20052054 Ver 1_Complete File_20060606

DWQ-5-2054 Town of Ayden CWMTF Sewer Outfall Replacement
Subject: DWQ 05-2054 Town of Ayden CWMTF Sewer Outfall Replacement
From: Laurie Dennison <[e-mail]>
Date: Fri, 09 Dec 2005 13:37:52 -0500
To: [e-mail]
Please see attached the Division of Water Quality's request for more information
related to your recent application. Please note that this message is being forwarded
to you electronically so that you may expedite preparation of your response. Please do
not send your response as a reply to this e-mail or via fax. The hard copy is being
sent via US Mail. All response correspondence is to be mailed via hard copy to the 401
oversight and Express Permits Unit, 2321 Crabtree Blvd., Raleigh, NC, 27604 unless
otherwise noted.
Content-Type: application/msword
052054TOAydenCWMTFSewerOutfall(Pitt)On HoldIdoc
Content-Encoding: base64
12/9/2005 1:44 PM

O
W ATF9
QG
r
- 'C
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
December 5, 2005
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
Town of Ayden
P.O. Box 219
Ayden, NC 28513
Alan W. Klimek, P.E. Director
Division of Water Quality
DWQ Project # 05-2054
Pitt County
Subject Property: Town of Ayden: CWMTF Sewer Outfall Replacement
Ut to Swift Creek [030409, 27-97-(0.5), C, SW, NSW]
REQUEST FOR MORE INFORMATION
Dear Sir or Madam:
On November 10, 2005, the Division of Water Quality (DWQ) received your application dated October
13, 2005, to impact 50 linear feet of stream to construct the proposed replacement of a dilapidated sewer
collection line. On December 2, 2005, the DWQ received additional information from you. The DWQ
has determined that your application remains incomplete and/or provided inaccurate information as
discussed below. The DWQ will require additional information in order to process your application to
impact protected wetlands and/or streams on the subject property. Therefore, unless we receive the
additional information requested below, we will have to move toward denial of your application as
required by 15A NCAC 2H.0506 and will place this project on hold as incomplete until we receive this
additional information. Please provide the following information so that we may continue to review your
project.
Additional Information Requested:
1. Please indicate all buffer impacts on the site plan. Specifically, with respect to the manhole
labeled as "Manhole 4A" on the site plans. Excavation of the stream, replacement of the manhole
and construction vehicles within the protected riparian buffer zone, could impact Zone 1 and
Zone 2 of the buffers.
2. Please provide a soil survey map with the boundaries of your project clearly marked.
Please respond within three weeks of the date of this letter by sending this information to me in writing
and Kyle Barnes of the DWQ Washington Regional Office. If we do not hear from you within three
weeks, we will assume that you no longer want to pursue. this project and we will consider the project as
withdrawn.
401 Oversight/Express Review Permitting Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: hn://h2o.etu.state.nc.us/ncwetiands
None Carolina
Naturally
An Equal Opportunity/Affirmative Action Employer- 50% Recycled/10% Post Consumer Paper
Town of Aydenr +t
Page 2 of 2
December 5, 2005
This letter only addresses the application review and does not authorize any impacts to wetlands, waters
or protected buffers. Please be aware that any impacts requested within your application are not
authorized (at this time) by the DWQ. Please call Ms. Cyndi Karoly or Mr. Ian McMillan at 919-733-
1786 if you have any questions regarding or would like to set up a meeting to discuss this matter.
Sincerely,
Cyndi Karoly, Supervisor
401 Oversight/Express Review Permitting Unit
CBK/ijm
cc: Richard B. Moore, McDavid & Associates, Inc., P.O. Drawer 49, Farmville, NC 27828
Kyles Barnes, DWQ Washington Regional Office
USACE Washington Regulatory Field Office
File Copy
Central Files
Filename: 052054TOAydenC WMTFS ewerOutfall(Pitt)On_Hold2

