20052129 Ver 1_Complete File_20051129

Certificate of Completion
DWQ Project No.: O 5 - 2 / 2 County:
CO /0 aV.V-Ir S
Applicant: Zn"11a4U1,/ ?v,'N/i / L.a/,(i,- iµ7 CtiUre- L)
Project Name: l?/w'i1z A4, o
Date of Issuance of 401 Water Quality Certification: Feb : -2- , 1 OZ) 6
Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules, and
any subsequent modifications, the applicant is required to return this certificate to the 401/Wetlands Unit,
North Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC, 27699-1621. This form
may be returned to DWQ by the applicant, the applicant's authorized. agent, or the project engineer. It is
not necessary to send certificates from all of these.
Applicant's Certification
hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be
built within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature:
Agent's Certification
Date:
I, hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be
built within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
Signature:
Date:
If this project was designed by a Certified Professional
I, - T as ?`?` Z- 51 /'' as a duly registered Professional (i.e.
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized to
observe (periodically, weekly, full time) the construction of the project, for the Permittee hereby state that,
to the best of my abilities, due care and diligence was used in the observation of the construction such that
the construction was observed to be built within substantial compliance and intent of the 401 Water Quality
Certification and Buffers ,J proved plans and specifications, and other supporting materials.
?;?
Signature: /
Registration No.: / 5 L472-
%
~1/
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X11
Op Fig OCT 1 2 2006
Date: DENR - VVIAT[R QUALM'
NETI-AMR A%! r) CTfiw NV.9TrP PRP, Mra
O?O? wAT F9QG
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4 '<
Rev. Bruce C. Sheeks
Immanuel Evangelical Lutheran Church
2070 Emmanuel Church Road
Rockwell, NC 28138
Subject: Kluttz Mine, Sansbury Road, Cabarrus County
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources

Alan W. Klimek, P.E. Director
Division of Water Quality
February 2, 2006
DWQ# 05-2129
Cabarrus County
APPROVAL of 401 Water Quality Certification with Additional Conditions
Dear Reverend Sheeks:
You have our approval, in accordance with the attached conditions and those listed below, to impact
148 linear feet (If) of perennial stream (unnamed tributary to Little Buffalo Creek) in order to relocate a haul
road for mine expansion in Cabarrus County, as described in your application received by the Division of Water
Quality (DWQ) on January 6, 2006. After reviewing your application, we have determined that this project is
covered by Water Quality General Certification Number 3402, which can be viewed on our web site at
http://h2o.enr.state.nc.us/ncwetlands. This General Certification allows you to use Nationwide Permit Number
39 once it is issued to you by the U.S. Army Corps of Engineers. Please note that you should get any other
federal, state or local permits before proceeding with your project, including those required by (but not limited
to) Sediment and Erosion Control, Non-Discharge, and Water Supply Watershed regulations.
The above noted Certification will expire when the associated 404 permit expires unless otherwise
specified in the General Certification. This approval is only valid for the purpose and design that you described
in your application. If you change your project, you must notify us in writing, and you may be required to send
us a new application for a new certification. If the property is sold, the new owner must be given a copy of the
Certification and approval letter; and is thereby responsible for complying with all conditions.
In addition to the requirements of the certification, you must also comply with the following conditions:
Continuing Compliance. The applicant shall conduct all activities in a manner so as not to contravene any
state water quality standard (including any requirements for compliance with section 303(d) of the Clean
Water Act) and any other appropriate requirements of state and federal law. If DWQ determines that such
standards or laws are not being met (including the failure to sustain a designated or achieved use) or that
state or federal law is being violated, or that further conditions are necessary to assure compliance, DWQ
may reevaluate and modify this certification to include conditions appropriate to assure compliance with such
standards and requirements in accordance with 15 A NCAC 2H.0507(d). Before codifying the certification,
DWQ shall notify the applicant and the US Army Corps of Engineers, provide public notice in accordance with
15A NCAC 2H.0503, and provide opportunity for public hearing in accordance with 15A NCAC 2H.0504. Any
new or revised conditions shall be provided to the applicant in writing, shall be provided to the United States
Army Corps of Engineers for reference in any permit issued pursuant to Section 404 of the Clean Water Act,
and shall also become conditions of the 404 Permit for the project.
