grass (Scirpus cyperinus), and saltmarsh cordgrass (Spartina
alterniflora).
3.0 Identified Areas of Disturbance
On June 3rd (2009), staff of Land Management Group, Inc. (LMG) met on-site with Robert Pope to
determine the extent of the identified disturbance. During the course of this evaluation, LMG
confirmed that a pond considered jurisdictional waters of the US has been filled in order to reduce
the liability of neighborhood children from falling into the pond or encountering venomous pests
such as the Cottonmouth Water Moccassin (Agkistrodon piscivorus) which has recently inhabited the
pond (Figures 5, 7, 8 and site photos). Only a portion of the pond has been filled which equals an
area approximately 0.108 acres in size (Figure 5 & 7). Total existing disturbance for the site equals
4,700 ft' or 0.108 acres (Figure 5).
4.0 Remedial Action
Portions of the unauthorized pond fill will be restored to a natural state by constructing a 20' wide
shallow meandering stream shaped to a 1:100 slope (1%) through existing fill material (Figures 6-
10). This construction will bring the area back to its natural swale like state prior to the pond
construction with the restoration and/or creation of an ephemeral stream and abutting wetland areas.
The existing pond area will be drained during construction to avoid sediment erosion into adjacent
wetlands. A backhoe or grader will be used in this area to construct the shallow stream. Elevation
readings were taken along the length of the project area in order to determine the slope of the
proposed stream. It was determined that around two (2) feet of fall will be needed for the
approximate 200' of proposed construction. In order to stabilize the newly constructed area, Coastal
Bermuda grass (Cynodon dactylon) will be planted along the top banks of the proposed stream along
with Wax Myrtles (Morella cerifera) every thirty (30) feet and soft rush (Juncus effuses) along the
4
stream edge. A sediment pond lined with rock will be constructed where the existing dike/berm is
located, and will be left in place until the vegetation stabilizes the constructed stream area. Rain and
ground water will be allowed to trickle into the sediment pond and through the rock check dams into
the unnamed creek. The mouth of the stream will be stabilized before removing/lowering the stones.
Upon concurrence of this plan of action by the USACE, restoration activities will be initiated. The
USACE will be notified of completion of such activities to ensure the area is adequately restored.
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`Br_ ui idaf ies are app oxlma e a t)(1 Hi E
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Map Source: North Carolina Atlas & Gazetteer,2007 p. 86 SCALE 1" = 1 Mile
7219 Island View Place SW
Robert Pope LM G
Ocean Isle Beach
Figure 1
Brunswick County, NC www.LMGroup.net Vicinity Map
01-09-099 Phone: [phone] •1.866.LMG.1078
Fax: [phone]
June 2009 P.O. Box 2522, Wilmington, NC 28402
i
6

qvV3ACOA51
`Boundaries are appioxi ate atw i,F-
not meant to be absolute
Map Source: Shallotte Quadrangle 7.5 minute (topographic) 1990. SCALE 1" = 500'
7219 Island View Place SW
Robert Pope
4 ND I G; LMG
Ocean Isle Beach MA 1 '''I C _!; , 1, Figure 2
Brunswick County, NC vvww.LMGroup.net USGS Topgraphic Map
01-09-099 Phone: [phone] •1.866.LMG.1078
Fax: [phone]
June 2009 P.O. Box 2522, Wilmington, NC 28402
WaB: Wando fine sand
BO: Bohicket silty clay loam
"Boundaries ate approxiniatr ano are.
slot meant to be absolute
Map Source: NRCS Soil Survey GIS Data. SCALE 1" = 500'
7219 Island View Place SW
Robert Pope LMG
Ocean Isle Beach "?D"' f-„ 1, , Figure 3
Brunswick County, NC :www.LMGroup.net Soils Map
01-09-099 Phone: [phone] •1.866.LMG.1078
Fax: [phone]
June 2009 P.O. Box 2522, Wilmington, NC 28402
}Boundaries are approximate and arF
not meant to be absolute
Map Source: 2004 NAPP Aerial Photography SCALE 1" = 100'
7219 Island View Place SW
Robert Pope LMG
Ocean Isle Beach "n"`"a`'`,""T1,h°`r' Figure 4
Brunswick County, NC -vrvm.LMGroup.net Aerial Photograph
01-09-099 Phone: [phone] •1.866.LMG.1078
Fax: [phone]
June 2009 P.O. Box 2522, Wilmington, NC 28402
- Existing Pond Fill Area ( - 0.108 acres)
- Existing Pond Area ( - 0.049 acres)
- Existing Berm Area ( - 0.029 acres)
;?' ?;?• - Existing CAMA Marsh Area
"Boundaries are approximate and are
not meant to be absolute.
N
W ? E
S
SCALE 1" = 100'
7219 Island View Place SW
Robert Pope LMG
Ocean Isle Beach LAND MAN kc, MEN1 ` 1KI Figure 5
Brunswick County, NC Wwww.LMGroup.net "Existing Conditions"
01-09-099 Phone: [phone] •1.866.LMG.1078 of Project Area
Fax: [phone]
June 2009 P.O. Box 2522, Wilmington, NC 28402
-? % = - Proposed Riparian Restoration Area
711 0.082 acres)
- Proposed Stream Channel
Restoration ( - 250 LF)
Toundaries are approximate and are
not meant to be absolute.
N
W- 7 E
S
SCALE 1 100'
7219 Island View Place SW
Robert Pope LMG
Ocean Isle Beach IAN DMAN A,;MLN1CA t,:'
Figure 6
Brunswick County, NC Orr i www.LMGroup.net "Proposed Restoration"
01-09-099 Phone: [phone] •1.866.LMG.1078
Fax: [phone]
June 2009 P.O. Box 2522, Wilmington, NC 28402

