20060096 Ver 1_COMPLETE FILE_20060117

Certification of Completion
DWQProjectNo.: 06-009(0 County: IFUTt1r-R?oRD
Applicant: /?2 r` IZR S. -R/9 R/? Y ?` L d
Project Name: THOA16A-); ES i -rZ-1S /LZ//LD 7-
Date of Issuance of Isolated Wetland Permit: I ,3 O ?O 6
Certificate of Completion
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, 1650 Mail Service Center, Raleigh, NC 27699-1650. 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
I /of/,XRY 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: lv ?? 6
Agent's Certification
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 , 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 Buffer
Rules, the approved plans and specifications, and other supporting materials.
Signature:
c9c1?? ?
Q
OCT 2 5 2006
Date:
UENR - WATER QUALITY
WETLANDS AND STOMAVATER MCH
IF I
Detallsl
Project Number: ',20060096 Version: 11 Status: iRecelved LastActlon Deec: Application sent to Region Save

"Project Name: marry Bloch Lot 67 Shumont Estates -Project Type: I Bulkheads i
Project Desc: Ibulkhoad & dock
"Owner: iBloch, Barry clear Details...
'Received From: Applicant j I After the Fact COE ID: `PrimaryCounty: Rulherfmd
DOTTIP: I •Admin Revlon: Asheville I
-
Received DC 0111712006 Courtesy Copy 1 Involves public land Reviewer. r kevin barne
Issued Dt. I NEPAI SEPA required
'SecondaryCOUnty

- --- -- Add
Statutory Dt: ',0 310112 0 0 6 L] EEP I State Clear. finalized
I ICAMA NEPAISEPARecelvedDt: I r:'on :,c
DCM Office: SW Plan Received Dt:
COE Office: I COE Asheville Regulatory SW Plan Approved DI: Public Nollce Published Dt: J
Last Updated By: lourle.dennison SW Plan Location: I Public Notice Received Dt:
Last Updated On: 0111812006 Sewage Disposal: I l P.N. Comment Period Ends DI:
Flnlsh Cancel

Receive date of project 1/17/06
Stat date noted as 3/1/06
f !