Noy` Carolina
Naturally
North Carolina Division of Water Quality 610 East Center Ave., Suite 301 Mooresville, NC 28115 Phone [phone] Customer Service
Internet h2o.enr.state.nc.us FAX [phone]
An Equal Opportunity/Affirmative Action Employer - 50% Recycled110% Post Consumer Paper
Page 2
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You
must act within 60 days of the date that you receive this letter. To ask for a hearing, please send a written
petition that conforms to Chapter 150B of the North Carolina General Statutes to the Office of Administrative
Hearings, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its conditions are final and
binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act.
If you have any questions, please telephone Mr. Barry Love in the Mooresville Regional Office at 704-663-1699
or Ms. Cyndi Karoly in the Central Office in Raleigh 919-733-9721.
Sincerely,
for Alan W. Klimek, P.E.
Attachments
cc: Army Corps of Engineers, Asheville
Ian McMillan - Wetlands Unit
Central Files
wAr4?gQt:
r
O <
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
February 2, 2006
DWQ#. 05-2129
Cabarrus County
Rev. Bruce C. Sheeks
Immanuel Evangelical Lutheran Church
2070 Emmanuel Church Road
Rockwell, NC 28138
Subject: Kluttz Mine, Sansbury Road, Cabarrus County
APPROVAL of 401 Water Quality Certification with Additional Conditions
Dear Reverend Sheeks:
You have our approval, in accordance with the attached conditions and those listed below, to impact
148 linear feet (If) of perennial stream (unnamed tributary to Little Buffalo Creek) in order to relocate a haul
road for mine expansion in Cabarrus County, as described in your application received by the Division of Water
Quality (DWQ) on January 6, 2006. After reviewing your application, we have determined that this project is
covered by Water Quality General Certification Number 3402, which can be viewed on our web site at
http://h2o.enr.state.nc.us/ncwetiands. This General Certification allows you to use Nationwide Permit Number
39 once it is issued to you by the U.S. Army Corps of Engineers. Please note that you should get any other
federal, state or local permits before proceeding with your project, including those required by (but not limited
to) Sediment and Erosion Control, Non-Discharge, and Water Supply Watershed regulations.
The above noted Certification will expire when the associated 404 permit expires unless otherwise
specified in the General Certification. This approval is only valid for the purpose and design that you described
in your application. If you change your project, you must notify us in writing, and you may be required to send
us a new application for a new certification. If the property is sold, the new owner must be given a copy of the
Certification and approval letter; and is thereby responsible for complying with all conditions.
In addition to the requirements of the certification, you must also comply with the following conditions:
Continuing Compliance. The applicant shall conduct all activities in a manner so as not to contravene any
state water quality standard (including any requirements for compliance with section 303(d) of the Clean
Water Act) and any other appropriate requirements of state and federal law. If DWQ determines that such
standards or laws are not being met (including the failure to sustain a designated or achieved use) or that
state or federal law is being violated, or that further conditions are necessary to assure compliance, DWQ
may reevaluate and modify this certification to include conditions appropriate to assure compliance with such
standards and requirements in accordance with 15 A NCAC 2H.0507(d). Before codifying the certification,
DWQ shall notify the applicant and the US Army Corps of Engineers, provide public notice in accordance with
15A NCAC 2H.0503, and provide opportunity for public hearing in accordance with 15A NCAC 2H.0504. Any
new or revised conditions shall be provided to the applicant in writing, shall be provided to the United States
Army Corps of Engineers for reference in any permit issued pursuant to Section 404 of the Clean Water Act,
and shall also become conditions of the 404 Permit for the project.
Non,
chCarolina
Naturally
North Carolina Division of Water Quality 610 East Center Ave., Suite 301 Mooresville, NC 28115 Phone [phone] Customer Service
Internet: h2o.enr.state.nc.us FAX [phone]
An Equal Opportunity/Affirmative Action Employer- 50% Recycledll0% Post Consumer Paper
Page 2
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You
must act within 60 days of the date that you receive this letter. To ask for a hearing, please send a written
petition that conforms to Chapter 1508 of the North Carolina General Statutes to the Office of Administrative
Hearings, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its conditions are final and
binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act.