Subject: DWQ # 05-2054 Town of Ayden CWMTF Sewer Outfall Replacement
From: Laurie Dennison <laurie [e-mail]>
Date: Mon, 05 Dec 2005 14:57:04 -0500
To: [e-mail]
CC: [e-mail]
Please see attached the Division of Water Quality's request for more information
related to your recent application. Please note that this message is being forwarded
to you electronically so that you may expedite preparation of your response. Please do
not send your response as a reply to this e-mail or via fax. The hard copy is being
sent via US Mail. All response correspondence is to be mailed via hard copy to the 401
Oversight and Express Permits Unit, 2321 Crabtree Blvd., Raleigh, NC, 27604 unless
otherwise noted.
052054TOAydenCWMTFSewerOutfall(Pitt)On_Hold2.doc Content-Type: application/msword
Content-Encoding: base64
l of 1 12/5/2005 2:57 PM
O5 - a-o' t?
McDAVIDAsSOCIATES, INC.
M.IN Engineers • Planners • Land Surveyors
CORPORATE OFFICE GOLDSBORO OFFICE
[phone] • Fax [phone] [phone] • Fax [phone]
E-mail: [e-mail] E-mail: [e-mail]
3714 N. Main Street • P.O. Drawer 49 109 E. Walnut Street • P.O. Box 1776
Farmville, NC 27828 Goldsboro, NC 27533
December 7, 2005
oar D
Ms. Cyndi Karoly, Supervisor DEC 8 2005
401 Oversight/Express Review Permitting Unit
Division of Water Quality LADENR NDS NDS -WATER QUALITY
yy1T tA AND STOR1dINATER BRANCH
1650 Mail Service Center
Raleigh, NC 27699-1650
SUBJECT: 401 Water Quality Certification
Nationwide Permit Request
Outfall Sanitary Sewer Improvements
Town of Ayden
Pitt County
Dear Ms. Karoly:
In reference to the subject project and in response to your December 5, 2005 correspondence
(Karoly to Town of Ayden), please find enclosed one (1) copy of each of the following items for your
review:
1. Revised plan sheets 3 and 4 showing buffer impacts resulting from replacement of
manhole 4A.
2. Soil survey panel extract showing the proposed project area.
Per your comment, construction of manhole 4A will impact both Zone 1 and Zone 2 of the
riparian buffer zone. Where the existing sewer main has an aerial crossing of the perennial steam,
impact cannot be avoided. Please note that potential impact is minimal when compared to runoff
experienced from the agriculture field each year. The justification of the project is repetitive sewer
overflows that discharge direct to the perennial stream. Coliform sampling from the surface water
confirmed elevated colony counts representing the presence of a potential health hazard. The project
does not propose to service any new development, only replace existing dilapidated facilities. A
completed project will serve to better protect the existing surface waters by eliminating the potential
for sewer spills.
Reference manhole 4A, there is no practical alternative to replacing the manhole as proposed.
Existing outfall sewer is at a grade that does not meet Division of Water Quality minimum design
requirements. Replacement will correct grade deficiencies, requiring construction of a new manhole.
Existing sewer mains run east and west from manhole 4A that will not be relocated as a part of this
project. Manhole 4A cannot be relocated outside of riparian buffers because of the existing east/west
sewer mains.
D405RBM05 1 3:28pm
AYDEN-OUTFALL-SSI401-NATIONWIDE-PERMIT. LTR;3 051207
Thank you for your prompt review. Please advise as I may provide additional information
for your review.
Sincerely,
Mc DAVID ASST
I
to
Farmville Office
TES, INC.
, P. E.
RBM:bbr
Enclosures
cc: Kyle Barnes (w/encl)
D405RBM05 2
AYDEN-OUTFALL-SSI-401-NATION WIDE-PERMIT. LTR; 3
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8pm
051207
PI_,
D5 - ?- ©5 q
McDAVIDAssOCUTES, INC.
INC. Engineers • Planners • Land Surveyors
CORPORATE OFFICE GOLDSBORO OFFICE
[phone] • Fax [phone] [phone] • Fax [phone]
E-mail: [e-mail] E-mail: [e-mail]
3714 N. Main Street • P.O. Drawer 49 109 E. Walnut Street • P.O. Box 1776
Farmville, NC 27828 Goldsboro, NC 27533
December 1, 2005
DEC 2 2005
Ms. Cyndi Karoly, Supervisor
401 Oversight/Express Review Permitting Unit DENR - WATER QUALITY
Division of Water Quality WETLANDS AND STORMWATER BRANCH
1650 Mail Service Center
Raleigh, NC 27699-1650
SUBJECT: 401 Water Quality Certification
Nationwide Permit Request
Outfall Sanitary Sewer Improvements
Town of Ayden
Pitt County, NC
Dear Ms. Karoly:
In reference to the subject project and in response to your November 17, 2005
correspondence (Karoly to Town of Ayden), please find enclosed one (1) set of revised construction
plans. Per your request for additional information, the following changes have been made to plans:
1. Stream crossings are shown in the profile section of plan sheets. Unfortunately, the
existing aerial crossings of sewer mains can not be corrected by proposed
replacement. A note has been added requiring slope to be restored to original
condition and Contractor to use netting in support of seeding activities.
2. Buffer descriptions and locations have been added to plan profile sheets. The vicinity
map on the cover sheet shows the two (2) stream crossings.
3. Zone 1 and Zone 2 buffers are marked on plan profile drawings
Please note that the proposed project replaces existing infrastructure that was installed and
in use prior to implementation of riparian buffer restrictions. There is no intent to convert the current
use of adjacent agriculture property.
D405RBM05 1 1:20pm
AYDEN-05-C WMTF-OUTFALL-D W Q-401-PER-REQ. LTR;2 051201

Thank you for your assistance. Please advise as I may provide additional information for
your review.
Sincerely,
McDAVID ASS9FCIATES, INC.
R1ehafrdB. oore, p.E.
Farniville Office
RBM:Icm
Enclosures
cc: Adam Mitchell
Kyle Barnes (w/encl)
D405RBM05 2
AYDEN-05-C WMTF-OUTFALL-D W Q-401-PER-REQ. LTR; 2
C. ? M
1 INC.
01201

