20060872 Ver 1_COMPLETE FILE_20060525

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Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
June 7, 2006
Mr. Howard Brown
114 Brown Road
Colerain, NC 27924
Subject Property:
Brown Property
Chowan River [030103, 25, B, NSW]
Alan W. Klimek, P.E. Director
Division of Water Quality
DWQ Project # 06-0872
Hertford County
Approval of 401 Water Quality Certification (GC3400) with Additional Conditions
Dear Mr. Brown:
You have our approval, in accordance with the attached conditions, to place fill material within or
otherwise impact 0.01 acres of forested wetland to construct a carport as described in your application
dated May 22, 2006, received by the Division'of Water Quality (DWQ) 401 Oversight/Express Review
Permitting Unit on May 25, 2006. After reviewing your application, we have determined that the
Division of Water Quality (DWQ) General Water Quality Certification Number 3402 (GC 3402) covers
these water impacts. This Certification allows you to use Nationwide Permit(s) 3402 (NW3402) when
issued by the US Army Corps of Engineers (USACE). In addition, you should get or otherwise comply
with any other federal, state and local requirements before you go ahead with your project including (but
not limited to) erosion and sediment control regulations and CAMA. 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 and design 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:
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) I Plan Location or Reference
404/Wetland 0.01 (acres) PCN page 8 of 12
401 Oversight/Express Permitting Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: htto://h2o.enr.state.ne.us/ncwetlands
None Carolina
Ntura!!y
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
Mr. Howard Brown
Page 2 of 3
June 7, 2006
Sediment and Erosion Control:
2. 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. Sufficient materials required for stabilization and/or repair of erosion control measures and
stormwater routing and treatment shall be on site at all times.
3. 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 404/40 1 Permit Application. 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;
4. 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. Protective Fencing - The outside buffer, wetland or water boundary and along the construction corridor
within these boundaries approved under this authorization shall be clearly marked with orange warning
fencing (or similar high visibility material) for the areas that have been approved to infringe within the
buffer, wetland or water prior to any land disturbing activities to ensure compliance with 15 NCAC 2H,
Section.0500;
6. Deed Notifications - Deed notifications 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. A sample deed notification can be downloaded from the 401/Wetlands Unit
web site at http://h2o.enr.state.nc.us/ncwetiands. The text of the sample deed notification may be
modified as appropriate to suit to this project;
7. 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 4011 Oversight/Express Review Permitting Unit, North Carolina
Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650.
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.
Mr. Howard Brown
Page 3 of 3
June 7, 2006
If you do not accept any of the conditions of this Certification (associated with the approved water
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.
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 Cyndi Karoly in the Central Office in Raleigh at 919-
733-9721 or Kyle Barnes in the DWQ Washington Regional Office at 252-946-6481.
AWK/ym
Enclosures: GC 3402
Certification of Completion
Sincerely,
r Alan W. Klimek, P.E.
cc: Doug Huggett, DCM
USACE Washington Regulatory Field Office
Kyle Barnes, DWQ Washington Regional Office
File Copy
Central Files
Mike Street, P.O. Box 769, Morehead City, NC 27557
Filename: 060872B rownProperty(liertford)401