Impacts Mltlpallons ? r see ; Affiliations t nmte Inspections Comments j History
Wallet Deta1ls2 Pormits and "Orts "
Protect Nurnbor. 20060006 Version. 1 Status: Roughed Lasl Action Dasc. Application sent to Region Gave
Protect Name: Barry Bloch Lot 87 Shumont Estates Protect Type: Bulkheads Primary County: Rutherford
`Event Type Event Pais S Due Date 7 Cateq
Application received in Co 6111 712006
Incomplete App - Additional Into requested 0111812006 :No impacts noted laurle denn! 01/1 BI
Incomplete App - Additional info received l_. 01/3012006
Info received 1/30/06 but statutory date remains as 3/1/06
Why wouldn't stat date change?
Laurie
[Fwd: Bims Statutory Date Question]
Subject: [Fwd: Bims Statutory Date Question]
From: Laurie Dennison <[e-mail]>
Date: Wed, 10 May 2006 07:58:56 -0400
To: Jennifer Hiser <[e-mail]>
Any word on why this stat date did not change?
L
Subject: Bims Statutory Date Question
From: Laurie Dennison <[e-mail]>
Date: Tue, 11 Apr 2006 14:42:31 -0400
To: Jennifer Hiser <[e-mail]>
See attachment screens
Laurie
Bims Statutory Date Question.cml Content-Type: message/rfc822
Content-Encoding: 7bit
Bims screen 2.doc Content-Type: application/msword
Content-Encoding: base64
Content-Type: application/msword 11
Bims screen l.doc
Content-Encoding: base64
I of 1 5/10/2006 7:59 AM
[Fwd: Re: Bims Statutory Date Question]
Subject: [Fwd: Re: Bims Statutory Date Question]
From: Laurie Dennison <[e-mail]>
Date: Tue, 18 Apr 2006 09:30:16 -0400
To: bev strickland <[e-mail]>
here 'tis...L
Subject: Re: Bims Statutory Date Question
From: Jennifer Hiser <[e-mail]>
Date: Wed, 12 Apr 2006 09:04:26 -0400
To: Laurie Dennison <[e-mail]>
I am going to look into this more. I do not know why it did not change
Laurie Dennison wrote:
Jennifer Hiser, Consultant
NC Dept. of Environment and Natural Resources
Division of Water Quality
Environmental Technologies Unit - BIMS Development Team phone: [phone] x372
fax: [phone]
http://h2o.enr.state.nc.us/bims/
Re: Bims Statutory Date Question Content-Type: message/rfc822
Content-Encoding: 7bit
1 of 1 4/18/2006 11:04 AM
Apr 10 06 09:34a ProTech Professional Prod
5614939825 p.2
Certification of Completion
D WQ Project No.: O 6~ O C% 9 6 County: T o-FN/E/Q OA D
Applicant: AL z r- M)Qs. ?&AjgRY
Project Name: S1YUA4b" E'S TCJS // ?LO 7' i ??
Date of Issuance of Isolated Wetland Permit: 3,1,36/6(o
Certificate of Completion
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, 160 Mail Service Center, Raleigh, NC 27699-1650. 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
I ?, .Q L 66 // 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 terials.
Signature: Date:
Agent's Cer1 ca tion
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 , 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 Buffer
Rules, the approved plans and specifications, and other supporting materials.
Signature:
Date:
MAY 1 9 2006
DENrt - WATER QUALITY
1:sM"fD3 MD 3TONAVATE.R V'NC i
r of wArF
Michael F. Easley, Govemor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
March 30, 2006
Mr. & Mrs. Barry Bloch
6660 North West 23d Terrace
Boca Raton, 'FL 33496
Subject Property: Shumont Estates 111 Lot #87
Lake Lure, NC
DWQ Project # 06-0096
Rutherford County
Approval of 401 Water Quality Certification with Additional Conditions
Dear Mr. & Mrs. Bloch:
You have our approval, in accordance with the attached conditions and those listed
below, to place fill within or otherwise impact 60 linear feet of shoreline for the purpose
of stabilization at the subject property, as described within your application received by
the N.C. Division of Water Quality (DWQ) on January 30, 2006. After reviewing your
application, we have decided that the impacts are covered by General Water Quality
Certification Number(s) 3492 (GC3492). The Certification (s) allows you to use
Permit(s) NW30 when issued by the US Army Corps of Engineers (USAGE). In
addition, you should obtain or otherwise comply with any other required federal, state or
local permits before you go ahead with your project including (but not limited to) Erosion
and Sediment Control, Non-discharge, and buffer regulations. Also, this approval to
proceed with your proposed impacts or to conduct impacts to waters as depicted
in your application shall expire upon expiration of the 404 or CAMA Permit.
This approval is for the purpose that you described in your application. If you change
your project, you must notify us and you may be required to send us a new application.
If the property is sold, the new owner must be given a copy of this Certification and
approval letter and is thereby responsible for complying with all conditions. If total fills
for this project (now or in the future) exceed one acre of wetland or 150 linear feet of
stream, compensatory mitigation may be required as described in 15A NCAC 2H .0506
(h). This approval requires you to follow the conditions listed in the attached
certification and any additional conditions listed below.
The Additional Conditions of the Certification are: ?Fw F= D
APB - T ZQ06
Dtt'il? VJATL-RQUA-!1Y
VSM103 N) 57CCu, A LATER ERANCN
NoonLCarolina
401 Wetlands Certification Unit JValumil!f
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] FAX [phone] Internet: www.ncwateraualitv.orci