O
W ATF9
QG
r
- 'C
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
December 5, 2005
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
Town of Ayden
P.O. Box 219
Ayden, NC 28513
Alan W. Klimek, P.E. Director
Division of Water Quality
DWQ Project # 05-2054
Pitt County
Subject Property: Town of Ayden: CWMTF Sewer Outfall Replacement
Ut to Swift Creek [030409, 27-97-(0.5), C, SW, NSW]
REQUEST FOR MORE INFORMATION
Dear Sir or Madam:
On November 10, 2005, the Division of Water Quality (DWQ) received your application dated October
13, 2005, to impact 50 linear feet of stream to construct the proposed replacement of a dilapidated sewer
collection line. On December 2, 2005, the DWQ received additional information from you. The DWQ
has determined that your application remains incomplete and/or provided inaccurate information as
discussed below. The DWQ will require additional information in order to process your application to
impact protected wetlands and/or streams on the subject property. Therefore, unless we receive the
additional information requested below, we will have to move toward denial of your application as
required by 15A NCAC 2H.0506 and will place this project on hold as incomplete until we receive this
additional information. Please provide the following information so that we may continue to review your
project.
Additional Information Requested:
1. Please indicate all buffer impacts on the site plan. Specifically, with respect to the manhole
labeled as "Manhole 4A" on the site plans. Excavation of the stream, replacement of the manhole
and construction vehicles within the protected riparian buffer zone, could impact Zone 1 and
Zone 2 of the buffers.
2. Please provide a soil survey map with the boundaries of your project clearly marked.
Please respond within three weeks of the date of this letter by sending this information to me in writing
and Kyle Barnes of the DWQ Washington Regional Office. If we do not hear from you within three
weeks, we will assume that you no longer want to pursue. this project and we will consider the project as
withdrawn.
401 Oversight/Express Review Permitting Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: hn://h2o.etu.state.nc.us/ncwetiands
None Carolina
Naturally
An Equal Opportunity/Affirmative Action Employer- 50% Recycled/10% Post Consumer Paper
Town of Aydenr +t
Page 2 of 2
December 5, 2005
This letter only addresses the application review and does not authorize any impacts to wetlands, waters
or protected buffers. Please be aware that any impacts requested within your application are not
authorized (at this time) by the DWQ. Please call Ms. Cyndi Karoly or Mr. Ian McMillan at 919-733-
1786 if you have any questions regarding or would like to set up a meeting to discuss this matter.
Sincerely,
Cyndi Karoly, Supervisor
401 Oversight/Express Review Permitting Unit
CBK/ijm
cc: Richard B. Moore, McDavid & Associates, Inc., P.O. Drawer 49, Farmville, NC 27828
Kyles Barnes, DWQ Washington Regional Office
USACE Washington Regulatory Field Office
File Copy
Central Files
Filename: 052054TOAydenC WMTFS ewerOutfall(Pitt)On_Hold2

Subject: DWQ # 05-2054 Town of Ayden CWMTF Sewer Outfall Replacement
From: Laurie Dennison <laurie [e-mail]>
Date: Mon, 05 Dec 2005 14:57:04 -0500
To: [e-mail]
CC: [e-mail]
Please see attached the Division of Water Quality's request for more information
related to your recent application. Please note that this message is being forwarded
to you electronically so that you may expedite preparation of your response. Please do
not send your response as a reply to this e-mail or via fax. The hard copy is being
sent via US Mail. All response correspondence is to be mailed via hard copy to the 401
Oversight and Express Permits Unit, 2321 Crabtree Blvd., Raleigh, NC, 27604 unless
otherwise noted.
052054TOAydenCWMTFSewerOutfall(Pitt)On_Hold2.doc Content-Type: application/msword
Content-Encoding: base64
l of 1 12/5/2005 2:57 PM
INC.
McDAVIDAsSOCUTES, INC.
Engineers • Planners • Land Surveyors
CORPORATE OFFICE
[phone] • Fax [phone]
E-mail: [e-mail]
3714 N. Main Street • P.O. Drawer 49
Farmville, NC 27828
Division of Water Quality
401/Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
November 8, 2005