C) 3 a
Office Use Only: Form Version March 05
USACE Action ID No. -?"&'HY DWQ No.
(If any particular item is not applicable to this project, please enter N01 Appucaoic or i,412-.
I. 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
_2 401 Water Quality Certification ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: N &J-P 1 9
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: E
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 Managem nt Area of
Environmental Concern (see the top of page 2 for further details), check ?(5Q i OW2 D
l ?f
II. Applicant Information MAY 2 5 2006
1. Owner/Applicant Informatio?Wfljki tpSl? lp ATERR QUAI Y
Name: NoW r d t'rETlAt
Mailing Address: 114
D /e ral n N Ll ??92
o ,
Telephone Number a,f? 33 -"Lggy Fax Number:
E-mail Address:
yl' 2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
1 V must be attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax
Updated 11/1/2005
Page 5 of 12
III. Project Information
5
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: fro w
2. T.I.P. Project Number or State Project Number (NCDOT Only): &/
(. q?2 G - 14- 6q-7a
3. Property Identification Number (Tax PIN): G9 A6 - 14- X 907
(g 1-6 - /.s--,ro 3
4. Location 4t/? __?
County: Nearest Town: 13 m q;_s _
Subdivision na phase/lot number): ?
Directions to site (include road numbers/names, landmarks, etc.): -61- is /ocafed /n
4L,, Il -.I r_1,0 c,,LJ.:,,!.1J% ? 1) It iv00WA_A _ V* -- 11 /?1_V T-LL (-) kb /L1fh
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): -`pi _ /-:3 Q e re_s
7. Name of nearest receiving body of water: 0 6!20.n 21 ye-
r-8. River Basin: (2 knU)ah
(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 thVite and general land use in the vicinity of the project
at the time of this application: '-e3;dev.-? ? al ?Df s I? ?+?, cjeye
0,/ o Se_ VCra, rna.6 - MgA e- 0-0-rig-1 i -
attach a sheet that
oW
Updated 11/1/2005
Page 6 of 12
10. De cribe the overall project in detail, including the type of equipment to be used:
QcLaLteN. aL -??II /1'la P?iti I,LJr-;.. WO e e an .s, 4,1 co I
11. Explain the purpose of the proposed work: -110- Cons- rae- ' e,?_ror? -?b YA zr
1/ l?Ps for ?'x )s f;nA rct? d?n?er
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. /Yp J? I A 4 Qtr rrt ?, 4' s
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide jus ification for the exclusion of this work from the current application.
A/. _ _ . r w. .. L 1 I _ L4-.--
Proposed Impacts to Waters of the United States/Waters of the State
VI.
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts are proposed to these systems.
Wetland and stream evaluation and delineation forms should be included as appropriate.
Photographs may be included at the applicant's discretion. If this proposed impact is strictly for
wetland or stream mitigation, list and describe the impact in Section 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: `t Jctee me nt a? f? 11
nt o-le-r ? al 'rm*,p woeded ide4 tared area. -tom ham-:/Q 1-/L/-T
Updated 11/1/2005
Page 7 of 12
2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
senarately list impacts due to both structure and flooding.
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)
r.

Total Wetland Impact (acres) Q, Q
3. List the total acreage (estimated) of all existing wetlands on the property: 0 • ?•?
4 Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
mpacts. Stream impacts include, t are not limited to placement of fill or culverts, dam
c nstruction, flooding, relocati , stabilization activities (e.g., cement walls, rip-rap, crib
wa s, gabions, etc.), excavat' n, ditching/straightening, etc. If stream relocation is proposed,
plan nd profiles showi the linear footprint for both the original and relocated streams
must he 'ncluded. To calculate acreage, multiply length X width, then divide by 43,560.
Stream Impact
Number
(indicate on ma
Str me
Type of Impact Perennial or
Intermittent? Average
Stream Width
Before Impact Impact
Length
linear feet Area of
Impact
acres

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. dredging. floodins(, drainage, bulkheads, etc.
Open Water Impact
Site Number
indicate on ma Name of Water \dy
(if applicable
Type of Impact Type of Waterbody
(lake, pond, estuary, sound, bay,
ocean, etc. Area of
Impact
acres