If you have any questions, please telephone Mr. Barry Love in the Mooresville Regional Office at 704-663-1699
or Ms. Cyndi Karoly in the Central Office in Raleigh 919-733-9721.
Sincerely,
for Alan W. Klimek, P.E.
Attachments
cc: Army Corps of Engineers, Asheville
Ian McMillan - Wetlands Unit
Central Files
Triage Check List
Date: 1/09/05 Project Name: Kluttz Mine Expansion
DWQ#: 05-2129
County: Cabarrus
Alan Johnson, Mooresville Regional Office
To:
60-day Processing Time: 1/06/06 - 3/07/06
From: Cyndi Karoly Telephone : [phone]
The file attached is being forwarded to you for your evaluation.
Please call if you need assistance.
? Stream length impacted
? Stream determination
Wetland determination and distance to blue-line surface waters on USFW topo maps
? Minimization/avoidance issues
? Buffer Rules (Meuse, Tar-Pamlico, Catawba, Randleman)
? Pond fill
Mitigation Ratios
? Ditching
? Are the stream and or wetland mitigation sites available and viable?
? Check drawings for accuracy
? Is the application consistent with pre-application meetings?
? Cumulative impact concern
Comments: As per our discussion regarding revision of the triage and delegation processes,
please review the attached file. Note that you are the first reviewer, so this file will need to be
reviewed for administrative as well as technical details. If you elect to place this project on hold,
please ask the applicant to provide your requested information to both the Central Office in
Raleigh as well as the Asheville Regional Office. As we discussed, this is an experimental, interim
procedure as we slowly transition to electronic applications. Please apprise me of any
complications you encounter, whether related to workload, processing times, or lack of a "second
reviewer" as the triage process in Central had previously provided. Also, if you think of ways to
improve this process, especially so that we can plan for the electronic applications, let me know.
Thanks!
-= --=- Immanuel Lutheran Church
2070 IMMANUEL CHURCH ROAD
ROCKWELL, NORTH CAROLINA 28138
-- - [phone]
December 29, 2005
- _ o C?Gaa? D
? D
N.C. DENR Division of Water Quality
Wetlands/401 Unit JAN -? 2006
Cyndi Karoly
1650 Mail Service Center DENR-wAIeRQUALITY
Raleigh, North Carolina 27699-1650 WETIANMAND51&?MgMill"H
Subject: Kluttz Mine Expansion
Application Fee Payment
Dear Cyndi Karoly,
We are going to try a third time ...maybe this time we will get
it right! Let's review:
First check on November 29, 2005 in the amount of $275.00
Second check on December 11, 2005 in the amount of $250.00
Third check (enclosed) on December 18, 2005 in the amount of $200.00
We received on Saturday, December 17, 2005 your letter stating that we
needed to send a check in the correct amount to the N.C. Division of Water
Quality so they could review our application. We also received back the
earlier check that was made payable in the amount of $250.00.
We are enclosing a check in the amount of $200.00. This is the fee
for application to our project as it impacts less than an acre of wetland
and less than 150 linear feet of streams.
If this is not the right amount or it is not payable to the right
person or company, please let me know again, and the next time we plan to
mail you a blank check signed and we would appreciate you filling in the
amount, etc. Again, thanks for handling this matter.
Sincerely,
&, c. %WA-r-)-
Bruce C. Sheeks
$275.00 check #1001 (returned)
$250.00 check #1022 returned
$200.00 check #1023 enclosed
W ATF Michael F. Easley, Governor
\O?fl 9PG ' William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
GJ r Alan W. Klimek, P.E., Director
j Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
December 14, 2005
DWQ # 20052129
Cabarrus County
CERTIFIED MAIL
Immanuel Evangelical Lutheran Church
Attn: Rev. Bruce Sheeks
2020 Emmanuel Church Road
Rockwell, NC 28138
Subject: Kluttz Mine Expansion
Application Fee Payment
Rev. Sheeks:
On December 14, 2005 the Wetlands/401 Unit of the Division of Water Quality received your check in the
amount of $250.00 for a 401 Water Quality Certification in Cabarrus County, North Carolina. The fee amount
that should be remitted for this application is $200 as it impacts less than an acre of wetland and less than 150
linear feet of streams.
