20061368 Ver 1_COMPLETE FILE_20060823

Michael F. Easley, Governor
?OFWA1FgQ
William G. Ross Jr., Secretary
\Q North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
11, M_ r
Division of Water Quality
s
August 30, 2006
DWQ Project # 06-1368
Rowan County
Mr. Tracy Neely
615 White Crane Rd.
Salisbury, NC 28146
Subject Property: 615 White Crane Rd., High Rock Lake
Approval Of 401 Water Quality Certification And Authorization Certificate
with Additional Conditions
Dear Mr. Neely:
You have our approval, in accordance with the attached conditions and those listed
below, fo place fill in or to otherwise impact/stabilize the following as described in your
application dated August 23, 2006:
Amount Approved Units Plan Location or Reference
Dredge 11,400 cu. feet
404/CAMA Wetlands acres
Waters 0.5 acres
Buffers -• Zone 1 (square ft.
Buffers- Zone 2 (square ft.
After reviewing your application, we have determined that N.C. Division of Water Quality (DWQ)
General Water Quality Certification Number 3492 covers the impacts. This Certification
allows you to use Regional General Permit No. 198200030 when issued to you by the US Army
Corps of Engineers (USACE). This letter shall also serve as your approved Authorization
Certificate for impacts to the protected riparian buffers per 15A NCAC 2B .0243. In addition,
you should obtain or otherwise comply with any other required federal, state or local permits
before you proceed with your project, including (but not limited to) those required by Erosion
and Sediment Control, Non-Discharge, Duke Power, and Water Supply Watershed regulations.
The above noted Certification will expire when the associated USACOE's 404 permit
expires unless otherwise specified in the General Certification. This approval is for the purpose
and design that you described in your application. If you change your project, you must notify
this office and you may be required to submit 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.
This approval requires you to follow the conditions listed in the attached certification and
any additional conditions listed below.
Nor` hCarolina
Naturally
North Carolina Division of Water Quality 610 East Center Ave., Suite 301 Mooresville, NC 28115 Phone [phone]
Customer Service Internet: ncwaterquality.org FAX [phone]
1-877-623-6748
An Equal Opportunity/Affirmative Action Employer - 50% Recycled110% Post Consumer Paper
Page 2 of 2
1. Upon completion of all work approved by this 401 Water Quality Certification, and any
subsequent approved modifications, the applicant is required to return the attached
certificate of completion form to the 401 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. 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.
Any disputes over determinations regarding this Authorization Certificate (associated
with the approved buffer impacts) shall be referred in writing to the Director for a decision. The
Director's decision is subject to review as provided in Articles 3 and 4 of G.S. 1508.
This letter completes the review of the Division of Water Quality under Section 401 of the
Clean Water Act and the Catawba riparian buffer protection rule as described within 15A NCAC
2B .0243. If you have any questions, please telephone Cyndi Karoly at 919-733-1786 or Alan
Johnson at 704-663-1699.
Sincerely,
for Alan W. Klimek, P. E.
Enclosures: Certificate of Completion
GC 3492
cc: Ian McMillan, Wetlands Unit
Alcoa
USACE Asheville Regulatory Field Office
Becky Fox, EPA
Central Files
R0,61"[20WR
k-179 5
SEP 6 2006
DENR - b1Y,i E13 .
mwxi Rio ioK?RNr•. _
Triage Check Dist
Date: 8/25/06
Alan Johnson, Mooresville Regional Office
To:
60-day Processing Time: 8/23/06 -10/21/06
From: Cyndi Karoly Telephone : [phone]
Project Name: Tracy B. Neely
DWQ#: 06-1368
County: Rowan
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 (Neuse, Tar-Pamlico, Catawba, Randleman)
? Pond fill
Mitigation Ratios
? Ditching
? Are the stream and or wetland mitigation sites available and viable?
? Check drawings for accuracy
? Is the application consistent with pre-application meetings?
? Cumulative impact concern

Comments: As per our discussion regarding revision of the triage and delegation processes,
please review the attached file. Note that you are the first reviewer, so this file will need to be
reviewed for administrative as well as technical details. If you elect to place this project on hold,
please ask the applicant to provide your requested information to both the Central Office in
Raleigh as well as the Asheville Regional Office. As we discussed, this is an experimental, interim
procedure as we slowly transition to electronic applications. Please apprise me of any
complications you encounter, whether related to workload, processing times, or lack of a "second
reviewer" as the triage process in Central had previously provided. Also, if you think of ways to
improve this process, especially so that we can plan for the electronic applications, let me know.
Thanks!