T tal Open Water Imp t (acres)
Updated 11/1/2005
Page 8 of 12
6. List the cumulative impact to all Waters of the U.S. resulting from the project:
Stream Im act (acres): D
Wetland Impact (acres):
Open Water Impact (acres):
Total Impact to Waters of the U.S. (acres)
Total Stream Impact (linear feet):
7. Isolated Waters
Do any isolated waters exist on the property? ? Yes 2No
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,yXaters that have specifically been determined to be isolated by the USACE.
8. d Creation
If cons on of a pond is proposed, associated wetland and stream impacts should be
included above it wetland and stream impact sections. Also, the proposed pond should
be described here and illus on any maps included with this application.
Pond to be created in (check all that ? uplands ? stream ? wetlands
Describe the method of construction (e.g., m/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock
local stormwater requirement, etc.):
Current land use in the vicinity of the pond:
Size of watershed draining to pond:
VII. Impact Justification (Avoidance and Minimization)
Expected pond surface
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. / /
nA. "n" rn A,ono A 4-A rm,l n',w i u D&re_(I 1Al_?itrS• t??!I //)rindSQ,.
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.
irrigation, aesthetic, trout pond,
Updated 11/1/2005
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.
2
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/strmgide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much ' ormation as possible, including, but not limited to: site location (attach directions
and/or map, i fsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation pro sed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechan (e.g., deed restrictions, conservation easement, etc.), and a
description of the current 'te condi.tions and proposed method of construction. Please attach
a separate sheet if more spac is needed.
-4 1 14 A
JV It
itigation may also be made by payment into the North Carolina Ecosystem Enhancement
Progr NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
(919) 715- 6 to determine availability, and written approval from the NCEEP indicating
that they are wi o accept payment for the mitigation must be attached to this form. For
additional informatio egarding the application process for the NCEEP, check the NCEEP
website at lltt ://h2o.enr.s , e.nc.us/wm/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on p 'e five and provide the following information:
Amount of stream mitigation requeste linear feet):
Amount of buffer mitigation requested (sq e feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Updated 11/1/2005
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of public (federal/st to/local) funds or the use of
public (federal/state) land? Yes ? No 21
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 (919) 73 -5083 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 J2
Y. 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
(Neuse), 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 5Zr
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
I Zone* ? Impact I Multiplier I Required
auare feed Mitigation
1
2
Total
* Zone 1 extends out 30 feet perpendicular from
additional 20 feet from the edge of Zone 1.
3 (2 for Catawba)
1.5
top of the near bank of channel; Zone 2 extends an
3. If buffer mitigation is required, please discuss wh type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration / hancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appr 'ate information as identified
within 15A NCAC 2B .0242 or.0244, or.0260.
Updated 11/1/2005
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. 'D4e_1 N01e r- e-42/?29-Z 1-1 62C --
C_w4i rv_ S;7e,
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed pr ject, or available capacity of the subject facility.
E%'A &4-1 na _Se??'Sc /AnIL
XIII. Violations (required by DWQ)
Is this site in violation of DW Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application? Yes ? No
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
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://h2 o.enr.state.nc.us/ncwetlands. 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).
All
Y / z Z/z-'?
G Applicant/argani's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Updated 11/1/2005
Page 12 of 12

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Office Use Only' Form Version March 05
USACE Action ID No. /141.L_ on All, At. %) nGfi? DWQ No.
(If any particular item is not applicable to this project, please enter ivot Appucaote or iNtA .)
1. Processinb

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:
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: E
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 Managem nt Area of
Environmental Concern (see the top of page 2 for further details), ch k here:
[2 rp-A aMC p
II. Applicant Information
MAY 2 5 2006
1. Owner/Applicant Informatio
DENR -
Name: Noula r d Wain t' "',.:. WATER QUALITY
"- BRAWCH
Mailing Address: /14
Telephone Number (g9,0-) 33 - Fax Number:
E-mail Address:
fig 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:
E-mail Address:
Fax?er:
Updated I1/l/2005
Page 5 of 12
III. Project Information
5
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 proj
2. T.I.P. Project Number or State Project Number (NCDOT Only):
6q?2 G - i,/- 61-7n
3. Property Identification Number (Tax PIN): G 9 AG - 14- 1,7.0 .1
&g 1 3
4. Location
County: Nearest Town: i / llN?s ki in Subdivision name (include phase/lot number):
Directions to site (include road numbers/names, landmarks, e?tc1.): Coy-15 /acafed In
-1-L,, /I- - . 1 ( '_ .iv c., L „J: !.I n nu ?VOO VW a Y1 .Il?- - n ,n V ?-b, 0- 4 D mull
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): Aao ro X l • 3 a e re- s
7. Name of nearest receiving body of water: tioulan ?i Ke- r-
8. River Basin: 6 Wa-M
(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 tV-e:* ite and general land use in the vicinity of the project
at the time of this application: ;nl eh-? i a( ?D fs W '1+k care1ot2clAe.nf"
CL?o SQ. t/C? -? _C11?N -r11a.d? __Ca.r1a./s -
attach a sheet that
ow
Updated 11/1/2005
Page 6 of 12
10. D?cribe the overall project in detail, including the type of equipment to be used:
1 / . . / t i_1_Ll I
11. Explain the purpose of the proposed work: -70 CO A i?rke? erQriepr? 'f b YDc?r ?,
1/ kP e Ls for ?x.sf;na rcc cl?n?er
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. /P/ On*-y i ens e r ?4- s
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.
VI.
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts are proposed to these systems.
Wetland and stream evaluation and delineation forms should be included as appropriate.
Photographs may be included at the applicant's discretion. If this proposed impact is strictly for
wetland or stream mitigation, list and describe the impact in Section 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: -
Updated 11/1/2005
Page 7 of 12
Proposed Impacts to Waters of the United States/Waters of the State
2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
separately list impacts due to both structure and flooding.
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
(yes/no) Distance to
Nearest
Stream
linear feet) Area of
Impact
(acres)
r. '+e 'l , o