GOLDSBORO OFFICE
[phone] • Fax [phone]
E-mail: [e-mail]
109 E. Walnut Street • P.O. Box 1776
D ko ffu?1533
NOV 1 0 2005
DENR - WATER QUALITY
4WEWDS AND STGRMWATER BMN(;H
SUBJECT: 401 Water Quality Certification
Nationwide Permit Request
Outfall Sanitary Sewer Improvements
Town of Ayden
Pitt County, NC
Dear Sirs/Madams:
In reference to the subject project and on behalf of the Town of Ayden, please find enclosed
the following exhibits for your review:
1. Seven (7) copies of a "Pre-Construction Notification (PCN) Application Form" as
executed by the Ayden Town Manager, Mr. Adam Mitchell.
2. One (1) set of construction drawings.
3. Seven (7) copies of a USGS Quadrangle map extract depicting project scope.
4. One (1) copy of correspondence submitted to the US Army Corps of Engineers.
5. Processing fee in the amount of $200.00 payable by check from McDavid Associates,
Inc.
Proposed project scope consists of replacement of an existing dilapidated sewer outfall pipe
that includes aerial crossings of defined drainage outlets.
Please provide a DWQ 401 permit at your convenience.
Sincerely,
McDAVID ASSATES, INC.
Rich'd 1 . Mkofe, P.E.
Farmville Office
RBM:bbr
Enclosures
D405RBM05 1
AYDEN-05-OUTFALL-DWQ-401-PERMIT-REQ.LTR;2
9:37am
051108
??F W A rF9Q Michael F. Easley, Governor
?0 G William G. Ross Jr., Secretary
r North Carolina Department of Environment and Natural Resources
Q Alan W. Klimek, P.E. Director
Division of Water Quality
November 17, 2005
DWQ Project # 05-2054
Pitt County
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
Town of Ayden
P.O. Box 219
Ayden, NC 28513
Subject Property: Town of Ayden: CWMTF Sewer Outfall Replacement
Ut to Swift Creek [030409, 27-97-(0.5), C, SW, NSW]
REQUEST FOR MORE INFORMATION
Dear Sir or Madam:
On November 10, 2005, the Division of Water Quality (DWQ) received your application dated October
13, 2005, to impact 50 linear feet of stream to construct the proposed replacement of a dilapidated sewer
collection line. The DWQ has determined that your application was incomplete and/or provided
inaccurate information as discussed below. The DWQ will require additional information in order to
process your application to impact protected wetlands and/or streams on the subject property. Therefore,
unless we receive the additional information requested below, we will have to move toward denial of your
application as required by 15A NCAC 2H .0506 and will place this project on hold as incomplete until we
receive this additional information. Please provide the following information so that we may continue to
review your project.
Additional Information Requested:
1. Please show all stream impacts, including all fill slopes, dissipaters, and bank stabilization on the
site plan.
2. Please indicate all buffer impacts on the site plan.
3. Please indicate the location of the protected buffers as overlays on the site plan.
Please respond within three weeks of the date of this letter by sending this information to me in writing
and Kyle Barnes of the DWQ Washington Regional Office. If we do not hear from you within three
weeks, we will assume that you no longer want to pursue this project and we will consider the project as
withdrawn.
401 Oversight/Express Review Permitting Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: http://h2o.enr.state.nc.us/ncwetlands
None Carolina
Naturally
An Equal Opportunity/Affirmative Action Employer- 50% Recycled/10% Post Consumer Paper
Town of Ayden
Page 2 of 2
November 17, 2005
This letter only addresses the application review and does not authorize any impacts to wetlands, waters
or protected buffers. Please be aware that any impacts requested within your application are not
authorized (at this time) by the DWQ. Please call Ms. Cyndi Karoly or Mr. Ian McMillan at 919-733-
1786 if you have any questions regarding or would like to set up a meeting to discuss this matter.
Sincerely,
Cyndi Karoly, Supervisor
401 Oversight/Express Review Permitting Unit
CBK/ijm
cc: Richard B. Moore, McDavid & Associates, Inc., P.O. Drawer 49, Farmville, NC 27828
Kyles Barnes, DWQ Washington Regional Office
USACE Washington Regulatory Field Office
File Copy
Central Files
"z
Filename: 052054TOAydenC WMTFSewerOutfall(Pitt)On_Hold
DWg405-2454 CWMTF Sewer Outfall
Subject: DWQ # 05-2054 CWMTF Sewer Outfall
From: Laurie Dennison <[e-mail]>
Date: Thu, 17 Nov 2005 10:19:57 -0500
To: [e-mail]
CC: [e-mail]
Please see attached the Division of Water Quality's request for more information
related to your recent application. Please note that this message is being forwarded
to you electronically so that you may expedite preparation of your response. Please do
not send your response as a reply to this e-mail or via fax. The hard copy is being
sent via US Mail. All response correspondence is to be mailed via hard copy to the 401
oversight and Express Permits Unit, 2321 Crabtree Blvd., Raleigh, NC, 27604 unless
otherwise noted.
Content-Type: application/msword
052054TOAydenCWMTFSewerOutfall(Pitt)On_Hold.doc
Content-Encoding: base64
11/17/2005 10:20 AM
INC.
McDAVIDAsSOCUTES, INC.
Engineers • Planners • Land Surveyors
CORPORATE OFFICE
[phone] • Fax [phone]
E-mail: [e-mail]
3714 N. Main Street • P.O. Drawer 49
Farmville, NC 27828
Division of Water Quality
401/Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
November 8, 2005

GOLDSBORO OFFICE
[phone] • Fax [phone]
E-mail: [e-mail]
109 E. Walnut Street • P.O. Box 1776
D ko ffu?1533
NOV 1 0 2005
DENR - WATER QUALITY
4WEWDS AND STGRMWATER BMN(;H
SUBJECT: 401 Water Quality Certification
Nationwide Permit Request
Outfall Sanitary Sewer Improvements
Town of Ayden
Pitt County, NC
Dear Sirs/Madams:
In reference to the subject project and on behalf of the Town of Ayden, please find enclosed
the following exhibits for your review:
1. Seven (7) copies of a "Pre-Construction Notification (PCN) Application Form" as
executed by the Ayden Town Manager, Mr. Adam Mitchell.
2. One (1) set of construction drawings.
3. Seven (7) copies of a USGS Quadrangle map extract depicting project scope.
4. One (1) copy of correspondence submitted to the US Army Corps of Engineers.
5. Processing fee in the amount of $200.00 payable by check from McDavid Associates,
Inc.
Proposed project scope consists of replacement of an existing dilapidated sewer outfall pipe
that includes aerial crossings of defined drainage outlets.
Please provide a DWQ 401 permit at your convenience.
Sincerely,
McDAVID ASSATES, INC.
Rich'd 1 . Mkofe, P.E.
Farmville Office
RBM:bbr
Enclosures
D405RBM05 1
AYDEN-05-OUTFALL-DWQ-401-PERMIT-REQ.LTR;2
9:37am
051108

