20061946 Ver 1_COMPLETE FILE_20061220

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
February 6, 2007
DWQ Project # 06-1946
Wake County
Page 1 of 3
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
Mr. James Snell
10408 Boxelder Drive
Raleigh, NC 27613
Subject Property: Riverbend Plantation, 3500 Willow Bluff, Raleigh, NC
Lake Iris [030402,27-(22.5), C, NSW]
Authorization Certificate per the Neuse River Buffer Protection Rules (15A NCAC 2B .0233)
with Additional Conditions
Dear Mr. Snell:
You have our authorization, in accordance with 15A NCAC 02B .0233 and any conditions listed below,
to impact 240 square feet of Zone 2 protected riparian buffers for the purpose of constructing the
driveway at the subject property as described within your application dated November 1, 2006 and
received by the Division of Water Quality (DWQ) on December 20, 2006 with additional information
received by DWQ on January 16, 2007. 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 regulations.
This authorization 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 authorization letter and is thereby responsible for
complying with all conditions. This authorization requires you to follow the 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 Authorization are met. No other impacts are approved including incidental
impacts:
Amount Approved (Units) Plan Location or Reference
Zone 2 Buffers 240 (square ft. Page 11 of the PCN
401 Oversight/Express Review Permitting Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet: http://h2o.enr.state.nc.us/ncwetlands
Nn` Carolin
oa
Ntura!!y
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
r --IN
7. Deed Notifications
Mr. James Snell
Page 3 of 3
February 6, 2007
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 Authorization Certificate. A sample deed notification can
be downloaded from the 401/Wetlands Unit web site at: http://h2o.enr.state.nc,us/ncwetlands.
The text of the sample deed notification may be modified as appropriate to suit to this project.
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. 150B. This Authorization Certificate shall
expire five (5) years from the date of this letter.
This letter completes the review of the "No Practical Alternatives" determination under 15A NCAC 2B
.0233. If you have any questions or would like a copy of the buffer rules, please call Amy Chapman at
[phone]. This letter does not authorize any impacts to either Waters of the United States or
Waters of the State. Please contact the US Army Corps of Engineers (US/ CE) or NC Division of Water
Quality (DWQ) if any impacts are proposed to either of these waters. u
Sinc eIy,
Alan W. Klimek, P.E.
AW K/cbk/asc
Enclosures: Certificate of Completion
NCEEP Form
cc: Mike Horan, DWQ Raleigh Regional Office
DLR Raleigh Regional Office
File Copy
Central Files
Filename: 061946RiverbendPl antation3500 W illowB luff(Wake)NBR

ApplicantJAgent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.

JAN 16 2007
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Page H of W

December 18, 2006
James D Snell
10408 Boxelder Dr
Raleigh, NC 27613
Division of Water Quality-Park View Bld
2321 Crabtree Blv. Suite 250
Raleigh, NC 27604
Re: 3500 Willow Bluff
Dear Sir/Madam:
2006 1946
Attached is my PCN application form. This form is being submitted for Buffer Rule
approval only.
The property is a single lot of a four lot subdivision established in March of 1995 (see
subdivision plan attached). The entrance to the property is 54 feet wide and is adjacent to
Iris pond. An existing asphalt and gravel drive extends from the entrance of the property
to the Iris lake dam and runs adjacent to the lake. The first 75 feet of the drive is asphalt
and is an extension of the existing Stout Drive. The remainder of the drive is non-
permeable gravel.
My intention is to use approximately 125 feet of the existing drive and then cross over
zone 2 of the buffer and continue with the drive to the house site that is outside the
buffer.
The new impact will be an area of 12 feet by 20 feet in zone 2 of the buffer.
Please contact me at 919-264-0377 with any questions.
Thank ydu,
James D Snell
F,.
r
?;_?, 2006