An Equal OpportunitylAffinative Action Employer- 50% Recycled/10% Post Consumer Paper
Barry Bloch
Page 2 of 5
March 30, 2006
1. Impacts Approved
The following impacts are hereby approved as long as all of the other specific
and general conditions of this Certification (or Isolated Wetland Permit) are met.
No other impacts are approved including incidental impacts:
Amount
Approved Units Plan Location or Reference
Shoreline 60 linear feet A
2. Erosion & Sediment Control Practices
Erosion and sediment control practices must be in full compliance with all
specifications governing the proper design, installation and operation and
maintenance of such Best Management Practices in order to protect surface
waters standards:
a. The erosion and sediment control measures for the project must be
designed, installed, operated, and maintained in accordance with the most
recent version of the North Carolina Sediment and Erosion Control Planning
and Design Manual.
b. The design, installation, operation, and maintenance of the sediment and
erosion control measures must be such that they equal, or exceed, the
requirements specified in the most recent version of the North Carolina
Sediment and Erosion Control Manual. The devices shall be maintained on
all construction sites, borrow sites, and waste pile (spoil) projects, including
contractor-owned or leased borrow pits associated with the project.
c. For borrow pit sites, the erosion and sediment control measures must be
designed, installed, operated, and maintained in accordance with the most
recent version of the North Carolina Surface Mining Manual.
d. The reclamation measures and implementation must comply with the
reclamation in accordance with the requirements of the Sedimentation
Pollution Control Act.
3. No Waste, Spoil, Solids, or Fill of Any Kind
No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or riparian
areas beyond the footprint of the impacts depicted in the Pre-Construction
Notification. All construction activities, including the design, installation, operation,
and maintenance of sediment and erosion control Best Management Practices,
shall be performed so that no violations of state water quality standards, statutes,
or rules occur.
t
Barry Bloch
Page 3 of 5
March 30, 2006
4. No Sediment & Erosion Control Measures w/n Wetlands or Waters
Sediment and erosion control measures shall not be placed in wetlands or waters
to the maximum extent practicable. If placement of sediment and erosion control
devices in wetlands and waters is unavoidable, they shall be removed and the
natural grade restored within six months of the date that the Division of Land
Resources has released the project.
5. Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification
or applicable Buffer Rules, and any subsequent modifications, the applicant is
required to return the attached certificate of completion to the'401/Wetlands Unit,
North Carolina Division of Water Quality, 1650 Mail Service Center, Raleigh, NC,
27699-1650.
6. No Net Gain of Land Area
The proposed shoreline stabilization activity shall not result in any filling beyond
the existing shoreline and shall not result in additional gain of land area.
I '
7. Riprap Installation
All banks shall be laid back at a 2:1 (length : height) slope and riprap applied at
the water / land interface (at full pool). Riprap shall be placed as a linear
protective measure upon the regarded slopes. Stone used in stabilization shall
be a random size, varying from Class B riprap up to 6 feet in 'diameter to provide
additional wildlife habitat. All exposed soils above the Riprap stabilized area
shall be replanted in accordance with the attached Guidelines for Riparian
Buffer Restoration. This authorization shall in no way be construed as allowing
the installation of a bulkhead or seawall.
8. Heavy Equipment
Heavy equipment should be operated from the bank whenever possible. All
mechanized equipment operated near surface waters should be inspected and
maintained regularly to prevent contamination of stream waters from fuels,
lubricants, hydraulic fluids or other toxic materials. Equipment used in stream
channel must be clean, new or low hour equipment.
9. Diffuse Flow
All constructed stormwater conveyance outlets shall be directed and maintained
as diffuse flow at non-erosive velocities through the protected stream buffers
such that it will not re-concentrate before being discharged.' If;this is not possible,
it may be necessary to provide stormwater facilities that' are considered to
remove nitrogen. This may require additional approval from this Office.
Barry Bloch
Page 4 of 5
March 30, 2006
10. Disturbed banks and a 25-foot vegetated zone, must be restored along the
shoreline to natural riparian conditions with native trees and shrubs (e.g., silky
dogwood, rhododendron, dog hobble, red maple, silky willow, tag alder, black
willow, sycamore) to provide long-term bank stability and stream shading. Note,
silky dogwood, silky willow and black willow can be planted as live stakes
collected during the dormant growing season. Cuttings should be randomly
planted on four (4) foot centers from the waters edge to the top of the bank.