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NOV 1 0 2005
DENR - WATER QUALITY
WETIANDSAND STORMWATER SRMcH
2 0 0 5 20 5 4

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Pre-Construction Notification (PCN) Application Form
Fo Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
eneral 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' (USACE)
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 Individual Permit application form is available online at
http://www.saw.usace.army.mi]/wetlands/Perm app.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 http://www.saw.usace.army.miI/wetlands/regtour.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 401/Wetlands Unit website at
http://l12o.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
Commission (NCWRC) is required for projects occurring in any of North Carolina's twenty-five
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 12
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 USACE 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
http://www.saw.usace.army.mil/wetlands/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, 1650 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/ncwetlands/fees.html. 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 401 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
Asheville Regulatory Field Office Alexander Caldwell Haywood McDowell Swain
US Army Corps of Engineers Alleghany Catawba Henderson Mecklenburg Transylvania
151 Patton Avenue Ashe Cherokee Iredell Mitchell Union
Room 208 Avery Clay Jackson Polk Watauga
Asheville, NC 28801-5006 Buncombe Cleveland Lincoln Rowan Yancey
Telephone: [phone] Burke Gaston Macon Rutherford
Fax: [phone] Cabarrus Graham Madison Stanley
Raleigh Regulatory Field Office Alamance Franklin Nash Surry
US Army Corps Of Engineers Caswell Forsyth Northampton Vance
6508 Falls of the Neuse Road Chatham Granville Orange Wake
Suite 120 Davidson Guilford Person Warren
Raleigh, NC 27615 Davie Halifax Randolph Wilkes
Telephone: [phone] Durham Johnston Rockingham Wilson
Fax: [phone] Edgecombe Lee Stokes Yadkin
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers Bertie Dare Lenoir Tyrrell
Post Office Box 1000 Camden Gates Martin Washington
Washington, NC 27889-1000 Carteret* Green Pamlico Wayne
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans *Croatan National Forest Only
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
North Carolina State Agencies
Division of Water Quality
Wetlands Restoration Program
1619 Mail Service Center
Raleigh, NC 27699-1619
Telephone: [phone]
Fax: [phone]
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 276994617
Telephone: [phone]
Fax: [phone]
US Fish and Wildlife Service / National Marine Fisheries Service
US Fish and Wildlife Service US Fish and Wildlife Service National Marine Fisheries Service
Raleigh Field Office Asheville Field Office Habitat Conservation Division
Post Office Box 33726 160 Zillicoa Street Pivers Island
Raleigh, NC 27636-3726 Asheville, NC 28801 Beaufort, NC 28516
Telephone: [phone] Telephone: [phone] Telephone: [phone]
Page 3 of 12
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kernersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
APPLICATION FORM BEGINS ON PAGE 5. PLEASE DO NOT SUBMIT PAGES 1- 4.
Page 4 of 12

Office Use Only: Form Version May 2002
20052054
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
II. Applicant Information NO V 1 0 2005
WERAA 6S?pSTTERQUALITY
1. Owner/Applicant Information CATER ERANCH
Name: Town of Ayden
Mailing Address: P.O. Box 219
Ayden NC 28513
1. Check all of the approval(s) requested for this project:
® Section 404 Permit F-1 Riparian or Watershed Buffer Rules
F-1 Section 10 Permit F-1 Isolated Wetland Permit from DWQ
® 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: 12
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 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: El
5. If your project is located in any of North Carolina's twenty coast counties (listed on page
4), and the project is within a North Carolina Division of Co ¢? of
Environmental Concern (see the top of page 2 for further details), Jcere. [,5 D
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: amitchell(@,Uden.com
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: Richard B. Moore, P.E.
Company Affiliation: McDavid Associates Inc.
Mailing Address: P.O. Drawer 49
Farmville, NC 27828
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: rbm()mcdavid-inc coin
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 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: CWMTF Sewer Outfall Replacement
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN):
4. Location
County: Pitt County Nearest Town: Town of Ayden
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): From NC 102 (Third Street) in an
easterly direction, take a right on West Avenue. From West Avenue, take a left on to Edge
Road. Edge Road ends where an asphalt drive extends in a southerly direction. Sewer
outfall proposed for replacement extends north/south parallel with asphalt drive.
5. Site coordinates, if available (UTM or Lat/Long): See attached sheets
(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): N/A
7. Nearest body of water (stream/river/sound/ocean/lake): Swift Creek
8. River Basin: Neuse
(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.ne.us/admin/m4ps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Agriculture
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used:
Excavator will be used to install gravity sanitary sewer collection line to replace an existing,
dilapidated line. Existing sewer line crosses several ditches and an un-named tributary to the
Swift Creek.
11. Explain the purpose of the proposed work: The purpose of proposed work is to replace
dilapidated sewer collection line that is contributing to excessive inflow/infiltration within
the Town's sewer system. Problems have been documented by reported sewer overflows and
video inspection that identifies blockages within the existing line.
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.
None
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.
None
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
Page 7 of 12
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Provide a written description of the proposed impacts: Excavation of un-named
tributary of the Swift Creek will be needed to install gravity sanitary sewer collection line
Sewer line will be ductile iron, Class 51, mechanical joint where no joint connections exist
within the limits of the crossing.
2. Individually list wetland impacts below:
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***