€ ffice Use Only:
USA.CT Ae ion M No.
miy particular item is not applicable to
1. Processing
Fona Version Much 05
_ DWQ No. 2006 19 46
project, please enter "Not Applicable" or -'N/A",)
1. Check all of the approval(s) requested for this project.-
:section 404 Permit Riparian or Watershed ButTer 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:
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 Vlll,
and clieck here: `k
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 Concerti (see the top of page 2 for further details), check here: El
ll., Applicant Information
t. Ovvner/Applicant Information
Name: = la'?-, IIos J
Mailing Address:__._
F
17 (7_7 '7>
DEC G 0 2005
Telephone Number: Pax Number t
E-mail Address: { i ?-k? 4 ` i$ ?? s?> _ __ ___ __
2. AgentlC;onsttltatit 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 Number:
Pap5ofl4
Ill. Pr€kiect Information
Attach a vicinity inap clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plait 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,
impei-,,ious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and MRCS 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.
Name of project:
, . 1',1.P. project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN : 1
4. Location
County:
Nearest Town _A4 X`1C
Subdivision name (include hllasellotnumber):C;r,,,t-21,-?r 7
l,.
Directions to site (include road nurmbers/names. landmarks- etc-)-

6. Property sire (acres):
7. Name of nearest receiving body of water:

8. River Basin.- / J_= e s ?-
(Note -- this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at ltttp://h2o.enr.state ne.tis/adminfnla?/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application f r ?? { ;1 _ r f k t,
l''?!.,'s;i4YSt.
Pave 6 of 14
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): ___ UST - ?,??
10, Describe the overall project in detail, including the type of equipment to be used
IV.
V.
Vl.
11. Explain the purpose of the proposed wo
t t
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 USAGE Action III 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.
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 tl- current application.
r
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)
si10uld 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 Vlll below. If additional
space is needed for listing or description, please attach a separate sheet.
1. Provide a written description of the proposed impacts: AV

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 paratcly list impacts due to both structure and flooding.
-Welland 11111NIct Type of Wetland Located within Dist nice to Area of j
Site Number T}r sae of Impact (e.g., =- forested, rlkarsll. 100-year
Floodplain Nearest.
Stream Impact
(acres)
(indicate oil nlaap)
-•--------__...,_.._.___._..
.._.___...__..._._____.._..._.....____.._____?. herbaceous, bog, etc.)
___
{}`Gyfli?)
(IillCntft;ct) l
{----- „

Total Wetland Impact (acres)
3. List the total acreage (estimated) of all exiting wetlands on the property
1. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts- Stream impacts include, but are not limited to placement of till or culverts, darn
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 acreai)e_ multiply le.myth X.' width thou j;w;ria h 41 <,n
_
Stream llllpact -

I?fnlllbcr
(indicate oil Inal3)
_
--- ^ _ 1

Stream Name --- - _, _ ___
R-?_-

Type of Impact __??_q ._ ??.

Perennial or

Intermittent? •.svre n, ?aawaa 4cl
tlvcrage

Stream Width

Before Impact v1?I1/ V T?,?
llllpact

Length

(lillear feet) VV,
Area of

fill pact

(acres)

Total Str am Impact (by 1crigth and acreage)
i
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=, loodints. drainaire_ blilkheadk etc
Opell 6V<Iter tlupact
Site Number Name of ?Vaterbod}

(if applicable)
Type of Impact Type of aterbody
(lake, pond, esttia sound, ba
x y, Area of I
IIn act
p
(indictlte oil ItL'i I) occal), etc.) {acres)