In order for DWQ to begin review and process your request, you must send a check in' the appropriate amount
made payable to the N.C. Division of Water Quality. Your check is being returned for correction of payment
amount. This project remains on hold pending receipt of the application fee payment
If you have any questions regarding this letter please do not hesitate to call me at [phone]:
Enclosure: Check #1022 for $250.00
CBK/ jd
cc: File copy + check copy
Central File + check copy
Sincerely,
AVO?5
Cyndi Karoly
ox,t, zt,4- use
20052129 Kluttz Mine Exp (Cabairus)_2_ Hold-Fee Payment
A
ANN. C. Division of Water Quality, 401 Wetlands Certification Unit,.
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Addr C)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (httn://h2o.enr.state.nc.us/ncwetlands)
Customer Service #: 1-877-623-6748

-PUZ9
1! C& Immanuel Lutheran Church

2070 IMMANUEL CHURCH ROAD
ROCKWELL, NORTH CAROLINA 28138
• _ [phone]
December 11, 2005
N.C. DENR Division of Water Quality
Wetlands/401 Unit
Cyndi Karoly
1650 Mail Service Center
Raleigh, North Carolina 27699-1650
Subject: Kluttz Mine Expansion
Application Fee Payment
LEI
all Q0 E? I
DEC 1. 4 195
'.
ti a'?TII?OS ?tiD ST0+214 V? ID
Dear Cyndi Karoly,
We received on Saturday, December S, 2005 your letter stating that we
needed to send a check in the correct amount to the N.C. Division of Water
Quality so they could review our application. We al o received back the
earlier check that was made payable in the amount of $275.00.
We are enclosing a check in the amount of $250.00. This is the fee
for application to our project.
-If you have any questions regarding this payment, please do not
hesitate to call me at 704-279-3737. Thanks for handling this matter.
Sincerely,
63W,, C. %WA-c -
Bruce C. Sheeks
WA?F _ Michael F. Easley, Governor
?Q - William G. Ross Jr., Secretary
\O? QG North Carolina Department of Environment and Natural Resources
C? - Alan W. Klimek, P.E., Director
j Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
November 30, 2005
DWQ # 20052129
Cabarrus County
CERTIFIED MAIL
Immanuel Evangelical Lutheran Church
Attn: Rev. Bruce Sheeks
2020 Emmanuel Church Road
Rockwell, NC 28138
Subject: Kluttz Mine Expansion
Application Fee Payment
Rev. Sheeks:
On November 29, 2005 the Wetlands/401 Unit of the Division of Water Quality received your application and
check in the amount of $275.00 for a 401 Water Quality Certification in Cabamzs County, North Carolina. Please
note that beginning January 1, 1999, the N.C. General Assembly passed legislation requiring payment of a fee for
all 401 applications. The fee for applications is $200 for projects impacting less than an acre of wetland and less
than 150 linear feet of streams. For projects impacting one or more acres of wetland or 150 or more feet of
streams, the fee is $475.
In order for DWQ to begin review and process your request, you must send a check in the appropriate amount
made payable to the N.C. Division of Water Quality. Your check is being returned for correction of payment
amount. This project as been.Rlaced on hold pending receipt of the application fee payment
If you have any questions regarding this letter please do not hesitate to call me at [phone].
Sincerely,
Cyndi Karoly
Enclosure: Check #1001 for $275.00
CBK/ jd
cc: File copy + check copy
Central File + check copy
20052129 Kluttz Mine Exp (Cabanus)_ Hold-Fee Payment
N. C. Division of Water 401 Wetlands Certification
Quality, Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (http://h2o.enr.state.nc.us/ncwetlands)
Customer Service 4: 1-877-623-6748
ROCKWELL, NC 28138
ul' ZENS SOUM 108 WEST MAIN STREET v
+••• ROCKYIEI.l;NC28138.