* 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 hqp://www.fema.gov.
*** 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:
Total area of wetland impact proposed:
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)
1 Excavation 50' UT to Swift Creek 20' Perennial

* 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 loss/gain),
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 be found 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 USGS at 1-800-358-9616, or online at
www.usgs.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mgpguest.com, etc.).
Page 8 of 12
Cumulative impacts (linear distance in feet) to all streams on site:- 50' (includes banks)
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
Site Number

indicate on ma
Type of Impact* Area of
Impact

acres
Name ofWaterbody
(if applicable) Type of Waterbody

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

List each impact separately anu icentity 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.
Where excavation occurs, erosion and sedimentation control measures will be used to
minimize sediment runoff. Impact to stream segment is unavoidable as existing sewer line needs
to be replaced. No long-term adverse impact will result from the proposed project.
Page 9 of 12
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 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
hgp://h2o.enr.state.nc.us/ncwetlands/strrngide.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.
Not applicable
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 htip://h2o.enr.state.nc.us/wrp/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): N/A
Amount of buffer mitigation requested (square feet): N/A
Page 10 of 12
Feb 09 06 03:35p McDavid Associates Inc. 252 753 7220
!LICDAVID ASSOCIATES, INC.
P. O. DRAWER 49
FARMVI.LLE, NC 27828
p.1
FACSIMILE TRANSMITTAL SHEET
I u PRi r 6t.
Ian "fC[h1Lln Richard B. Moore, P.E.
xyN-',>r,: DAII::
Division of Water Quality 21/9/2006
...?: N iMB1.12.: T(A'AI. NO. 01? PAGES INCLUD11IG I"R:
():9) 733-6893 1
M ?. 0N.•: NUNIBil,J,: SI?;NDI:R'S -rtt'.la'nv1NI: N_TNI31i
119)7t
k9l , 75-4631 (352) 753-21139
;;i, ti3NDI-'VS FA:( NUMNIT
't'own of_A?Tden -401 Pennit Request [phone]
Q LIR(;I: l'I' ? F01, RF.VIFIC ? PI,IiA?:i CO IKIENT ? PLIf,?tiP: RFP1.Y ? P1.1?AJI( RECY(;1,17
RIt. Ian i?IcAhliau
40I C;vcrsi}hrilixpressPermitting
Unit
Division of C:'ater Quality
Mr, YC`1111an:
Reference the subject project and per your request, the following is a tabulation of impact 10 Zone 1
and Zonc 2 of the Ncusc i7iver Ripatian Buflcr rulci:
7nnc• 1
Totr•1 Length = 221) LF
1)i,turlied Avua = 1,940 SF
Note: Length of imp.tct and disturbed arca is based upon a ntaxirrrunr trench width of 12'. Actual sewer line
will only be pla;.ed in 121 Lr of Zone 1 huffer. Rennaining impact is a result of the trench viclth.
Zone 2
7('111 Lcnglh = SU L
Disturbed :'trey = 9605F
Plca;c advise as 1 ma,; provide.Iddiiional information for your rc Aew. The Town is anxious to proceed acrd a
YUi pen-nit is the last construction permit needed to allow the project to proceed. The Army Corps of
Er1gureers has issued a 403 permit.
:"hacks for vour assistlncc.
l:idiard B.'Quore, F.L.
FEB-9-2006 THU 15:30 TEL:[phone] NAME:DWQ-WETLANDS P. 1
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
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 El
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 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify V
Yes ? 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.
Zone* Impact
s feet Multiplier Required
Miti ation
1 3
2 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 1.
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.
Not applicable
M. 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.
None
MI. 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.
None
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
MV. 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, an 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).
os?
Appl4ant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
41,
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PROPOSED SEWER LINE
TO BE REPLACED.
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20052054