Total Opcii Water Iinpact (acres)
Pao'- R of 11
b. 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)
Total Stream Impact (linear feet):
7. Isolated Waters
Do any isolated waters exist on the property? ? Yes ? 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 USAGE.
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:
V11. impact Justification (.voidance 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. ']Glee applicant may attach drawings of
alternative, lower-impact site layouts, and explain why these design options were not
feasible. Also discuss hoax impacts were minimized once the desired site plan was
developed. If applicable, discuss construction techniques to be followed during
construction to reduce impacts.
Vll1. Mitigaatio.t
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.
P,Ao., 0 of t3
USACE --- In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Resister 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.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USAGE 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
Ejttp:l412o.enr_state_n? :us/ncwetlaannds/strm?e.htmi.
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 neap, 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.&, deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sleet if more space is needed.
2, 'litigation 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.aac.aas/,vva•ra/index lama.
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 gruffer mitigation requested (square feet): e '4'o
Amount of Riparian wetland mitigation requested (:acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
[3.,,,.. III -C 1A
Ix.
X.
Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of public (federal/stateflocal) funds or the use of
public (federal/state) land? Yes [] No 0
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 (NEP?/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call tile 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 n No ?
Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section V11 above. All proposed impacts must be listed
herein, and inust be clearly identifiable on the accompanying site plan. All buffers must be
shower on a reap, 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 213 .0233
(Neuse), 15A NCAC 213 .0259 (Tar-Pamlico), 15A NCAC 0213 .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify-- )? Yes 0 No []
2. if "yes", identify the square feet and acreae of impact to each zone of the riparian buffers-
1-1
If buffer mitigation is required calculate the required amount of mitigation by applying the
buffer multipliers.
Z011e* I larapact
2 1 )_ t
Ttat t -
" "Zone I eytends out 30 feet. perp adieu
additional 20 feet from the edge of Zone I.
Multiplier Required
Miti gatior
3 (2 for Cat;a-,Nba)
1.5
, I C,
the top of the near lxuik of channel; Zone 2 extends an
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 ally appropriate information as identified
within 15A NC:AC 2B .0212 or .0244, or.0260.
Pao,- 11 of 11
X1. Stor€nwater (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 properly. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level.
X11, 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.
XIfl. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (I5A NCAC 211.0500) orany Buffer Rubs?
Yes ? No -
Is this an alley-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 ET
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the rnost recent Noah Carolina Division of Water (,duality policy posted on our vvebsite at
Prtin://h e c to 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 takes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
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DESCRIPTION: PLAT
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MAP NAME: 173:
f . ?zrk PIN NUM.
} 173.
1 k ; PIN EXT: 000
CITY.
1 1
- r Z x PLAN JURIS:
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? TOWNSHIP: NEU
YEAR BUILT:
4 0
SALEPRiCE: 0
SALEDATE:
1 TYPE USE: Voce
k DESIGN DESIGN STYLE:
#t UNITS: 0
.Z_LANDCLASS: VAC
„J -0
LD PARCEL NUMBER:
440-
"RALEIGH SITE ADDRESSES 1
STREET NUM: 350C
s STREET SUITE:
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STREET NAME: WiLI
STREETTYPE: [3R
STREET DIR SUF:
ADDRESS TYPE: Parc
' ADDRESS STATUS

CODE DESCR: ACT

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.2 K- f t

December 18, 2006
James D Snell
10408 Boxelder Dr
Raleigh, NC 27613
Division of Water Quality-Park View Bld
2321 Crabtree Blv. Suite 250
Raleigh, NC 27604
Re: 3500 Willow Bluff
Dear Sir/Madam:
2006 1946
Attached is my PCN application form. This form is being submitted for Buffer Rule
approval only.
The property is a single lot of a four lot subdivision established in March of 1995 (see
subdivision plan attached). The entrance to the property is 54 feet wide and is adjacent to
Iris pond. An existing asphalt and gravel drive extends from the entrance of the property
to the Iris lake dam and runs adjacent to the lake. The first 75 feet of the drive is asphalt
and is an extension of the existing Stout Drive. The remainder of the drive is non-
permeable gravel.
My intention is to use approximately 125 feet of the existing drive and then cross over
zone 2 of the buffer and continue with the drive to the house site that is outside the
buffer.
The new impact will be an area of 12 feet by 20 feet in zone 2 of the buffer.
Please contact me at 919-264-0377 with any questions.
Thank you,
James D Snell
lb C!"
F"? F a
EEC2G2006
ry N'R - b AT R QUALITY

Office Use Only:
f1SAC1 Action ID No.
(lt`any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. Processing
1. Check all of the approval(s) requested for this project.-
Section 404 Permit Riparian or Watershed Buffer Mules
? Section 10 Permit El 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: ?
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: 1
If your project is located in any of forth 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: ?
11. Applicant Information
Owner/Applicant Information
Name-. a?+ lF ('_...7
Mailing Address: 1 f ? - j'