Existin Proposed
Existing Pond Fill Area 0.108 acres)Proposed Riparian Restoration Area
- Existing Pond Area 0.049 acres) 0.082 acres)
- Existing Berm Area - Proposed Stream Channel
g 0.029 acres) Restoration ( - 250 LF)
- Existing CAMA Marsh Area
Toundaries are approximate and are
not meant to be absolute.
N
WE 6661
s??( SCALE 1 50'
7219 Island View Place SW
Robert Pope LMG
Ocean Isle Beach 1.ANjIMANAGE&RNi(1';°1"
. 11.1,.,-, 01, 1, Figure 7
Brunswick County, NC www.LMGroup.net "Zoom In" of Restoration
01-09-099 Phone: [phone] •1.866.LMG.1078
Fax: [phone] Area
June 2009 P.O. Box 2522, Wilmington, NC 28402
MHW
Myrtle
Grape ?
CatBrier
Yaupon
Poison Ivy
Vertical
4' Bank
Live
Oak
Erosion
into
roots
worm/dam Breast - Fill
Ordinary Water Level
g, 1 „
Pond
76
I
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1 F-- Fill Material
Approximate Limit of
Old Pond Bank

26
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,TTTTT E--- Existing bridge
CAMA
Marsh
*--Juncus, Scirpus, Giant Spartina
B x Marsh Mud - 11'2"
tea- z
"Boundaries are approximate and are
not meant to be absolute.
A
66"
Ditch
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IV
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7219 Island View Place SW
Robert Pope LMG
ND MAK'X' MINT 61M F
Ocean Isle Beach LAND , -1 figure 8
Brunswick County, NC i
?w - -roup.net "Top View" of Restoration
01-09-099 Phone: [phone] •1.8661MG.1078 Area w/ Elevation
Fax: [phone] Readings
June 2009 P.O. Box 2522, Wilmington, NC 28402

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7219 Island View Place SW
Robert Pope LMG
Ocean Isle Beach LAND HAKAf F MP4F 61': P -'W 1 1.11 ,' ?,-„Appendix A: 11 Brunswick County, NC www.LMGroup.net Site Photographs
01-09-099 Phone: [phone] •1.866.LMG.1078 Page1
Fax: [phone]
June 2009 P.O. Box 2522, Wilmington, NC 28402
View of Existing Pond Fill and Pond w/ scoured banks - Looking East
View of scoured bank exposing live oak roots