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2Gi15212J
October 23, 2005
Asheville Regulatory Field Office
U.S. [Tny Corps of Engineers
151 Patton Avenue
Room 208 CS . Dtj
Asheville, NC 28801-5006
K1uttz
Subject: Nationwide Permit 44 Application for Mine Expansion for Kintz Mine by Immanuel
Evangelical Lutheran Church, Cabarrus County. Mining Permit 113-02.
Dear Sir/Madame:.
Enclosed is the Preconstruction Notification form for a Nationwide Permit 44, Mining Activities for the
proposed expansion of the existing rock quarry (called Klutz Mine) owned by Immanuel Evangelical
Lutheran Church. The proposed project will impact 148 linear feet of perennial stream channel, and no
wetlands. Avoidance and minimization will be accomplished to the greatest extent feasible and practicable.
By copy of this letter we also submit this application to the Division of Water Quality (DWQ) for review
and certification. We have included seven paper copies for of the application package for their review.
The subject property consists of approximately 73.3 acres, and is located at the intersection of SR 2416 and
SR 2442, on north side of SR 2416, NE of Mt. Pleasant.
The subject site is located on the Rockwell and Mount Pleasant USGS Topographic Quadrangle Map, at
approximately UTM 17 556208E, 3926578N, or latitude 35.8411 degrees N, 80.3804 degrees West (WGS
84/NAD 83). The subject site is located in the Yadkin River Basin, and the unnamed tributary on the
subject site flows into Little Buffalo Creek.
The proposed project will result in the loss of 148 linear feet of a perennial stream and the creation of open
water contiguous to existing open water. The proposed road crossing will install a 60 foot long culvert, sized
for the hydraulic requirements of the stream. The application package includes topographic, aerial and soil
survey maps and proposed site plan. If any additional information is needed, please contact Ms. Robin
Little at [phone] or Rev. Bruce C Sheeks at 704-279-3737. We look forward to meeting with you to
discuss this project in the near future.
Sincerely,
Gw" C_ %who-
Reverend Bruce C. Sheeks
CC: Mr. T. Patrick Shillington, E2S
Ys. Robin Maycock Little
?s. Cyndi Karoly, DWQ
Q?c?r?oeE?
NOV. 2'9 2005
DENR • WATER QUALITY
WETLANDS AND STORMWATER BRANCH

Office Use Only: Form Version May 2002
20005 2 1 2 9
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: NWP 44
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), c p LS-2161E D
D
H. Applicant Information
NOV. 2 9 2005
1. Owner/Applicant Information
Name: Rev. Bruce C. Sheeks WETLANDS AND STMIMTER BRWH
Mailing Address:_ Immanuel Evaneelical Lutheran Church
2070 Emmanuel Church Road
Rockwell NC 28138
Telephone Number: Fax Number:
E-mail Address:
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name: Robin M. Little
Company Affiliation:
Mailing Address: 5409 New Rebel Court
Youngsville, NC 27596
Telephone Number: [phone] Fax Number:
E-mail Address: Environmental Solutions(a,hotmail.com
Page 5 of 12
M. 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.
Kl uttz ?'ii -9'0t
Name of prof
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN):
4. Location
County: Cabarrus Nearest Town: Rockwell
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): Located at the intersection of SR
2416 and SR 2442, on north side of SR 2416, NE of Mt. Pleasant.
5. Site coordinates, if available (UTM or Lat/Long): UTM 17 556208E, 3926578N, or
35.8411 deg. N, 80.3804 deg W (WGS84/NAD83)
(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): 73.3 acres
7. Nearest body of water (stream/river/sound/ocean/lake): UT to Little Buffalo Creek
8. River Basin: Yadkin DWO Classification # 13-17-11-6 C
(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: Existing mine, needs to relocate haul road 148 feet upstream
on UT in order to expand mine
10. Describe the overall project in detail, including the type of equipment to be used:
Page 6 of 12
Existing haul road to be moved 148 feet upstream on UT to Little Buffalo Creek,
existing mine to be expanded out to new haul road/culvert. Heavy equipment: excavators,
backhoes, mining equipment. Proposed excavation will remove existing creek, and create
additional open water contiguous with existing open water.
11. Explain the purpose of the proposed work: To mine remnants of specific geologic materials
within geologic map unit.