J 30347,
Office Use Only: 2 FrVcr•ion March 05
0 0 61 3 6 8
USACE Action ID No. DWQ No.
(If any particuL:r item is not applicable to this project, please enter "Not Applicable" or "N/A".)
L Processing
1. Check all of the approval(s) requested for this project:
['Section 404 Permit ? Riparian or Watershed Buller Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
Q,401 Water Quality Certification ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: l
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), check here: U /;ZI M Q V?i D
H. Applicant Information M2
AU G 2 3 2006
1. Owner/Applicant Information
Mailing
DENR. WATER DUALITY
..inc eun ST(14uWATER BRANCH
Telephone
E-mail Ad
Fax Number.,
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:
Updated 11/1/2005
Page 5 of 12
HL Proiza Lafoir=tion
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: LLI r (XYcel IAA` ("11 03LI C?15 Wh?.Crc?rti3. ???
2. T.LP. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): LR it 004
4. Location
County: tSDW n Nearest Town: Sa?17,r
Subdivision name (include phase/lot number): QMn e- C!2v a L41 -Sec-Non A_
Directions to site (include road numbcrs/namcs, landmarks, etc.): RSIA 'to e-kt. $
T--Ir q4 ramp r) L-bry,, Pere-L, -5 ?1 r n R-9 i tvtt!, bra
Prv# . -?111?_ Uernm 'Z& t-m at- P_-P r. Whit_ (',fr. v%,L P -A l &i
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): S n1o 01` ,AA" IF °N S W° 5$' Qo" 'W
6. Property size (acres): 1-1542 pa-
7. Name of nearest receiving body of water. + t \ QOCX LaK--
8. River Basin: \.? 0A V-t
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://l12o.enr.state.ne.tis/admin/naps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: b rrr 4 )a?t<r dx4lbO h?a4-me OA_Ir ib iA `
Updated 11/12605
Page 6 of 12
10. Describe the overall project in detail, including the /type of equipment to?beused:
0'Y 14 , 0- ? Gai I ?'(LN` ?{C? y O Lt3C1?CY ?l Ka
11. Explain the purpose of the proposed work:-- ??
? u ? ., u .,1:.... r% L Co rl t mP n?.n?tcan -po w-
SQ4k%A
IV. Prior Projec 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. Mo ne ,
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. 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 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: ?2? t1 i tL? So t mr-VN l or\w
Updated 11/1MO5
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,
se aratel list impacts due to both structure and floodin .
Wetland Impact
Site Number
(indicate on map)
Typo of Impact Type of Wctland
(c.g., forested, mach,
hcrbaccous, bog, etc,) Located within
100-year
Floodplain
cs/no Distance to
Nearest
Stream
(linear feet Area of
Impact
(acres)
0t1

Total Wetland Impact (acres)
3. List the total acreage (estimated) of all existing wetlands on the property: C?pf' tl
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 acreap multiply length X width- then divide b 43 560
Stream Impact
Number
indicate on map)
Stream Name
Type of Impact
Perennial al 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, dred in floodin drainage, bulkheads etc.
Open Water Impact
Site Number
indicate on map) Name of Watabody

(? applicable)
Type of Impact Type of Waterbody
(lake, pond, estuary, sound, bay,
etc.
occan, Area of
Impact
acres
(00 03 0

Total Open Water Impact (arcs)
Updated IUU2005
Page 8 of 12
6. List the cumulative impact to all Waters of the U.S. resultinr-Y from the nmiect
Stream Imp act (acres :
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 [ c3 '
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.
8. Pond Creation rJ ! N
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 TElinimizaticn)
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 alterative, 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 im?acts.?D VPrat-t?n
VUL 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.
Updated 1111/2005
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 cresting, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or 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
littn://h2o.enr.state.nc.us/ncwedands/Stnngide_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 strearn and river basin, type and amount (acreagellinear 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.
4; avn cLrr ess - ca?r? ?rtr?.?? !?? Derv ? ?t` w? 11
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 paymcmt for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
websitc at httn://h2o.enr.state.ne.us/ivrv/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): N
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):
up&<<a 11/1/2005
Page 10 of 12
IX. Environmental Decumentation (required by DVirQ)
1. Does the project involve an expenditure of public (federal/sta oval) funds or the use of
public (fedcral/state) land? Yes ? No f
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 BuiMers (required by DWQ) N ) Ar
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 2B.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 ?
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
I Zone' I Impaat_., I Multiplier I Rr-Tai i
3 (2 for Q
1.5
Total I I I 1
' Zono 1 extends out 30 feet perpendicular from the top of the near hanl of chan=t; Zono 2 extends an
additional 20 feet from the edge ofZonc 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.
Updated I I/MD05
Page 11 of 12
XL Stcrmwater (required by DNVQ)
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. N !. A
XIL 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.
Nb-
XM. Viol.:tions (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 211.0500) 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 additio al
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://l12o.enr.state.ne.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).
?l1
Applican / kmas Signat Date
(Agent's signature is valid only if authorization letter from the applicant is provided)
Updatcd 11/1/2005
Page 12 of 12
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Office Use Only: Form Version March 05
USACE Action ID No DViQ No. 2 n n n 'i E R Q
(If any particukzr itcra is not applicable to this project, please enter "Not Applicable" or WAR.)
L Processing
1. Check all of the approval(s) requested for this project:
(V?Scction 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
GJ-401 Water Quality Certification ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: 1
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), check here: ? -?nn(/ D
H. Applicant Information 3 ZOOS
?.
1. Owner/Applicant Information A`UG Qty
Name: r ?- . M- -
Mailing Address (g lS t Jhi Cram '; ?1?U5 toDSTC. •?
Telephone Number.?"LQN-(a3!a-?3q 3 FaxN
E-mail Address: -h'?p?ltt ?n Cc ) mrol?
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:
Updatcd I WM05
Page 5 of 12
HL 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 US GS 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
'-? 'U&rArste?
1. Name of project ?-? i - _V_ (,LS Wh r C21 l D (2 tl O3?f
2. TIP. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): (tt It 034
4. Location
County: Nearest Town: C
Subdivision name (nclude phase/lot number):' 'gn e, Y?
Directions to site (include road numb es, landmarks, etc.
A .}- D , CCi tYie r.. ,. i2 c1 _ t ` 15}- (- ?4-`hen _t.?1Ft1 K. tn,YCtr
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 waterbodye s i o
Decimal Degrees (6 digits minimum): S 21° 03' 02" °N 5 64 58 Da W
6. Property size (acres): 1.1342 N t.
Name of nearest receiving body of water. i tx r--L,
8. River Basin: ?-t n
(Note - this must be one of North Carolina's seventeen designated major river basins. The
ns/.)
River Basin map is available at littp:/Ai2o.enr.state.ne.us/admin/ma
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: r,irrr4 )A Al&Y he ??irn,r?.??-?. `- y a
. - -.-- - I -- .k, arh?c Je. mere u.x w ?h__
updated 1 UIl2W5 Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used: MbVC•A
o,r, rl' D SCd tY?Q?1 .('t?u+? ? CAx"kL S' c,Wa44+' (c kK-a
11. Explain the purpose of the proposed
.?-. - I . - r c.. J',-A
sq4k
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 aNCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules. Monet
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.
Aor-.•
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 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: ? re" 1 A% SoAi men4 (W
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,
.. ,t., t:..+:.,,.,.,..tp l„n to hnth ctntrtnrp and flnndingy_
JG all cti

