20070255 Ver 1_401 Application_20070207

JAN-25-2@@7 @9:@4 FRDM:DWQ-WETLANDS 9197336893 TD: 95984175 P:2.22
UffCe Use 4n[3': Form Version Mm•ct~ QS E
USACE Action l~ No. Iaw~Na. 2 0 4 7 0 2 5 5 E
(f f ~}' particular item is not applicable to this paralx~, please ear "N.pi Applirabk" Ar "NJA ".}
I. ProCessin~ •
1. Check all of the appmvaJ~s) rerwested for teas praj~t:
Section 404 Permit ~^ Riparian ar Watershed Buffer Rules
Sc~tl~cin t 4 I'e~l,+ilt ~ lst~at~+d ~Idetiamd Permit frrnn'DWQ
401. Water (~uafity Certification Express 40I Water (duality Certi~catian
2. Nationwide, Regional ar General Permit Number(s) Requested:
3. If this notification is solely a courtesy copy because written approval far the 441 Certification
is trot r~egrri~d, check here: ^
4. If payment xeto the Borth Carolina Ecosystem ~n~aaneement Fragram (NCEEP) is proposed
~'ar mitigation of impacts, attach the acceptance letter from I~fCEEP, complete station VIII,
and cEreGk .here: ^~
5. Ti:' your project is located in any of North Carolina's twenty coastal counties (listed one page
4), and the project is wit}tin a North Carolina laivisian of Coastal Management Area of
Environmental Cancem (see the top of page 2 for further details), check here: ^ ~`' ~ t 6~ ;' ~ '~`' ~~ i
II. Applicant Information '1 ~, ~
F L~ ~ ~OO I
1 ()vvn;erlApplicant 1nf 1~~atian C /^~, (~ `/l ~~,~~- `~~;~~ru>~~i~
1Y8~71 e: W J ~`7 J V r \ 'la~i~~~U ~(L ~Ti~~A~4k~F YC~~i2.Q~`~~~!
Mailing Address: '
Telephone Number: Number: ~- ~h `~
Email Address: A c~
-~,~ "~. 4~ge~#~Go~t~s~lt~t ~~foaticri '(A sig~d aaYd datet~ of tl~e ,A.gcnt ~tuthorixatian letter
must be attached i • t e Agent has aignatary authority far the owner/applicaztt.}
Name: `~ D,J
Company A#Ialiation: °r Tvt~C;, ~ ~Tr~.~• ~-
~' etiephane l~umber:__ ~I ~ ~ ~~3 • ~i t ~~ Fax Number: ~i > ~S ~3_ - y 1 ~~,_
E-rnai 1 Address:
Page 5 of 12

JAN-252007 09:04 FROM:DWQ-WETLANDS 9197336893 70:95984175
~Q. Project Inforrr~atian ,
,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 si#e plan showing ~'oF~Y
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrovv_ The specific faatpcints o£ all bui~di~gs,
impervious surfaces, or other facilities must be included. If passible, the maps and plans should
include the appropriate USGS Topagraphin Quid ,Map .and 3`JRCS Sail Survey ~virh t~ pt'op~stt~y
boundaries outlined. Plan drawings, ar other~maps may be Included at th.e appIicant's discretion,
so long, as the property is clearly de~ic~ed. For adm,;n~stsa+~iye as~d distxits~cie~+ acs. i~
US~CE requires information to be submitted on sheets no larger than 11 by ]?-inch forrn.at;
however, DyVQ msy.' accept €~Per~vark ~I' arty size. ;!3Wt~ prr6ers frt~r sip vronsorurrtion
drawings rather than :a sequential sheet version of the full-size plans. If full-size plans are
red #,~ a ~a44 acal~e stis,E, t1~t ~hc f mraS v~icm ira il3cgibie, t'nt arpphGarit ~iil be informed tfiat
the project has been placed on hall until decipherable maps are provided.
~ . Name of proj ect: ~ ~ ©~l ,~~>s~l ~ ~~ .
2. T.I.P. Project N'u~ber or State Project Number (NCDf7T Only}: ,
3. Property Identification Number (Tax PIN):
a,~ 4. T.,acatian
County: 1~iS ~ ~c. r~ _-- _ Nearest Town: r
Subdivision name (include phasellot number): _
Directions to site ( elude road nnuxnberslnames, landmarks, etc.):- ~~~ „ /~.<.~
~'+-e~ „~S+c) ~ 17fn. , ref' Cn'l I~~'f'
5. Site coordinates (For l,.inear projects, such as a road or utility line, attach a sheet that
separately i,ists the coordinates for each crossing crf a distinct vv~~tErbddy_)
Decimal Degrees (6 digits rninimum~: °)r1 °W
6~ Frvperty size (acres):- Z5G(~~~9-~-
., - -
7. Name of nearest receiving body of water:--- r„~, ; ,,-cr _
~ $. River Basin• 1 ~c~~~e.. _ -
(IVc~tc - #hls must bye tare of~Varz'}t C'ar~olirr$'s sevent~ctt t+l~sr`grrat~d nrgfar rr'ver hasrrts. 'ire
River Basin map is available at http:11h2o.enr.state.nc.us/admin/ma~s/.)
'~ 9. Describe the existing can.ditions an the site nd ~~eencral land use in the vicinity of the project
a~ rl~e tmY~ vfdris aplrtt~drort: i,~ dlt
P:3~22
Page 6 of 12