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,
C'Sb5 list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
Kl uttz 1 Mine has been in operation since the 1940's. Mining downstream of proposed impact
occurred before 1979, so no permits have been issued except for Mining Permit 113-02..
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.
NA
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Provide a written description of the proposed impacts: Relocate existing haul road 148
feet upstream, excavate upstream of existing culvert to proposed culvert/haul road, removing
148 feet of perennial stream channel and replacing with open water
Page 7 of 12
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***
NA NA 0 NA NA NA

* 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: 0 acres
Total area of wetland impact proposed: 0 acres
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact Site
Number
indicate on ma
Type of
T
Impact Length of
Impact
linear feet
Stream Name**
Average Width of Stream
Before Impact Perennial or
Intermittent?
(please secif )
A Excavation 148 UT to Little
Buffalo Creek 4 feet 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.usp-s.gov. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.topozone.coni,
www.maRguest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 148 linear feet
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 Type of Impact*. Area of Name of Waterbod Type of Waterbody L]
Page 8 of 12
Site Number I I Impact I (if applicable) I (lake, pond, estuary, sound,
(indicate on maul (acres) bav. ocean, etc.)
impact separately and identify temporary impacts. Impacts
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.
Due to need to expand operation in order to mine remnant material, the proposed impacts are
unavoidable. However, adverse impacts will be minimized by the existing lake downstream of
the project. The stream to be impacted will be replaced by open water, and the headwaters will
be protected by adequate grade control at the proposed culvert.
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
Page 9 of 12
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.ne.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.
NA
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/wm/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): 0
Amount of buffer mitigation requested (square feet): 0
Amount of Riparian wetland mitigation requested (acres): 0
Amount of Non-riparian wetland mitigation requested (acres): 0
Amount of Coastal wetland mitigation requested (acres): 0
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
Page 10 of 12
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.
If buffer mitigation is required, please discuss what type of mitigation is proposed (Le., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (required by DWQ)
Page 11 of 12
'r
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.
NA
XII. 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.
NA
X1H. 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).
6'& c %WVZa_ II-67-0-5
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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October 23, 2005
2 0 0 5 2 1 2 9
Asheville Regulatory Field Office -
U.S. Army Corps of Engineers
151 Patton Avenue
Room 208 CS' ?D
Asheville, NC 28801-5006
Kluttz
Subject: Nationwide Permit 44 Application for Mine Expansion for Kfatz Mine by Immanuel
Evangelical Lutheran Church, Cabarrus County. Mining Permit 113-02.
Dear Sir/Madame:
Enclosed is the Preconstruction Notification form for a Nationwide Permit 44, Mining Activities for the
proposed expansion of the existing rock quarry (called Klutz Mine) owned by Immanuel Evangelical
Lutheran Church. The proposed project will impact 148 linear feet of perennial stream channel, and no
wetlands. Avoidance and minimization will be accomplished to the greatest extent feasible and practicable.
By copy of this letter we also submit this application to the Division of Water Quality (DWQ) for review
and certification. We have included seven paper copies for of the application package for their review.
The subject property consists of approximately 73.3 acres, and is located at the intersection of SR 2416 and
SR 2442, on north side of SR 2416, NE of Mt. Pleasant.
The subject site is located on the Rockwell and Mount Pleasant USGS Topographic Quadrangle Map, at
approximately UTM 17 556208E, 3926578N, or latitude 35.8411 degrees N, 80.3804 degrees West (WGS
84/NAD 83). The subject site is located in the Yadkin River Basin, and the unnamed tributary on the
subject site flows into Little Buffalo Creek.
The proposed project will result in the loss of 148 linear feet of a perennial stream and the creation of open
water contiguous to existing open water. The proposed road crossing will install a 60 foot long culvert, sized
for the hydraulic requirements of the stream. The application package includes topographic, aerial and soil
survey maps and proposed site plan. If any additional information is needed, please contact Ms. Robin
Little at [phone] or Rev. Bruce C Sheeks at 704-279-3737. We look forward to meeting with you to
discuss this project in the near future.
Sincerely,
(S3rw4lel C.