v V60 F wATF?9
NOV 1 0 200 QG
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?C
Pre-Construction Notification (PCN) 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' (USACE)
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 Individual Permit application form is available online at
http://www.saw.usace.army.miI/wetlands/Perm app.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 http://www.saw.usace.army.miI/wetlands/regtour.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 401/Wetlands Unit website at
http://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
Commission (NCWRC) is required for projects occurring in any of North Carolina's twenty-five
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 12
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 USACE 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
http://www.saw.usace.army.mil/wetlands/nww iinalFedReg 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, 1650 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/ncwetlands/fees.html. 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 401 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
Asheville Regulatory Field Office Alexander Caldwell Haywood McDowell Swain
US Army Corps of Engineers Alleghany Catawba Henderson Mecklenburg Transylvania
151 Patton Avenue Ashe Cherokee Iredell Mitchell Union
Room 208 Avery Clay Jackson Polk Watauga
Asheville, NC 28801-5006 Buncombe Cleveland Lincoln Rowan Yancey
Telephone: [phone] Burke Gaston Macon Rutherford
Fax: [phone] Cabamxs Graham Madison Stanley
Raleigh Regulatory Field Office Alamance Franklin Nash Surry
US Army Corps Of Engineers Caswell Forsyth Northampton Vance
6508 Falls of the Neuse Road Chatham Granville Orange Wake
Suite 120 Davidson Guilford Person Warren
Raleigh, NC 27615 Davie Halifax Randolph Wilkes
Telephone: [phone] Durham Johnston Rockingham Wilson
Fax: [phone] Edgecombe Lee Stokes Yadkin
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers Bertie Dare Lenoir Tyrrell
Post Office Box 1000 Camden Gates Martin Washington
Washington, NC 27889-1000 Carteret* Green Pamlico Wayne
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans *Croatan National Forest Only
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
North Carolina State Agencies
Division of Water Quality Division of Water Quality State Historic Preservation Office
401 Wetlands Unit Wetlands Restoration Program Department Of Cultural Resources
1650 Mail Service Center 1619 Mail Service Center 4617 Mail Service Center
Raleigh, NC 27699-1650 Raleigh, NC 27699-1619 Raleigh, NC 276994617
Telephone: [phone] Telephone: [phone] Telephone: [phone]
Fax: [phone] Fax: [phone] Fax: [phone]
US Fis
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
h and Wildlife Service / National N
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
(arine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivers Island
Beaufort, NC 28516
Telephone: [phone]
Page 3 of 12
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kemersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
APPLICATION FORM BEGINS ON PAGE 5. PLEASE DO NOT SUBMIT PAGES 1- 4.
Page 4 of 12
Office Use Only: Form Version May 2002
USACE Action ID No. DWQ No. 0 2 tJ 5 4
(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:
N Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
N 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: 12
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 Wetlands Restoration Program (NC)VRP) 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: ?
II. Applicant Information [2 rm 0W[2 D
1. Owner/Applicant Information NOV 1 0 2005
Name: Town of Ayden
Mailing Address: P.O. Box 219 D1=trn v?"Kra` c ,.g?.?y
Ayden, NC 28513 R ti JCH
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: amitchell(i?Uden.com
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: Richard B. Moore P.E.
Company Affiliation: McDavid Associates, Inc.
Mailing Address: P.O. Drawer 49
Farmville, NC 27828
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: rbm(ar),mcdavid-inc.com
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 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: CWMTF Sewer Outfall Replacement
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN):
4. Location
County: Pitt County Nearest Town: Town of Ayden
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): From NC 102 (Third Street in an
easterly direction, take a right on West Avenue. From West Avenue take a left on to Edge
Road. Edge Road ends where an asphalt drive extends in a southerly direction Sewer
outfall proposed for replacement extends north/south parallel with asphalt drive.
5. Site coordinates, if available (UTM or Lat/Long): See attached sheets
(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): N/A
7. Nearest body of water (stream/river/sound/ocean/lake): Swift Creek
8. River Basin: Neuse
(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: Agriculture
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used:
Excavator will be used to install gravity sanitary sewer collection line to replace an existing,
dilapidated line. Existing sewer line crosses several ditches and an un-named tributary to the
Swift Creek.
11. Explain the purpose of the proposed work: The purpose of proposed work is to replace
dilapidated sewer collection line that is contributing to excessive inflow/infiltration within
the Town's sewer system. Problems have been documented by reported sewer overflows and
video inspection that identifies blockages within the existing line.
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.
None
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.
None
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
Page 7 of 12
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Provide a written description of the proposed impacts: Excavation of un-named
tributary of the Swift Creek will be needed to install gravity sanitary sewer collection line.
Sewer line will be ductile iron, Class 51, mechanical joint where no joint connections exist
within the limits of the crossing.
2. Individually list wetland impacts below:
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***

* 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.gov.
*** 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:
Total area of wetland impact proposed:
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before act Perennial or
Intermittent?
leasespecify)
1 Excavation 50' UT to Swift Creek 20' Perennial

i i i i i I
* 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 loss/gain),
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 be found 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 USGS at 1-800-358-9616, or online at
www.uses.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.tol2ozone.com,
www.manquest.com, etc.).
Page 8 of 12
Cumulative impacts (linear distance in feet) to all streams on site: 50' (includes banks)
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
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Name of
(if applicable) Watee) Type of Waterbody
(lake, pond estuary, sound,
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.
Where excavation occurs, erosion and sedimentation control measures will be used to
minimize sediment runoff. Impact to stream segment is unavoidable as existing sewer line needs
to be replaced. No long-term adverse impact will result from the proposed project.
Page 9 of 12
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 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
htt,o://h2o.enr.state.nc.us/ncwetlands/strrngide.htrnl.
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.
Not applicable
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 http://h2o.enr.state.nc.us/wrp/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): N/A
Amount of buffer mitigation requested (square feet): N/A
Page 10 of 12
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
IX.
X.
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 N 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 N
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 ?
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.
Yes ? No N If you answered "yes", provide the following information:
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify, )?
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* square nipafeet Multiplier M ti Required
1 3
2 1.5
Total
* Zone I extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
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.
Not annlicable
M. 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.
None
MI. 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.
None
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
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, an 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).
LU&
•(3?v&"
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
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Pre-Construction Notification (PCN) 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' (USACE)
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 Individual Permit application form is available online at
http://www.saw.usace.army.miI/wetlands/Perm app.lltm.
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 http://www.saw.usace.army.miI/wetlands/regtour.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 401/Wetlands Unit website at
http://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
Commission (NCWRC) is required for projects occurring in any of North Carolina's twenty-five
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 i of 12