Total Wetland Impact (acres) Q, Q
3. List the total acreage (estimated) of all existing wetlands on the property: 0 . IX-
4 Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
\was, s. Stream impacts include, t are not limited to placement of fill or culverts, dam
ction, flooding, relocati , stabilization activities (e.g., cement walls, rip-rap, crib
gabions, etc.), ex cavat' n, itching/straightening, etc. If stream relocation is proposed,
nd profiles showi the linear footprint for both the original and relocated streams
must be ' eluded. To r-alculate acreage, multiply length X width, then divide by 43,560.
Stream Impact
Number
(indicate on ma
Str me
Type of Impact Perennial or
Intermittent? Average
Stream Width
Before Impact Impact
Length
linear feet Area of
Impact
acres

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, dredging, floodin , drainage, bulkheads, etc.
Open Water Impact
Site Number
indicate on ma
dy
Name of Water
(if applicable)
Type of Impact Type of Waterbody
(lake, pond, estuary, sound, bay,
ocean, etc. Area of
Impact
acres

T tal Open Water Imp t (acres)
Updated 11/1/2005
Page 8 of 12
6. List the cumulative im act to all Waters of the U.S. resulting from the project:
Stream Impact (acres): O
Wetland Impact (acres):
Open Water Impact (acres):
Total Impact to Waters of the U.S. (acres)
Total Stream Impact (linear feet):
7. Isolated Waters
Do any isolated waters exist on the property? ? Yes 2No
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 joy Vaters that have specifically been determined to be isolated by the USACE.
d Creation
If cons on of a pond is proposed, associated wetland and stream impacts should be
included above > wetland and stream impact sections. Also, the proposed pond should
be described here and illus on any maps included with this application.
Pond to be created in (check all that ? uplands ? stream ? wetlands
Describe the method of construction (e.g., m/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock waten-ilg
local stormwater requirement, etc.):
Current land use in the vicinity of the pond:
, aesthetic, trout pond,
Size of watershed draining to pond: Expected pond surface
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.
AS koen rAe4aCPd 4h i o V
--, n., III Vl 11 " I,1 0,1 r. 4A F4 AV- /2 ?GN iclP <.
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.
Updatcd 11/1/2005
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.
2
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/ncwetlands/strmgide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much ' ormation as possible, including, but not limited to: site location (attach directions
and/or map, i fsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation pro sed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechan (e.g., deed restrictions, conservation easement, etc.), and a
description of the current 'te conditions and proposed method of construction. Please attach
a separate sheet if more spac s needed.
14
itigation may also be made by payment into the North Carolina Ecosystem Enhancement
Progr CEEP). Please note it is the applicant's responsibility to contact the NCEEP at
(919) 715- 6 to determine availability, and written approval from the NCEEP indicating
that they are wi o accept payment for the mitigation must be attached to this form. For
additional informatio egarding the application process for the NCEEP, check the NCEEP
website at htt ://h2o.enr.s e.nc.us/wm/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on p five and provide the following information:
Amount of stream mitigation requeste linear feet):
Amount of buffer mitigation requested (sq e feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Updated 11/1/2005
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of public (federal/st to/local) funds or the use of
public (federaUstate) 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
083 to review current thresholds for environmental documentation.
coordinator at (919V_
Yes ? No -
r I ?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
(Neuse), 15A NCAC 2B .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
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 multinlier,,,
F-Zone* Impact I Multiplier I Required
1__?ouare feet) Mitigation
2
Total
* Zone 1 extends out 30 feet perpendicular from
additional 20 feet from the edge of Zone 1.
3 (2 for Catawba)
1.5
top of the near bank of channel; Zone 2 extends an
3. If buffer mitigation is required, please discuss wh type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration / hancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appr iate information as identified
within 15A NCAC 213.0242 or.0244, or.0260.
Updated 11/1/2005
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. /Yclea o e- 9-e!22 Lar
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed pr ject, or available capacity of the subject facility.
E % 1 s4-1 na _?Sp N?'1 c An IL
VIII. Violations (required by DWQ)
Is this site in violation of DW Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No 21,
Is this an after-the-fact permit application? Yes ? No
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in addi onal
development, which could impact nearby downstream water quality? Yes ? No ,
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
http://h 2o.enr.state.nc.us/ncwetlands. 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).
rrill
r/z Z/?-' ?
Applicant/_i_; s Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Updated 11/1/2005
Page 12 of 12
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