View of undisturbed ditch to east of undisturbed wetland area
7219 Island View Place SW
Robert Pope 1. M G
Ocean Isle Beach 1 AR D&IA G A1; i MILN I(,R0,1
?" "
Appendix A:
Brunswick County, NC
01-09-099 www.LMGroup.net Site Photographs
Phone: [phone] •1.866.LMG.1078
Page 2
Fax: [phone]
June 2009 P.O. Box 2522, Wilmington, NC 28402
View of undisturbed wetland area to north of existing pond fill
7219 Island View Place SW
Robert Pope LM G
Ocean Isle Beach `Aura",""",i.MFN` `RO' P
<,., , ,.,,,.;.,,<<,,, ,.,,t`
Appendix A:
Brunswick County, NC
01-09-099 ?www.LMGroup.net Site Photographs
Phone: [phone] •1.866.LMG.1078 page 3
Fax: [phone]
June 2009 P.O. Box 2522, Wilmington, NC 28402
View of existing pond fill looking west towards pond and berm area
View of pond and 6" outfall culvert

+_ 3

7219 Island View Place SW
Robert Pope LMG
Ocean Isle Beach IANDMAN",LNN,°h"`'' `
,,
Appendix A:
Brunswick County, NC www.LMGroup.net Site Photographs
01-09-099 Phone: [phone] •1.866.LMG.1078 Page 4
Fax: [phone]
June 2009 P.O. Box 2522, Wilmington, NC 28402
View of Cottonmouth Water Moccassin in pond
b
is
View of existing berm area
View of 6" outfall pipe and wetland area
7219 Island View Place SW
Robert Pope LMG
Ocean Isle Beach LAND MANAI' ""'"ROLY
Appendix A:
Brunswick County, NC www.LMGroup.net Site Photographs
01-09-099 Phone: [phone] •1.866.LMG.1078 Page 5
Fax: [phone]
June 2009 P.O. Box 2522, Wilmington, NC 28402
Oq-0 72 3
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9
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Office Use Only:
Corps action ID no.
DWQ project no.
Form Version 1.3 Dec 10 2008
Pre-Construction Notification (PCN) Form
'

A.
??
Applicant Information ESY
UKI

COPY
1. Processing
1 a. Type(s) of approval sought from the
Corps: After-the-Fact Section 404 Permit
®404 Permit ? Section 10 Permit
1 b. Specify Nationwide Permit (NWP) number: 18 & 33 or General Permit (GP) number:
1c. Has the NWP or GP number been verified by the Corps? ® Yes ? No
1 d. Type(s) of approval sought from the DWQ (check all that apply):
? 401 Water Quality Certification - Regular ? Non-404 Jurisdictional General Permit
? 401 Water Quality Certification - Express ? Riparian Buffer Authorization
1e. Is this notification solely for the record
because written approval is not required? For the record only for DWQ 401
Certification:
® Yes ? No For the record only for Corps Permit:

? Yes ? No
1f. Is payment into a mitigation bank or in-lieu fee program proposed for mitigation
of impacts? If so, attach the acceptance letter from mitigation bank or in-lieu
fee program. ? Yes ® No
1 g. Is the project located in any of NC's twenty coastal counties. If yes, answer 1 h
below. ® Yes ? No
1 h. Is the project located within a NC DCM Area of Environmental Concern (AEC)? ? Yes ® No
2. Project Information
2a. Name of project: 7219 Island View Place SW
2b. County: Brunswick
2c. Nearest municipality / town: Ocean Isle Beach
2d. Subdivision name: Hideaway Estates
2e. NCDOT only, T.I.P. or state
project no:
3. Owner Information
3a. Name(s) on Recorded Deed: Robert E Pope
3b. Deed Book and Page No. 0576 / 0519
3c. Responsible Party (for LLC if
applicable):
3d. Street address: 7219 Island View Place SW
3e. City, state, zip: Ocean Isle Beach
3f. Telephone no.: 910-579-2117
3g. Fax no.:
3h. Email address:
Page 1 of 12
PCN Form - Version 1.3 December 10, 2008 Version
4. Applicant Information (if different from owner)
4a. Applicant is: ® Agent ? Other, specify:
4b. Name:
4c. Business name
(if applicable):
4d. Street address:
4e. City, state, zip:
4f. Telephone no.:
4g. Fax no.:
4h. Email address:
5. Agent/Consultant Information (if applicable)
5a. Name: Wes Fryar
5b. Business name
(if applicable): Land Management Group, Inc
5c. Street address: 3805 Wrightsville Avenue
5d. City, state, zip: Wilmington, NC, 28403
5e. Telephone no.: 910-452-0001
5f. Fax no.: 910-452-0060
5g. Email address: [e-mail]
Page 2 of 12
B. Project Information and Prior Project History
1. Property Identification
1a. Property identification no. (tax PIN or parcel ID): 105520716305
Latitude: 33.890282 Longitude: - 78.480793
1 b. Site coordinates (in decimal degrees): (DD.DDDDDD) (-DD.DDDDDD)
1 c. Property size: 6.97 acres
2. Surface Waters
2a. Name of nearest body of water (stream, river, etc.) to Unnamed tributary to AIWW; AIWW
proposed project:
2b. Water Quality Classification of nearest receiving water: SA; HQW
2c. River basin: Lumber
3. Project Description
3a. Describe the existing conditions on the site and the general land use in the vicinity of the project at the time of this
application:
The site remains mostly undeveloped with one residential home and one workshop present. A pond dug in the early
1970's has been partially filled in order to prevent the undermining of an adjacent live oak tree's roots and to reduce the
liability of neighborhood children from falling into the pond or encountering venomous snakes which have recently
inhabited the pond. Surrounding land use is primarily residential or undeveloped.
3b. List the total estimated acreage of all existing wetlands on the property:
- 2.30 acres
3c. List the total estimated linear feet of all existing streams (intermittent and perennial) on the property:
0
3d. Explain the purpose of the proposed project:
The purpose of the proposed project is to restore the pond area back to its natural swale/ ephemeral stream like state, to
prevent the undermining of an adjacent live oak tree's roots, and to reduce the liability of neighborhood children from
encountering danger near the pond.
3e. Describe the overall project in detail, including the type of equipment to be used:
Portions of the unauthorized pond fill will be restored to a natural state by constructing a 20' wide shallow meandering stream
shaped to a 1:100 slope (1%) through existing fill material (Figures 6-10). This construction will bring the area back to its
natural swale like state prior to the pond construction with the restoration and/or creation of an ephemeral stream and wetland
areas. The existing pond area will be drained during construction to avoid sediment erosion into adjacent wetlands. A
backhoe or grader will be used in this area to construct the shallow stream. Elevation readings were taken along the length of
the project area in order to determine the slope of the proposed stream. It was determined that around two (2) feet of fall will
be needed for the approximate 200' of proposed construction. In order to stabilize the newly constructed area, Coastal
Bermuda grass (Cynodon dactylon) will be planted along the top banks of the proposed stream along with Wax Myrtles
(Morella cerifera) every thirty (30) feet and soft rush (Juncus effuses) along the stream edge. A sediment pond lined with rock
will be constructed where the existing dike/berm is located, and will be left in place until the vegetation stabilizes the
constructed stream area. Rain and ground water will be allowed to trickle into the sediment pond and through the rock check
dams into the unnamed creek. The mouth of the stream will be stabilized before removing/lowering the stones.
Page 3 of 12
PCN Form - Version 1.3 December 10, 2008 Version
B. Project Information and Prior Project History
4. Jurisdictional Determinations
4a. Have jurisdictional wetland or stream determinations by the
Corps or State been requested or obtained for this property /
project (including all prior phases) in the past?
Comments:
? Yes ? No ® Unknown
4b. If the Corps made the jurisdictional determination, what type
of determination was made? ? Preliminary ? Final
4c. If yes, who delineated the jurisdictional areas?
Name (if known): Agency/Consultant Company:
Other:
4d. If yes, list the dates of the Corps jurisdictional determinations or State determinations and attach documentation.
5. Project History
5a. Have permits or certifications been requested or obtained for
this project (including all prior phases) in the past? ? Yes ? No ® Unknown
5b. If yes, explain in detail according to "help file" instructions.
6. Future Project Plans
6a. Is this a phased project? ? Yes ® No
6b. If yes, explain.
Page 4 of 12
C. Proposed Impacts Inventory
1. Impacts Summary
1a. Which sections were completed below for your project (check all that apply):
? Wetlands ? Streams - tributaries ? Buffers
® Open Waters ? Pond Construction
2. Wetland Impacts
If there are wetland impacts proposed on the site, then complete this question for each wetland area impacted.
2a. 2b. 2c. 2d. 2e.
Type of jurisdiction 2f.
Wetland impact
number - Type of impact Type of wetland Forested (Corps - 404, 10 Area of impact
Permanent (P) or (if known) DWQ - non-404, other) (acres)
Temporary T
? Yes
? Corps
W 1 ? P ? T ? No ? DWQ
? Yes ? Corps
W2 ? P ? T ? No ? DWQ
? Yes ? Corps
W3 ? P ? T ? No ? DWQ
? Yes ? Corps
W4 ? P ? T ? No ? DWQ
? Yes ? Corps
W5 ? P ? T ? No ? DWQ
? Yes ? Corps
W6 ? P ? T ? No ? DWQ
2g. Total wetland impacts N/A
2h. Comments:
3. Stream Impacts
If there are perennial or intermittent stream impacts (including temporary impacts) proposed on the site, then complete this
question for all stream sites impacted.
3a.
Stream impact 3b.
Type of impact 3c.
Stream name 3d.
Perennial 3e.
Type of jurisdiction 3f.
Average
t 3g.
Impact
length
number - (PER) or (Corps - 404, 10 ream
s
width (linear
Permanent (P) or intermittent
(INT)? DWQ - non-404,
ther) (feet) feet)
Temporary (T) o
? PER ? Corps
S1 ? P ? T ? INT ? DWQ
? PER ? Corps
S2 ? P ? T ? INT ? DWQ
? PER ? Corps
S3 ? P ? T ? INT ? DWQ
? PER ? Corps
S4 ? P ? T ? INT ? DWQ
? PER ? Corps
S5 ? P ? T ? INT ? DWQ
? PER ? Corps
S6 ? P ? T ? INT ? DWQ
3h. Total stream and tributary impacts N/A
3i. Comments:
Page 5 of 12
PCN Form - Version 1.3 December 10, 2008 Version
4. Open Water Impacts
If there are proposed impacts to lakes, ponds, estuaries, tributaries, sounds, the Atlantic Ocean, or any other open water of
the U.S. then individual) list all open water impacts below.
4a. 4b. 4c. 4d. 4e.
Open water Name of waterbody
impact number - (if applicable) Type of impact Waterbody type Area of impact (acres)
Permanent (P) or
Temporary T
01 ? P ®T Fill Pond 0.157
02 ®P ? T Fill Pond 0.075
03 ?P?T
04 ?P?T
0. Total open water impacts 0.157
4g. Comments: A temporary impact of 0.157 acres will account for the existing 0.108 acres of fill already in place plus an
additional 0.049 acres composing the remaining portion of the pond. Once the riparian area of 0.082 acres is restored the
permanent impact to Waters of the US will equal 0.075 acres.