Trees should be planted on ten (10) to twelve (12) foot centers. Stream banks in
these areas should also be seeded with a native annual and perennial seed mix
with a temporary nursery crop of wheat, millet or other grain.
10. No Impacts Beyond those in Application
No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or
riparian areas beyond the footprint of the impacts depicted in the Pre-
construction Notification. All construction -activities, including the design,
installation, operation, and maintenance of sediment and erosion control Best
Management Practices, shall be performed so that no violations of state water
quality standards, statutes, or rules occur.
12. Deed Restrictions
Deed Restrictions or similar mechanisms shall be placed on all retained
jurisdictional wetlands, waters and protective buffers in order to assure
compliance for future wetland, water and buffer impact. These mechanisms shall
be put in place prior to impacting any wetlands, waters and/or buffers approved
for impact under this Certification Approval and Authorization Certificate.
Violations of any condition herein set forth may result in revocation of this Certification
and may result in criminal and/or civil penalties. The authorization to proceed with your
proposed impacts or to conduct impacts to waters as depicted in your application and
as authorized by this Certification, shall expire upon expiration of the 404 or CAMA
Permit.
If you do not accept any of the conditions of this Certification (associated with the
approved wetland or stream impacts), 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,
send a written petition, which 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.
1
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 contact Mr.Kevin Barnett in the
DWQ Asheville Regional Office at either Kevin. Barnett(a-)-ncmail.net or at 828-296-4657.
Barry Bloch
Page 5 of 5
March 30 IM4
Sincerely,
i
6t- Alan W. Klimek, P.L, Director
Division of Water Quality
AW Klkhb
Enclosures: GC 3492
Certificate of Completion
Guidelines for Riparian Buffer Restoration
cc
USACE Asheville Regulatory Field Office
DWQ 401 Central Office
DLR Asheville Regional Office
File Copy
Central Files
Filename: 06-0096.Blcch.WQ3492.Approval
Re: 06-0096, Barry Bloch, Lot 87, Shumont Estates, Rutherford Co,...
Subject: Re: 06-0096, Barry Bloch, Lot 87, Shumont Estates, Rutherford Co, NW13 1/30/06 3/30/06
From: Kevin Barnett <[e-mail]>
Date: Fri, 31 Mar 2006 14:19:36 -0500
To: Ian McMillan <[e-mail]>
Issued yesterday.
I left Mr. Bloch a voice message to that effect this morning.
Thanks,
Kevin
Ian McMillan wrote:
Kevin, can you give me the status of this one? 06-0096, Barry Bloch, Lot 87; Shumont Estates,
Rutherford Co, NW13 1/30/06 3/30/06
BIMS shows it as "Received"
Thanks, Ian
Kevin Barnett - [e-mail]
North Carolina Dept. of Environment and Natural Resources
Asheville Regional Office
Division of Water Quality - Water Quality Section
2090 U.S. 70 Highway
Swannanoa, NC 28778
Tel: [phone]
Fax: [phone]
Kevin Barnett <Kevin.Barnett@ncmail. net>
NC DENR - Asheville Regional Office
Division of Water Quality - Water Quality Section
1 of 1 3/31/2006 2:30 PM
Triage Check List
Date: 2/01/06 Project Name: Barry Bloch, Lot 87, Shumont Estates
DWQ #:06-0096
County: Rutherford
Kevin Barnett, Asheville Regional Office
To:
60-day Processing Time: 1/30/06 to 3/30/06
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
F]
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!
W AT ?9QG
r
January 18, 2006
Rutherford County
DWQ 06-0096
CERTIFIED MAIL
Barry E. Bloch
6660 NW 23rd Terrace
Boca Raton, FL 33496
Subject: Bloch Lot 87 Shumont Estates
Dear Mr. Bloch:
r r r i r AN Q 206
f QUALITY
OENR - WATE U`NATER BRAt1CH
WETLWDS AWD STOR.
On January 17, 2006 the Wetlands/401 Unit of the Division of Water Quality received your application package
for your project on Lot 87, Shumont Estates in Rutherford County, North Carolina. Your project has been placed
on hold for the following reason:
• The PCN Application failed to supply necessary project impact details
If you have any questions regarding this correspondence please do not hesitate to call Ian McMillan or Cyndi Karoly
at [phone]. Please reference the above DWQ # in all future correspondence.
Sincerely,
Cyndi Karoly
CBK/ljd
Enclosure: Application sets and $200 fee (ck #4131)
CC: File copy
Central file
G?
060096 Barry Bloch Lot 87 (Rutherford)_Incomplcte Appl
A
tJCUf_P;t
N. C. Division of Water Quality, 401 Wetlands Certification 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), (httn:/ l12o.cnr.state.nc.usincwctl Inds) j
Customer Service #: 1-877-623-6748
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Envimnment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
X0060096
6660 NW 23`d Terrace
Boca Raton, FL 33496
January 12, 2006
N.C. Department of Water Quality
2321 Crabtree Blvd.
Raleigh, NC 27604
r
? ? I I
Gentlemen:
Enclosed please find five (5) copies of my permit application, and a check in the amount
of $200 for the application fee.
Please review this material and respond as quickly as possible. If you desire to ask me
any questions, I can be reached at work at 561/493-9818 Monday through Thursday from
9 am to 5 pm.
Thank you for your consideration.
Yours truly,