1
Telephone Number. V `° 4 '
s 1 7
Fax Number: •? ._ . f - ,
E-mail Address: 1i Jt > ;" rt t . sr?`' t
_
2- AgLnt/Consultant Information (A signed and dated copy of the Agent Authorization lettet-
must be attached if tile Agent has signatory authority for the owner/app Iicant_)
Name: x
Company Affiliation: All 1
Nfailing Address:
Telephone Number: Fax Number:
E-mail Address:
Form Version march U
D WQ No. 2 0 0 6 1 9 4 6
eta :.? .....' vf
83 07- C 2 G 2006
n_.__ c _a • e
aII. 11roject tit#ormation
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 1)1an 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
USACL rewires information to be submitted on sheets no larger than I I by 17-inch format-.
however, DWQ may accept paperwork of any size. DWQ prefers full-sire 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.
I . Name of project:
2, T.I.I'. Project ;NIumber or State Project Number (NCDOT Only):
3. Property Identification Number Tax PIN : f 1` -:I ;`
4. Location
County:______ Neares Town l I k, i? d _
Subdivision name (include phase/lot number):
Q,
y'-?'-"------
Directions to site (include road naumbers/narnes landmarks, etc.):_
t
Lp'77 ;P} ryi5/ ?rfd?i3-?4? f':b('s.{i? I"4i 3+'1C1f?.' kt t!t!lF`,, lri
. C4( n
r d : t C'I ,; ;. h 9 f FT t !;.
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 (b digits minimum): _ _°N
6i Property size (acres): I ,3 ?1.
ow
7. Name of nearest recz'iving body of water: is 1 s /(41111/11
8- River Basin: ?,?t, !`'4'rS,?
(Note -- this must be one of North Carolina's seventeen designated major river basins. The
River Basin neap is available at http://h2o.enr.st:ate.nc.tis/admire/raa?/.)
9. Describe the existing conditions on the site and general land use it, the vicinity of the project
at the time of this application: : , , ,r f ; rF? , ;; = t
S,a?`i 4l'; t..+L'`..?i' 4.r1? ar., ;f?` °ij- ,.., ? /€ ` L1e5t9;', {;
attach a sheet that
Pavc 6 of 14
10. Describe the overall project in detail, including the type of equipment _tolbe used:..
IV.
V.
V1.
11- X
11. Explain the purpose of the proposed work: TO
t
Prior Project History
If jurisdictional determinations andlor 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 USAGE Action III 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 NCDO'T' project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
Future Project Plus
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.
Proposed Impacts to Waters of (lie 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 farms 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:
aaf." 7 nr l:i
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.
Wetlsuid tanpiact
F_- Type of Welland Located within
100 -year Distance to ?
dearest Area of j
fatapact j
Si t" Number Type of Impact e- forested, nrarsti. ploodplain Stream (acres) i
}
(indicate on aaaap) herbaceous, bolt, etc.) {YUsf110) (linear feet)

Total Wetland Imp;ict (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 till or culverts, darn
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, multi ly len th width, then divide by 43,560,
Sfrc,t31n Ira?pact

Number

Stream Name f._._

Type of Impact Percnaual ni or r

1ntCCatitta:ilt
?? Average
( x
Stream Width Impact

Leaagtla Area of
I
frup?act
(indicate on map) Before Impact - (l?irrieea' feeet) (acres) ?

'All f i? S
i

?^{ 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, flooding, drainage, bulkheads, etc.
L3pesz 6v{iter fitaprct

Site Number
tuauicatc on inap) i _..__.?..____.
Naive of Wa`c,A._..._.rbod ?.
(if applicable) y
?
-.
Type of Impact
Type of ?'ate:rlx?dy
(lake, poiad, estuary, sound, bay,
ocean, etc.}
Area of
Impact ?
(:acres) -I I

'total Opcn Water Impact (acres) {
-
j 1
Pqa.- R If a,i
ti. List t.
V1I.
lie cumulative impact to an waters of tine us, resulting trom tile project
Stream Impact (acres): --
Wetland Impact (acres):
Open Water Impact (acres):
'T'otal Impact to Waters of the U.S. (acres)
'T'otal Stream Impact (linear feet):
7. Isolated Waters
Do any isolated waters exist on the property? 01 Yes [J- 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 tine USACE.
8. Pend 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 oil any maps included with this application.
Pond to be created in (check all that apply): n uplands rl' 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 (°.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:
luipact 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 protect. 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 clawing
construction to reduce impacts.
Vill. 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 1.50 linear feet of total impacts to perennial
streams.
T7aon U of iii
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 where
necessary to ensure that adverse etTects 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.
tf 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
tiit._4r 2o_enr.state.ne.us/ncwetlaiid strmgide,htmi.
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 of1'site), 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 inade 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 lit4p://lt2o.ciir.state.iie.iis/wrla/iiidex.litni.
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): ?f
Amount of Riparian wetland litigation requested (acres):
Ainiount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland iitigation requester) (acres):
D-- III .,F t o
IA. Environmental Documentation (required by DWQ)
I. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ? No EJ
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 SEI A
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 can the accompanying site plan. All buffers must be
shows[ on a cnal), 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. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neese), 15A NCAC 213.0259 (Tar-Pamlico), 15A NCAC 0213.0243 (Catawba) 15A NCAC
213 .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify )? Yes E] 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 nnultinliers.
*
Zaatc Intpacl ^-^----
1' altiplier Required
_(square feet) Mitigation
t
° 7 (2 for Catamba)
2 f.
; 1.5 ?i
I T01.11 i h s ?, I
Zone l e\lends out 30 sect perpendicular from the top of the near bwik of channel; "Lone 2 ektends wi
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.0_260. _J221 ??r 9- t?? ,
Pao" 1aof1;1
XI. Stvrmwater (required by DWQ)
Describe impervious acreage (existing and proposed) versus total acreage on the site. Disco,
storinwater 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.
X11. 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.
?gill. Violations (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 affer-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
L?gp:/Lgq.cq .st6lt -.nc.u /ncwetlands. If no, please provide a short narrative description: _
XV. Other Circumstauces (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).
0" "?. ' G>t: 1`_t : _ .! t i. t l 41..1 t`i 11'11'