5. Pond or Lake Construction
If and or lake construction proposed, then complete the chart below.
5a. 5b. 5c. 5d. 5e.
Wetland Impacts (acres) Stream Impacts (feet) Upland
Pond ID Proposed use or purpose (acres)
number of pond
Flooded
Filled
Excavated
Flooded
Filled
Excavated
Flooded
P1
P2
5f. Total
5g. Comments:
5h. Is a dam high hazard permit required?
? Yes ? No If yes, permit ID no:
5i. Expected pond surface area (acres):
5j. Size of pond watershed (acres):
5k. Method of construction:
Page 6 of 12
6. Buffer Impacts (for DWQ)
If project will impact a protected riparian buffer, then complete the chart below. If yes, then individually list all buffer impacts
below. If an impacts require mitigation, then you MUST fill out Section D of this form.
6a.
? Neuse ?Tar-Pamlico Other:
Project is in which protected basin? ? Catawba ? Randleman
6b. 6c. 6d. 6e. 6f. 6g.
Buffer impact
number-
Reason
Buffer
Zone 1 impact
Zone 2 impact
Permanent (P) or for Stream name mitigation (square feet) (square feet)
Temporary T impact required?
?Yes
61 ?P?T ? No
?Yes
B2 ?P?T ? No
? Yes
B3 ? P ? T ? No
6h. Total buffer impacts
6i. Comments:
Page 7 of 12
D. impact Justification and Mitigation
1. Avoidance and Minimization
1 a. Specifically describe measures taken to avoid or minimize the proposed impacts in designing project.
The owner has avoided and minimized to the maximum extent by draining the remaining water out of the existing pond
A 20' wide shallow ephemeral stream
nt wetlands
d
.
jace
during construction to avoid sediment and erosion runoff into a
ssociated wetlands will be constructed within the existing pond fill area and shaped to a 1:100 slope (1 %) to
d
an
a
conform to natural landscape elevations. The proposed stream restoration will replace approximately 0.082 acres of the
existing 0.157 acre pond area, resulting in a minimal net loss of 0.075 acres of Waters of the U.S.
1 b. Specifically describe measures taken to avoid or minimize the proposed impacts through construction techniques.
By draining the existing water level in the pond, no sediment will be allowed to reach adjacent wetlands. In order to
nodon dactylon) will be planted along the top banks of
rass (C
d
B
y
a g
ermu
stabilize the newly constructed area, Coastal
the proposed stream along with Wax Myrtles (Morelia cerifera) every thirty (30) feet and soft rush (Juncus effuses) along
ill b
e
the stream edge. A sediment pond lined with rock will be constructed where the existing dike/berm is located, and w
left in place until the vegetation stabilizes the constructed stream area.
2. Compensatory Mitigation for Impacts to Waters of the U.S. or Waters of the State
2a, Does the project require Compensatory Mitigation for ® Yes ? No
impacts to Waters of the U.S. or Waters of the State?
2b. If yes, mitigation is required by (check all that apply): ? DWQ ® Corps
? Mitigation bank
2c. If yes, which mitigation option will be used for this ? Payment to in-lieu fee program
project?
® Permittee Responsible Mitigation
3. Complete if Using a Mitigation Bank
3a. Name of Mitigation Bank:
3b. Credits Purchased (attach receipt and letter) Type Quantity
3c. Comments:
4. Complete if Making a Payment to In-lieu Fee Program
4a. Approval letter from in-lieu fee program is attached. ? Yes
4b. Stream mitigation requested: linear feet
4c. If using stream mitigation, stream temperature: ? warm ? cool ?cold
4d. Buffer mitigation requested (DWQ only): square feet
4e. Riparian wetland mitigation requested: acres
4f. Non-riparian wetland mitigation requested: acres
4g. Coastal (tidal) wetland mitigation requested: acres