Barry Bloch
CC : 61 •.Y./Iit.rI/6i?-P, /3 i= E;jCitjC-C4! S
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Office Use Only: Form Version March 05
USACE Action ID No. DWQ No. ? 0 0 0 0 9 u
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. Processing
I
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 ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested:/?wlaywix /3
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 Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP,' 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), cheek here: ?
H. Applicant Information D
1. Owner/Applicarlt Information JAN 1 7 2006
Name: -34ARY
r
Mailing Address: 46645 W 62 TA R Gf iltTUVOSI`d,'DSr 'rY
Telephone Number: /-,7 - Fax Number:S76I " - >Vor
E-mail Address: _f3Qor?H?l ??1TAc. @?Qc?GCSd cJT?',? Ak!r
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached i the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number: .
E-mail Address:
Page 5 of 12
JI N 3 0 2006
`DEt4R - WATER CUAL1
7Y
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: B1- OGIV n zur ?7 T f UM0-1'- CS 7,,q -t(rS
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN):
4. Location
County: " l U+' fIE/': MRJ Nearest Town: XA'
Subdivision name (include phase/lot number):6WV1':niJi 0
Directions to site include ?road numbers/names, land)? n.arks, etc.): /t Ni . oG ear 'VIA
6131 11.60PON &L-cs t".j' cle_ ;1GZ/` 1. Lf:Fr ON
??: f?C-iC? ?'F•'EEIE: rrt?
6 0 oZ I?/. 4, F•r &J S,,?/U0CA ' -65 IP7-45 T12. Ga ?/a /yi_ zf-Fr:' o u .4A?i?r";CrC4
?/TGr ON ?/?,yT.
Site coordinates (For linear projects, such as a road or utility line,
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum): ON
6. Property size (acres):
7. Name of nearest receiving body of water: ZJ jyo^014_r 4A <F
8. River Basin:_ P4fEb
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at httn://h26.enr.state.nc.us/adminhnaps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: ULAN r/L N(?M
attach a sheet that
ow
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used:
sill M.OVL, qZL LA/bR . t?2!' .4r-rAr,4AO .
11. Explain the purpose of the proposed work:
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.
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.
_ I
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project! Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. i All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts are proposed to these systems.
Wetland and stream evaluation and delineation forms should be included as appropriate.
Photographs may be included at the applicant's discretion. If this proposed impact is strictly for
wetland or stream mitigation, list and describe the impact in Section 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:
_ I
Page 7 of 12
2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/dramage, etc. For dams,
separately list impacts due to both structure and floodine.
Wetland Impact
Site Number
(indicate on map)
Type of Impact Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.) Located within
100-year
Floodplain
es/no Distance to
Nearest
Stream
linear feet Area of
Impact
(acres)
N