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 USACE 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
http://www.saw.usace.anny.mil/wetlands/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, 1650 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/ncwetlands/fees.html. 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 401 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
Asheville Regulatory Field Office Alexander Caldwell Haywood McDowell Swain
US Army Corps of Engineers Alleghany Catawba Henderson Mecklenburg Transylvania
151 Patton Avenue Ashe Cherokee Iredell Mitchell Union
Room 208 Avery Clay Jackson Polk Watauga
Asheville, NC 28801-5006 Buncombe Cleveland Lincoln Rowan Yancey
Telephone: [phone] Burke Gaston Macon Rutherford
Fax: [phone] Cabarrus Graham Madison Stanley
Raleigh Regulatory Field Office Alamance Franklin Nash Surry
US Army Corps Of Engineers Caswell Forsyth Northampton Vance
6508 Falls of the Neuse Road Chatham Granville Orange Wake
Suite 120 Davidson Guilford Person Warren
Raleigh, NC 27615 Davie Halifax Randolph Wilkes -
Telephone: [phone] Durham Johnston Rockingham Wilson
Fax: [phone] Edgecombe Lee Stokes Yadkin
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers Bertie Dare Lenoir Tyrrell
Post Office Box 1000 Camden Gates Martin Washington
Washington, NC 27889-1000 Carteret* Green Pamlico Wayne
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans *Croatan National Forest Only
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
North Carolina State Agencies
Division of Water Quality Division of Water Quality State Historic Preservation Office
401 Wetlands Unit Wetlands Restoration Program Department Of Cultural Resources
1650 Mail Service Center 1619 Mail Service Center 4617 Mail Service Center
Raleigh, NC 27699-1650 Raleigh, NC 27699-1619 Raleigh, NC 276994617
Telephone: [phone] Telephone: [phone] Telephone: [phone]
Fax: [phone] Fax: [phone] Fax: [phone]
US Fis
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
h and Wildlife Service / National N
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
[arine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivers Island
Beaufort, NC 28516
Telephone: [phone]
Page 3 of 12
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kernersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
APPLICATION FORM BEGINS ON PAGE 5. PLEASE DO NOT SUBMIT PAGES 1- 4.
Page 4 of 12
L)
Office Use Only: Form Version May 2002
a... ,i t.. t, 0 1.1 4
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
® 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: 12
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 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: ? _V 19 0 W II. Applicant Information 5
Nov 1 0 2005
1. Owner/Applicant Information
Name: Town of Ayden DE_NR - WATER QUALITY
Mailing Address: P.O. Box 219 WEMMOSAND R
Auden, NC 28513
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: amitchell(oDUden.com
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: Richard B. Moore, P.E.
Company Affiliation: McDavid Associates, Inc.
Mailing Address: P.O. Drawer 49
Farmville, NC 27828
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: rbm(a-),mcdavid-inc.com
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 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: CWMTF Sewer Outfall Replacement
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN):
4. Location
County: Pitt County Nearest Town: Town of Ayden
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): From NC 102 (Third Street) in an
easterly direction, take a right on West Avenue. From West Avenue, take a left on to Edge
Road. Edge Road ends where an asphalt drive extends in a southerly direction. Sewer
outfall proposed for replacement extends north/south parallel with asphalt drive.
5. Site coordinates, if available (UTM or Lat/Long): See attached sheets
(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): N/A
7. Nearest body of water (stream/river/sound/ocean/lake): Swift Creek
8. River Basin: Neuse
(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: Agriculture
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used:
Excavator will be used to install rg avity sanitary sewer collection line to replace an existing,
dilapidated line. Existing sewer line crosses several ditches and an un-named tributary to the
Swift Creek.
11. Explain the purpose of the proposed work: The purpose of proposed work is to replace
dilapidated sewer collection line that is contributing to excessive inflow/infiltration within
the Town's sewer system. Problems have been documented by reported sewer overflows and
video inspection that identifies blockages within the existing line.
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.
None
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.
None
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
Page 7 of 12
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Provide a written description of the proposed impacts: Excavation of un-named
tributary of the Swift Creek will be needed to install gravity sanitary sewer collection line
Sewer line will be ductile iron, Class 51, mechanical joint where no joint connections exist
within the limits of the crossing.
2. Individually list wetland impacts below:
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***

* 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.gov.
*** 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:
Total area of wetland impact proposed:
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)
1 Excavation 50' UT to Swift Creek 20' Perennial

* 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 loss/gain),
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 be found 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 USGS at 1-800-358-9616, or online at
www.usgs.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapguest.com, etc.).
Page 8 of 12
Cumulative impacts (linear distance in feet) to all streams on site: 50' (includes banks)
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
Site Number

indicate on ma
Type of Impact* Area of
Impact

acres
(if Name p Waterbody
applicable) Type of Waterbody

(lake, pond, estuary, sound,
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.
Where excavation occurs. erosion and sedimentation control measures will be used to
minimize sediment runoff. Impact to stream segment is unavoidable as existing sewer line needs
to be replaced. No long-term adverse impact will result from the proposed project.
Page 9 of 12
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 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
http://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.
Not applicable
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 htip://h2o.enr.state.nc.us/wrp/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): N/A
Amount of buffer mitigation requested (square feet): N/A
Page 10 of 12
Amount of Riparian wetland mitigation requested (acres): N/A
Amount of Non-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
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 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify, )?
Yes ? 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.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 3
2 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 1.
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.
Not applicable
M. 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.
None
MI. 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.
None
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes E] No
Is this an after-the-fact permit application?
Yes ? 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, an 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).
. I3. C,
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
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