4h. Comments:
c (`mm-lntn if I Icinn n Permittee Resoonsibie Mitigation Plan

Page 8 of 12
PCN Form - Version 1.3 December 10, 2008 Version
5a. If using a permittee responsible mitigation plan, provide a description of the proposed mitigation plan.
The owner will be restoring and creating a meandering ephemeral stream system and associated wetlands in place of the
existing pond fill which will provide for greater functions than the existing stagnant pond. This restoration/creation will
result in - 0.082 acres of riparian wetland area, as well as - 250 linear feet of ephemeral stream channel (See
Restoration Plan & Figures 6-10).
6. Buffer Mitigation (State Regulated Riparian Buffer Rules) - required by DWQ
6a. Will the project result in an impact within a protected riparian buffer that requires ? Yes ® No
buffer mitigation?
6b. If yes, then identify the square feet of impact to each zone of the riparian buffer that requires mitigation. Calculate the
amount of mitigation required.
6c. 6d. 6e.
Zone Reason for impact Total impact Multiplier Required mitigation
(square feet) (square feet)
Zone 1 3 (2 for Catawba)
Zone 2 1.5
1 6f. Total buffer mitigation required:
6g. If buffer mitigation is required, discuss what type of mitigation is proposed (e.g., payment to private mitigation bank,
permittee responsible riparian buffer restoration, payment into an approved in-lieu fee fund).
6h. Comments:
Page 9 of 12
E. Stormwater Management and Diffuse Flow Plan (required by DWQ)
1. Diffuse Flow Plan

1 a. Does the project include or is it adjacent to protected riparian buffers identified ? Yes ® No
within one of the NC Riparian Buffer Protection Rules?
1b. If yes, then is a diffuse flow plan included? If no, explain why. ? Yes ? No
Comments:
2. Stormwater Management Plan

2a. What is the overall percent imperviousness of this project? 1.7%
2b. Does this project require a Stormwater Management Plan? ? Yes ® No
2c. If this project DOES NOT require a Stormwater Management Plan, explain why: Every drainage area has been kept
below 24 percent imperviousness
2d. If this project DOES require a Stormwater Management Plan, then provide a brief, narrative description of the plan:
? Certified Local Government
2e. Who will be responsible for the review of the Stormwater Management Plan? ? DWQ Stormwater Program
? DWQ 401 Unit
3. Certified Local Government Stormwater Review