FEB-14-2007 01:31 AM
~8°13-20@7 12:58 FRDM:D4M~-WETLANDS 9197336693
i7i;, ~aaviie~oa>:reatra! Docameetsttloa (r''e9ai~od by DWG
P. 02
TA: J191~'~34175 P:2~2
~ 1. I7oe>! tha project invalva an axpenditurt: of public (federelltt~e!'looal,~ finds or the u9e of
pubiia {fedaral/state) Sand? Yes ^ No
~2. If ycs, dons the project require preparet}on of a~i environmental document pursuant to the
requirements of the National ar North Carolina Pnvirotunental Policy Aat (NEP,AISEPA)?
Note: If you aro not sure whether a NEPA/SLpA document is ,re0aired, raaJ! the SPA
aovtdlnator at (919 733-5083 ro raview currant thrGSholds fior environmental dacumentettion.
Ycs ^ No ~]
3. If yep ,has t}io dfxiarraeuat raw3ew 1xr~ !9t>sliaed by the Stata Cl~~ttghau~e? 7f av, pk~e
attach a copy v#'ttle IVEPA or Si~FA final approval letter. Yea ^ No ^
~C. Pw+uposed Impsacb era Aiprtrlau stud VHatcrsr*ed ~u:Qers {ref~ati,r~ed by D'WI~)
It is the appiicant'a (or stgCllt's) responsibility to dctertnlnc, delineate artd reap all impacts to
re~q~is~d a~ mnti 4t~4 hrorfi'rera ~sac,ciaAtx! with tttie pmjec;t, ~'ha app'iiGarn must atiso pravidc
Juet[fiuation for these impacts in Section Yl1,abOrrc. All propasvd impacts must be listed herein,
end must be arty idesrtiflab[e on the accompanying six plan. At! bu#~rs must be shpwa on a
map, whether or not impacts are proposed to the but*ers. Corresporxlcrtce irern the D W Q
Rcgianal Uffice may bo iaclurled as appropriate. P`hotograp~ malt' also be li'tchadcd at the
appl Itjarit's discretion.
~ l ~ Will the projeat Impact protected riparian bu?fers idfirrltified within 1 SA NCAC 2B ,4293
{Neusr:), 1 SA NCAC 2H ,4259{Tar-Peraiico), I.SA NCAC OZH .0243 (Catawba) 13A NCAC
2B A230 (R~dleirran Rules and Rtafer 3 ply Hui~cr Reguiremcnts), or other (picslsc
idcaatify ,4, a ~t1:~~. ~? Xes ~ No
~2. If "'yols'", identify the square f+uat and aaroago of impact to each zone of the riparian buffers.
~" bufPcar mitigation m regulrcd ca~ultite the ~eqult+ed amount of mitigation by app~ving the
buffer multiullers.
~, lmpaol R~utircd
a :care i~ec ~ Mkt anon
1 3 (Z tar Crlrwba)
3 I.,.~tM 1.S
~, Tom . ~ ~~~..,_ ti
Zone acomd~ out 36 fbot fault' il+o»- rho lop of t6r:Krr t>rntc of aha:mel; 7,ona 2 cxrands rn
wddttloael ZO fart rte the edar ofZone 1.
3. If buffer tnitigatioti is nquired~ please dlscuaa what type Qf mitig~lan if! pmpaa~ed {i.t~.,
Donatipt! of Ft^oparty, Ripari>!n Buffer Resto~ttion / Enhaitlxrnent, or Payrncnt into the
Riparian Buffer Restoration Farad}. Please ,eiraGl, sll,.ppprn~iaf~~~r~msulrun ~.s id~t~#~ad
within 1SANCAC 2H .024? o .4244, or.02tiQ.. _ ~~.G.C.. ~ e~t^a~-~;~,.~,
Prge a l of 1 ~
FEB-13-2807 TUE 13:26 TEL:[phone] NAME:DWQ-WETLANDS P. 2

JAN-2~,-2007 09:05 FROM:DWC~-WETLANDS 9197336$93 70:95984175 P:9122
~~. Stormwatez~ {r~yuxred ~y DWQ}
Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss
storn~water controls proposed in artier to protect surface waters clad wetlands downstream from
the property. if percent impervious surface ex s 20%, please provide calculations
demonstrating fiotal proposed irnpervipus level.
KII. Sewage Disposal (required hY L1WQ}
CJaarly detail the ultiroatr tr~aJ~e~t methtrds and dis,~sitir~rJ 'non-r!lsc.,ha~e ar c!lisclaarge~ of
wastewater generated £zorn the prQ~~sed project, ar available capacity of the subject facility.
7i~1<1IIt, Violati~uns (required by DWQ)
Is this site in violation of DW etland Rules (1 SA NCAC 2H .4540} or any Buffer Rules?
Yes ^ Na
3s this am af~tir~the-iao~,p~rni~ a~pp3ica~lian? ~'c~ ~ 330 ~^
~ .aii',iY, ~'armrrtatrve Impacts (required by ia~t~j
Will 1~is project (based ozx past and reasvnabtiy anticipated Future iumpacts) result in additional
development, which could impact nearby downstream water quality? Yes ^ No ^
If'ycs, please submit ~ qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina D'zvision of Water Quality policy posted on otur websitc at
~tttQ;1/}~2o.enr,state,nc.us(ncwetland,~ if noy~lease providC a short narrative descriptipn;
71rV'. Other Cirtamstances (Optional}.
It is the applicant's responsibility do submit the applioa#ion 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.
wprl~ schedules {e.g., draw-down schedules for Ickes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside ofthe applicant's controI).
3ignatare I Date ~
va!!d i~'att aarthrar7zatlrrr~ !ems frrNr~ the ap~rlecant is proviclerl.~}
Page l2 of 12

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