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Page 1 of 1.
December 18, 2006
James D Snell
10408 Boxelder Dr
Raleigh, NC 27613
Division of Water Quality-Park View Bld
2321 Crabtree Blv. Suite 250
Raleigh, NC 27604
Re: 3500 Willow Bluff
Dear Sir/Madam:
20061906
Attached is my PCN application form. This form is being submitted for Buffer Rule
approval only.
The property is a single lot of a four lot subdivision established in March of 1995 (see '
subdivision plan attached). The entrance to the property is 54 feet wide and is adjacent to
Iris pond. An existing asphalt and gravel drive extends from the entrance of the property
to the Iris lake dam and runs adjacent to the lake. The first 75 feet of the drive is asphalt
and is an extension of the existing Stout Drive. The remainder of the drive is non-
permeable gravel.
My intention is to use approximately 125 feet of the existing drive and then cross over
zone 2 of the buffer and continue with the drive to the house site that is outside the
buffer.
The new impact will be an area of 12 feet by 20 feet in zone 2 of the buffer.
Please contact me at 919-264-0377 with any questions.
Thank, y 'u,
James D Snell
QG?
D _ ? u 0 2006
? •)IrY FF :i?az? (i: i????t

Off-ice Use Only:
USACE Action 1D No. _
(if any particular item is not
ll.
Processing
DWQ No.
FOMI Version Kaclr O)
20061946
to this project, please enter "Not Applicable" or "N/A")
1. Check all of the approval(s) requested for this project:
? Section 404 Pert-nit Riparian or Watershed Buffer 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 Nuinber(s) Requested:
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 Progratn (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section Vill,
and check here: F
5. if your project is located in any of North Carolinas 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,hep ;?:L]j rov?17 ="
In t it La
I
Applicant Information
C°.C 2 C ZO11+0
L Owner/Applicant Information
Name: ^*3 f77i?°fi i/k` tt
Mailing Address: i 0r>'
Telephone Number: 1'/ ? ?- 673 ?:7 Fax Number
E-mail Address:_-
tkit
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.)
Company ?
Affiliation:
Mailing Address:
"Telephone Number:
E-mail Address:
Fax Number:
n_._,. r _r . 4
Ill. Project lul'ormation
Attach a vicinity map clearly showing the location of the property with respect to local
landnarks 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
USACB requires information to be submitted on sheets no larger than l I by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ pr=efers flull-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 (naps are provided.
Narvie of project:
2, T, H-1, Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): ?
4. Location
'
C'ouiity:,-_, Neares Town i< <..a 1"t rC tr
., /
Subdivision name (include phase/lot number}: _.?
Directions to site (include road numbers/names, landmarks, etc.):
P-
r'
6. Property size (acres): , ,? `
7. Nance of nearest receiving body of water:
8. River Basin:
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin inlap is available at littp:Hh2o,enr.state.ne.its/admin/intl.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
"J I
at the time of this application: G ` ( t` (
FaLe 6 of 14
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): °jy -` - ow
10, Describe the overall project in detail, including the type of equipment to be used:'.. _
11. Explain the purpose of the proposed wo