Total Wetland Impact (acres)
3. List the total acreage (estimated) of all existing wetlands on the property:
4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
must be included. To calculate acrea e, multi 1 length X width then divide b Al 560
Stream Impact
Number
indicate on ma
r9
Stream Name
Type of Impact
Perennia
l or
Intermittent? Average
Stream Width
Before Impact Impact
Length
linear feet Area of
Impact
aces

Total Stream Impact (by length and acreage)
5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, dredeine. flooding- drainnne hiM-henric Ptr•
Open Water Impact
Site Number
(indicate- on ma Name of Waterbody
(if applicable)
Type of Impact Type of Waterbody
(lake, pond, estuary, sound, bay,
ocean
t Area of
Impact
, e
c. (acres)

Total Open Water Impact (acres)
Page 8 of 12
6. List the cumulative impact to all Waters of the U.S. resulting from the project:
Stream Impact (acres):
Wetland Impact (acres):
Open Water Impact acres :
Total Impact to Waters of the U.S. (acres) ?. 00?
Total Stream Impact (linear feet : I
7. Isolated Waters
Do any isolated waters exist on the property? ? Yes L No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note; that this section only
applies to waters that have specifically been determined to be isolated by the USACE.
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.):
Current land use in the vicinity of the pond:
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 applic le, discuss construction
techniques to be followed during construction to reduce impacts.
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. N/n
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on January 15, 2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that 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. Ajl,A
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 NCEEP 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/strnit:ide.litml.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from! the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at http://h2o.enr.state.nc.us/wry/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ? No ,
i
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 ?
3. 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.
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 213 .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
213 .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify )? Yes ? No 9
2. If "yes", 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 Multiplier Required
(square feet Mitigation
1 3 (2 for Catawba)
2 1.5
Total
" Zone I extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration / Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B.0242 or.0244, or.0260. Lvi-r1
Page 11 of 12
XI. Stormwater (required by DWQ)
Describe impervious acreage (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. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level.
i
XII. Sewage Disposal (required by DWQ) j
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
was
tewater generated from the proposed project, or available capacity of the subject facility.
;WIA
I
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 2g
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ? No g]
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
httw//h 2o.enr.state.nc.us/newetlands. If no, please provide a short narrative description:
XV. 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).
Applicant/A.g? Signature ate
(Ag nt's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12

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Office Use Only: j Form Vcrsion March 05
O ;a G0 0 9 C;
USACE Action ID No. DWQ No.
Ofnnv narticulnr item is not nnnlicable to this nroiect. please enter "Not Amlicable" 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 ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested:W1q r/&V &JiX 03
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 Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, 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 off
Environmental Concern (see the top of page 2 for further details), check ll ?J?l
II. Applicant Information JAN 7 2006
1. Owner/Appliic ?t?Ilnformattiion DENR - WATER GUALI IY
Name: / F11 -3 I RRY V EW-DsN,D ST0R1.{'VATFR 4RMXH
Mailing Address: 4W,66 Cv o9 T?'??Rf Gr
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Telephone Number: /-(W - Fax Number:?-I - >Id/or
E-mail Address: PRod.474e- 0 Q5UW y V. /U
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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:_
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number: .
E-mail Address:
Page 5 of 12
IAN 3 0 2006
DENR - WATER QUALITY
IYETI.ANDSAND STnRAnv.ATC.
111. 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 sit' 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.1 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 protect: B< ?GN 40T ?7 ?TH UMan4'i CSiR i ?rS
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN):
4. Location
County:'1'! U7f/46R, MP-D Nearest Town: 40W II L-Uk5
Subdivision name (include phase/lot number):S11W lOtjy-
Directions to site include road numbers/names, landjn, arks, etc.): A± Ni . OG'
?C Gtr )? ??+p
4c a C'Rak_ WC• 60ow ari 6141 -noa c'/G 0-<t/Y1. 1- Fr nN 430;- iL. O !'FED' oR
GO o7 n//. GEFT GYM Sfl(jeICA ' 4'S
S/T?' ON ?lGffr.
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum): ON °W
6. Property size (acres):
7. Name of nearest receiving body of water:
8. River Basin:'_ PO/E]}
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at httl2://h26.eni-,st,,ite.nc.us/adinin/iiians/.?)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: #eGrSi'D4N rM<- //O Mf,-V
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10. Describe the overall project in detail, including the type of equipment to be used:
f y)q?h . 60 Fr. aa-*- eG 3 o AVS /vt fT x 12 Fr' :Docx • NCB e *
11. Explain the purpose of the proposed work:
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.
V. Future Project Plans
I
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.
Nv
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts are proposed to these systems.
Wetland and stream evaluation and delineation forms should be in 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. j
1. Provide a written description of the proposed impacts: N/A
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2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
separately list impacts due to both structure and floodine.
Wetland Impact
Site Number

(indicate on map)
Type of Impact Type of Wetland
(e.g., forested, marsh,

herbaceous, bog, etc.) Located within
100-year
Floodplain
odpl Distance to
Nearest
Stream
linear feet Area of
Impact
(acres)
N

Total Wetland Impact (acres)
3. List the total acreage (estimated) of all existing wetlands on the property:
4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
must be included. To calculate acreage- multinly lenoth X wirtth then A;x,;rlc I- Al GAn
Stream Impact
Number
indicate on ma
Stream Name
Type of Impact Perennial or

Intermittent? Average
Stream Width

Before Impact Impact
Length

linear feet Area of
Impact

acres
I

Total Stream Impact (by length and acreage)
Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include,!but are not limited to
fill, excavation. dredeina. floodinn_ drain;,np. Ndlehaarlc Pt;.
Open Water Impact
Site Number
indicate on ma Name of Waterbody
(if applicable)
Type of Impact Type of Watcrbody
(lake, pond, estuary, sound, bay,
ocean
tc Area of
Impact
, e
. acres
r