3a. In which local government's jurisdiction is this project? N/A
? Phase II
? NSW
3b. Which of the following locally-implemented stormwater management programs ? USMP
apply (check all that apply): ? Water Supply Watershed
? Other:
3c. Has the approved Stormwater Management Plan with proof of approval been ? Yes ? No
attached?
4. DWQ Stormwater Program Review
? Coastal counties
? HQW
4a. Which of the following state-implemented stormwater management programs apply ? ORW
(check all that apply): ? Session Law 2006-246
? Other:
4b. Has the approved Stormwater Management Plan with proof of approval been
? Yes ? No
attached?
5. DWQ 401 Unit Stormwater Review
5a. Does the Stormwater Management Plan meet the appropriate requirements? ? Yes ? No
5b. Have all of the 401 Unit submittal requirements been met? ? Yes ? No
Page 10 of 12
PCN Form - Version 1.3 December 10, 2008 Version
F. Supplementary Information
1. Environmental Documentation (DWQ Requirement)
1 a. Does the project involve an expenditure of public (federal/state/local) funds or the ? Yes ® No
use of public (federal/state) land?
1 b. If you answered "yes" to the above, does the project require preparation of an
St
t
l
? Yes ? No
e
a
or
environmental document pursuant to the requirements of the Nationa
(North Carolina) Environmental Policy Act (NEPA/SEPA)?
1c. If you answered "yes" to the above, has the document review been finalized by the
State Clearing House? (If so, attach a copy of the NEPA or SEPA final approval F-1 Yes ? No
letter.)
Comments:
2. Violations (DWQ Requirement)
2a. Is the site in violation of DWQ Wetland Rules (15A NCAC 2H .0500), Isolated
d
d
S
® Yes ? No
ar
s,
tan
Wetland Rules (15A NCAC 2H .1300), DWQ Surface Water or Wetland
or Riparian Buffer Rules (15A NCAC 2B .0200)?
2b. Is this an after-the-fact permit application? ® Yes ? No
2c. If you answered "yes" to one or both of the above questions, provide an explanation of the violation(s): Approximately
0.108 acres of the existing pond has been filled.
3. Cumulative Impacts (DWQ Requirement)
3a. Will this project (based on past and reasonably anticipated future impacts) result in ? Yes ® No
additional development, which could impact nearby downstream water quality?
3b. If you answered "yes" to the above, submit a qualitative or quantitative cumulative impact analysis in accordance with the
most recent DWQ policy. If you answered "no," provide a short narrative description.
4. Sewage Disposal (DWQ Requirement)
4a. 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.
Existing house has bathrooms that have been in place since 1958.
Page 11 of 12
PCN Form - Version 1.3 December 10, 2008 Version
5. Endangered Species and Designated Critical Habitat (Corps Requirement)
5a. Will this project occur in or near an area with federally protected species or ? Yes ® No
habitat?
5b. Have you checked with the USFWS concerning Endangered Species Act ? Yes ® No
impacts?
E:1 Raleigh
5c. If yes, indicate the USFWS Field Office you have contacted.
ville
? A
h
e
s
5d. What data sources did you use to determine whether your site would impact Endangered Species or Designated Critical
Habitat?
NC Natural Heritage Program Database
6. Essential Fish Habitat (Corps Requirement)
6a. Will this project occur in or near an area designated as essential fish habitat? ® Yes ? No
6b. What data sources did you use to determine whether your site would impact Essential Fish Habitat?
NOAA EFH Mapper
7. Historic or Prehistoric Cultural Resources (Corps Requirement)
7a. Will this project occur in or near an area that the state, federal or tribal
governments have designated as having historic or cultural preservation ? Yes ® No
status (e.g., National Historic Trust designation or properties significant in
North Carolina history and archaeology)?
7b. What data sources did you use to determine whether your site would impact historic or archeological resources?
NC Natural Heritage Program Database
8. Flood Zone Designation (Corps Requirement)
8a. Will this project occur in a FEMA-designated 100-year floodplain? ® Yes ? No
8b. If yes, explain how project meets FEMA requirements: House was built in 1958 prior to FEMA requirements
8c. What source(s) did you use to make the floodplain determination? www.ncfloodmaps.com
Wesley A Fryar 6/17/2009

Applicant/Agent's Printed Name Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant
is provided.)
Page 12 of 12