IV. Prior Project History
V.
Vi.
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 scl?edules.
Future Project flans
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_
> 411
F
Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's for agent's) responsibility to determine, delineate and snap 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 front
riprap dissipater pads). Be sure to indicate if an impact is tetnporaty. 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 oil 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: A k"s ='= r> A _.M
Pqo,, 7 nr I1
?. Individually list wetland impacts. Types of impacts include, but are not limited tc
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
se paratel • list impacts due to both structure and flooding.
?Wetlaud [uspact Type of Wetland Located witlriit i?istancc to Area of ?i
Site Number Typo, of Impact (o-g., forested, inarsh, 100-year
Floodplain Nearest
Stream Impact
(acres) i
(indicate on map) herbaceous, bog, etc.) (Yes/110) y
(liiicar feet)

,

Total Welland Impact (acres)
List the total acreage (estimated) of all existing wetlands on the property:
Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts- Stream impacts include, but are not limited to placement of till or culverts, darn.
construction, flooding, relocation, stabilization activities (e.g,, ceirient 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
trust be included. To calculate acreage, multiply length X width, then divide by 43 SGO.
5trc uu`Iniprct
Number
(indicate on iy i) .1
Stream Name __?
Type of Irnpact. Percnnial or
Intennittcnt7 A`.erage
Stream Width
Before 111) pact Impact
Length
(Iiiiear feet) Are of
luipact
(acres)

s

Total Strelin lu
tpact (by length and ac _
ruige) i
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„ flooding, drainage, bulkheads, etc.

? ?v<atcr 1111p act
4pc
Site Number
tindicate oti mi)
__.l?_

Nance of Waterbody

(if applicable)

ype of Impact
Type; oi' vdaterbody

(lake, pond, estuary, sound, bay,

ocean, etc.)
Area of
-11
Iimpaet ,

(acres)

4?
Total Qpeii Water linpact (acros) i
P'40.> V r-%r I 'l
ti. List the cumulative impact to all Waters of the U.S. resulting from the proiect:
Stream Impact (acres):
Wetland Impact (acres):
Open Water Impact (acres): -?-
Total Impact to Waters of the U. S. (acres)

Total Stream Impact (linear feet): _

1
7. Isolated Waters
Do any isolated waters exist on the property? ? Yes ? 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.
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., damlembankment, 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:
Vll. impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It Inaiy be useful to
provide informaetion 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.
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.
Ga.r., Q nr i 1
t1SACE --- 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.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USAGE 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 D ;HQ's
Drai`f Technical Guide for Stream Work in North Carolina, available at.
Igt1r.A112o_.enr. suite. nc;.us/wcwetlands/strmgide. htmi..
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 neap, if offsite), affected stream and river basin, type and amount (acreage/lineal- 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 slieet if more space is needed.
2. Mitigaition inaiy also be inade 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
froin 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://112o.enr.state.iie.vis/rvrli/iiidex.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):,2 _t1-0
Amount. of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
D-.- Sit.,r t.t
IX. Environmental Documentation (required by 1DWQ)
1. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes Q No 19
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 SERA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No 0
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 snap 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 inust 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.
t. Will the project impact protected riparian butf'ers identified within 15A NCAC 213 .0233
(Neese), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 0213 .0243 (Catawba) 15A NCAC
213 .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify )? Yes N No Q
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 tiaultit3liers.
zone* Inipact
Ivtultiplicr Required

uare feet)
(sq
Mitigation 1
I 3 (2 for Cati ba)
2 1.5
Total , h
R /xme i extends out sty ices perpenaicutar troin Me top et tite n= tutu of channel, Zone 2 extends an
additional 20 feet from the edge of Zone f.
>. 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 ally appropriate information as identified
within 15A NCAC 213 MW or .0244, or.0_260.
?h "1 t ;? ??t, EY;`.a''71?+?'.'t ? ?-;,s # -mot t r fr4
Pao,- i i of 11
AI. Storunvater (required by DWQ)
Describe impervious acreage (existing and proposed) versus total acreage oil the site. Discuss
storniwater controls proposed in order to protect surface waters and wetlands downstream froin
the property. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level.
X11. 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.
X111. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15th NCr1C 2II .0500) or any buffer Rules?
Yes ? No ?
Is this an after-the-fact permit application? Yes ? No ?
XIV. Cumulative Impacts (required by LDWQ)
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 or our website at
tt}?:11h2o.enr.state. nc uslncwetlands. If no, please provide a short narrative description:
XV. Other Circ:unist auccs (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 oil
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).
1':! 5 ' t;+: I'V tl--it?.I`Ih t ?

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