Total Open Water Impact (acres)
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6. List the cumulative impact to all Waters of the U.S. resulting from the project:
Stream Impact (acres):
Wetland Impact (acres):
Open Water Impact (acres : ccq
Total Impact to Waters of the U.S. (acres)
Total Stream Impact (linear feet :
a. ?
a
7. Isolated Waters
Do any isolated waters exist on the property? ? Yes ?K No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note j that this section only
applies to waters that have specifically been determined to be isolated by the USACE.
8. 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.):
Current land use in the vicinity of the pond:
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 app icc Ie, discuss construction
techniques to be followed during construction to reduce impacts.
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. Iv IA
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USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on January 15, 2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that 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. Ajl,A
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 NCEEP 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/ncwetiands/strm?ide.litml.
i
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.
i
2. Mitigation may also be made by payment into the North Carolina Eclosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility tocontact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at http://h2o.enr.state.nc.us/wrp/index.htni. If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
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IX. Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ? No ,
2. If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina 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 ?
3. 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 DNVQ)
i
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.
i
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 213 .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify )? Yes ? No I
I
2. If "yes", 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' I Impact Multiplier I Required I
(square feet) Mitigation 1
3 (2 for Catawba)
1.5
Total I I I 1 I
' Zone I extends out 30 feet perpendicular from the top of the 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, Riparian Buffer Restoration / Enhancement,; or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B .0242 or .0244, or .0260. el/A 1
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XI. Stormwater (required by DWQ)
Describe impervious acreage (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. If percent impervious surface exceeds 20%, pleas I provide calculations
demonstrating total proposed impervious level. WIA 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.
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
i
XIV. Cumulative Impacts (required by DWQ)
I
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ? No g]
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
http://h2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrati i ve description:
XV. 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).
I
11111M
Applicant/Ag®*44 Signature ate
s signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12

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•,; .:> tit.? s c: ? i, : ,: a .
WAT
? Michael F. Easley, Governor
0
O? QG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
\
Cq r Alan W. Klimek, P.E., Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
January 18, 2006
Rutherford County
DWQ 06-0096
CERTIFIED MAIL
Barry E. Bloch
6660 NW 23rd Terrace
Boca Raton, FL 33496
Subject: Bloch Lot 87 Shumont Estates
Dear Mr. Bloch:
On January 17, 2006 the Wetlands/401 Unit of the Division of Water Quality received your application package
for your project on Lot 87, Shumont Estates in Rutherford County, North Carolina. Your project has been placed
on hold for the following reason:
• The PCN Application failed to supply necessary project impact details j
If you have any questions regarding this correspondence please do not hesitate to call
at [phone]. Please reference the above DWQ # in all future correspondence.
Si eerely,
Cyndi Karoly
CBK/ljd
Enclosure: Application sets and $200 fee (ek #4131)
CC: File copy
Central file
N. C. Division of Water Quality, 401 Wetlands Certification 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), (httn://h2o.encstate.ne.us/ncwethinds)
Customer Service #: 1-877-623-6748
McMillan or Cyndi Karoly
060096 Barry Bloch Lot 87 (Ruthcrford)_Incomplcte App]
tJ?Dth
13 Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
13 Print your name and address on the reverse
so that we can return the card to you.
© Attach this card to the back of the maiipiece,
or on t Ie front if space permits.
V, icle ddressed to:
Barry B, Bloch
6660 NW 23" Terrace
Boca Raton, FL 33496
DWQ'0 06-0096-Rtitherford
/ C A ent
B. Recelved by (Printed Name) C. a r .I
J G
D. Is delivery address different from item 11 C Ye s
If YES, enter delivery address below: C No
3. Service Type
14 Certified Ma'I ? Express Mal
? Reglstered o"etum Rece!pt for Merchandise
? Insured Mail ? C.O.D.
4. Restricted Delivery? (Extra Fee) [
?r c e ') um r
PS Form, e ruary .. omes c um ece p
102595-02-rd-1540
UNITED STATES ??Q zT?IISE C^?E4,,? 5=.' ? i
-L 33--i 413
• Sender: Please print your name, address, and ZIP+4'in this box •
NC DENR Division of Water Quality
401 Oversight/Express Unit
2321 Crabtree Boulevard, Suite 250
Raleigh, NC 27604