WctLwd Impact
Site Number
(indicate on map) ;w1 uZa aui u W uuv w

Type of Impact ....... .,.?......r_ _--- ----
T of Wetland
YPe
(e.g., forested, marAs
herbaceous, bog, etc.) - -
Located within
100-year
??plar
es/no
Distance to
Nearest
Stream
(linear feet
Area of
Impact
(acres)
011

Total Wetland Impact (acres)
3. List the total acreage (estimated) of all existing wetlands on the property: Qf1
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
-V+ l.a innhiile-d Tn calrnlatr+ armane multiply length X width. then divide by 43,560.
a?auaa v
Stt=m Impact
Number
indicate on ma v ua

Stream Name

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 nvrnvntinn drrrrlainn finnrlinry_ dr.unnge- bulkheads. etc.
Open Water Impact
Site Number

indicate on ma Name of Watmbody -
)

(if applicable - ' --
Type of Impact Type of Waterbody
(lake, pond,
occan, etc,) estuary, sound. bay, Area of

Impact
( 00 03

Total Open Water Impact (acres)
tlpdatcd 11/1/2005
Page 8 of 12
6. List th
.__.? :----+ #- ?n wntom of he I I_S_ resulting from the project:
U UU111ut anvu uL u+.a w - _
Stream Impact (acres : _ _ ---
Wetland Imp act acres :
Open Water Impact acres :
Total impact to Waters of the U.S. acres
Total Stream Impact (finear feet):
7. Isolated Waters
Do any isolated waters exist on the property? ? Yes [ gib
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.
8. Pond Creation f4 I &
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/embaakment, 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 applicable, discuss construction
techniques to be followed during construction to reduce impacts. R? V13 f-
VHL 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.
upd.ud 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 snd practicable
mitigation as proposed Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or 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://l12o enr state nc us/ncwetiands/stppaide. ttml.
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 (acreagellinear 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 _ w
M? A-:C'C- tin Q,C @SS -yr.) Qn4 ' nrr n S Cy ? r
ICS v ?c? ('on ar. rrc
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
websitc at http•//h2o enr state ne.us/wmrindex.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): N
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparianwetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Updated I lIV2003 Pale 10 of 12
M Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of public (fedcral/stq?'Iocal) funds or the use of
public (fedcral/state) land? Yes ? No M
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 ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ) N) Ar
2.
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 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 ?
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
Impact RReTfired
Zone' uare feet Multiplier Nfitigation
1 3 (2 for Catawba)
2 1.5
Total
Zono 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from tho edge of Zono 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.
up Utad 11/112D05 Pale 11 of 12
XL Stonnwater (required by DWQ)
Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss
storm-water 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. 0 16
XU. 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.
NIA
XHL Violations (required by DWQ)
Is this site in violation of DWQ etland 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 additio al
development, which could impact nearby downstream water quality? Yes ? No If 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'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).
q
Applican/gent's bignal
(Agent's signature is valid only if
Updatcd I111/2M
' _ Date
authorization letter from the applicant is provided.)
Page 12 of 12
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