Reverend Bruce C. Sheeks
CC: Mr. T. Patrick Shillington, E2S
Ms. Robin Maycock Little
Ms. Cyndi Karoly, DWQ
F@12OW14
NOV. 2 9 2005
DENR - WATER QUALITY
14ETUMDS AND STORMWATER BRANCH

Office Use Only: Form Version May 2002
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. Processing
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: NWP 44
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) lm d*r= II. Applicant Information N (L OOV V 2 I
. 2 9 2005 1. Owner/Applicant Information DENR - WATER QUALITY
Name: Rev. Bruce C. Sheeks WETLAIDSAMDSTORMWATFRRRANCW
Mailing Address: Immanuel Evangelical Lutheran Church
2070 Emmanuel Church Road
Rockwell NC 28138
Telephone Number: Fax Number:
E-mail Address:
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name: Robin M. Little
Company Affiliation:
Mailing Address: 5409 New Rebel Court
Youngsville, NC 27596
Telephone Number: [phone] Fax Number:
E-mail Address: Environmental Solutions(a-),hotmail. corn
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 holi until decipherable maps are provided.
Kl uttz kk.-ci-
1. Name of project: _K trtgMine Expansion
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN):
4. Location
County: Cabarrus Nearest Town: Rockwell
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): Located at the intersection of SR
2416 and SR 2442, on north side of SR 2416, NE of Mt Pleasant
5. Site coordinates, if available (UTM or Lat/Long): UTM 17 556208E 3926578N or
35.8411 deg. N, 80.3804 deg W (WGS84/NAD83)
(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): 73.3 acres
7. Nearest body of water (stream/river/sound/ocean/lake): UT to Little Buffalo Creek
8. River Basin: Yadkin DWQ Classification # 13-17-11-6 C
(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/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: Existing mine, needs to relocate haul road 148 feet upstream
on UT in order to expand mine
10. Describe the overall project in detail, including the type of equipment to be used:
Page 6 of 12

Existing haul road to be moved 148 feet upstream on UT to Little Buffalo Creek,
existing mine to be expanded out to new haul road/culvert. Heavy equipment: excavators,
backhoes, mining equipment. Proposed excavation will remove existing creek, and create
additional open water contiguous with existing open water.
11. Explain the purpose of the proposed work: To mine remnants of specific geologic materials
within geologic map unit.
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,
Ca b'S list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
Kl uttz I£tft Mine has been in operation since the 1940's. Mining downstream of proposed impact
occurred before 1979, so no pennits have been issued except for Mining Permit 113-02..
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.
NA
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Provide a written description of the proposed impacts: Relocate existing haul road 148
feet upstream, excavate upstream of existing culvert to proposed culvert/haul road, removing
148 feet of perennial stream channel and replacing with open water
Page 7of12
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***
NA NA 0 NA NA NA

i i i I
* 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: 0 acres
Total area of wetland impact proposed: 0 acres
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)
A Excavation 148 UT to Little
Buffalo Creek 4 feet 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.coni,
www.mapguest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 148 linear feet
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 Im act Type of Impact* Area of Name of Waterbod Type of Waterbod
Page 8of12
Site Number I I Impact I (if applicable) I (lake, pond, estuary, sound,
(indicate on maul (acres) bav. ocean, etc.)
impact separately and identify temporary impacts. Impacts include, but are not
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.
Due to need to expand operation in order to mine remnant material, the proposed impacts are
unavoidable. However, adverse impacts will be minimized by the existing lake downstream of
the project. The stream to be impacted will be replaced by open water, and the headwaters will
be protected by adequate grade control at the proposed culvert.
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
Page 9 of 12
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/newetlands/strmgide.html.
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.
NA
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): 0
Amount of buffer mitigation requested (square feet): 0
Amount of Riparian wetland mitigation requested (acres): 0
Amount of Non-riparian wetland mitigation requested (acres): 0
Amount of Coastal wetland mitigation requested (acres): 0
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
Page 10 of 12
. S1
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 213 .0233
(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
(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.
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 213.0242 or.0260.
XI. Stormwater (required by DWQ)
Page 11 of 12

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.
NA
XII. 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.
NA
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).
aNv_e, 0- 11 -D4-D5
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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