20041711 Ver 1_Complete File_20041022

o?OF W A rFq
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Barry W. & Gloria Mason
PO Box 61
Elm City, NC 27822
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
January 27, 2005
Subject Property: Barry & Gloria Mason Property
Tar River [03-03-02, 28-(36), WS-1V, B NSW CA]
Alan W. Klimek, P.E. Director
Division of Water Quality
DWQ Project # 04-1711
Nash County
Approval of 401 Water Quality Certification and Authorization Certificate per the Tar-Pamlico
River Buffer Protection Rules (15A NCAC 2B .0259) with Additional Conditions
Dear Mr. & Mrs. Mason:
You have our approval, in accordance with the attached conditions and those listed below, to place fill
within or otherwise impact 0.014 acres of open water, 210 feet of shoreline and 2,500 square feet (ft2) of
protected riparian buffers for the purpose of a bulkhead at the subject property, as described within your
application dated October 22, 2004 and received by the N.C. Division of Water Quality (DWQ) on
October 22, 2004 and all additional information submitted and received by the Division of Water Quality
on November 30, 2004, December 6, 2004 and January 27, 2005. After reviewing your application, we
have decided that the impacts are covered by General Water Quality Certification Number 3495
(GC3495). The Certification allows you to use General Permit 197800080 when issued by the US Army
Corps of Engineers (USACE). This letter shall also act as your approved Authorization Certificate for
impacts to the protected riparian buffers per 15A NCAC 2B .0259. In addition, you should obtain or
otherwise comply with any other required federal, state or local permits before you go ahead with your
project including (but not limited to) Erosion and Sediment Control, Non-discharge, and Water Supply,
Watershed Protection regulations. Also, this approval to proceed with your proposed impacts or to
conduct impacts to waters as depicted in your application shall expire upon expiration of the 404 or
CAMA Permit.
This approval is for the purpose and design that you described in your application. If you change your
project, you must notify us and you may be required to send us a new application. If the property is sold,
the new owner must be given a copy of this Certification and approval letter and is thereby responsible for
complying with all conditions. If total fills for this project (now or in the future) exceed one acre of
wetland or 150 linear feet of stream, compensatory mitigation may be required as described in 15A
NCAC 2H.0506 (h). This approval requires you to follow the conditions listed in the attached
certification and any additional conditions listed below.
The Additional Conditions of the Certification are:
1. Impacts Approved
The following impacts are hereby approved as long as all of the other specific and general
conditions of this Certification (or Isolated Wetland Permit) are met. No other impacts are
approved including incidental impacts:
401 Wetlands Certification Unit
1650 Mail Service Center, Raleigh, North Carolina 27699.1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone] /FAX [phone] / Internet: htto://h2o.enr.state.nc.us/ncwetlands
No[ChCarolina
Alatiti-ally
An Equal Opportunity/Affirmative Action Employer- 50% Recycled/10% Post Consumer Paper
Barry & Gloria Mason .a
Page 2 of 3
1/27/05
Amount Approved
(Units) Plan Location or Reference
Stream (shoreline) 210 (feet) Plat ma
Waters 0.014 (acres) Plat ma
Buffers 2,500 (square ft.) Plat ma
2. Erosion & Sediment Control Practices
Erosion and sediment control practices must be in full compliance with all specifications
governing the proper design, installation and operation and maintenance of such Best
Management Practices in order to protect surface waters standards:
a. The erosion and sediment control measures for the project must be designed, installed,
operated, and maintained in accordance with the most recent version of the North Carolina
Sediment and Erosion Control Planning and Design Manual.
b. The design, installation, operation, and maintenance of the sediment and erosion control
measures must be such that they equal, or exceed, the requirements specified in the most
recent version of the North Carolina Sediment and Erosion Control Manual. The devices
shall be maintained on all construction sites, borrow sites, and waste pile (spoil) projects,
including contractor-owned or leased borrow pits associated with the project.
3. No Waste, Spoil, Solids, or Fill of Any Kind
No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or riparian areas beyond
the footprint of the impacts depicted in the Pre-Construction Notification. All construction
activities, including the design, installation, operation, and maintenance of sediment and erosion
control Best Management Practices, shall be performed so that no violations of state water quality
standards, statutes, or rules occur.
4. No Sediment & Erosion Control Measures w/n Wetlands or Waters
Sediment and erosion control measures shall not be placed in wetlands or waters to the maximum
extent practicable. If placement of sediment and erosion control devices in wetlands and waters
is unavoidable, they shall be removed and the natural grade restored within six months of the date
that the Division of Land Resources has released the project.
5. Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable
Buffer Rules, and any subsequent modifications, the applicant is required to return the attached
certificate of completion to the 401/Wetlands Unit, North Carolina Division of Water Quality,
1650 Mail Service Center, Raleigh, NC, 27699-1650.
6. Temporary Access Corridor(s)
The proposed access corridor(s) must be the minimum width required to get the construction
equipment to the shoreline and shall not exceed 25 feet in width. The number of access corridors
should be limited to the minimum number required to get the construction equipment to the
shoreline (many times only a single corridor is required) and shall not exceed one corridor(s).
Barry & Gloria Mason
Page 3 of 3
1/27/05
The access corridor(s) should cross the buffer as close to perpendicular as practicable and
disturbance to existing vegetation should be minimized.
Violations of any condition herein set forth may result in revocation of this Certification and may result in
criminal and/or civil penalties. The authorization to proceed with your proposed impacts or to conduct
impacts to waters as depicted in your application and as authorized by this Certification, shall expire upon
expiration of the 404 or CAMA Permit.
If you do not accept any of the conditions of this Certification (associated with the approved wetland or
stream impacts), you may ask for an adjudicatory hearing. You must act within 60 days of the date that
you receive this letter. To ask for a hearing, send a written petition, which conforms to Chapter 150B of
the North Carolina General Statutes to the Office of Administrative Hearings, 6714 Mail Service Center,
Raleigh, N.C. 27699-6714. This certification and its conditions are final and binding unless you ask for a
hearing.
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 letter completes the review of the Division of Water Quality under Section 401 of the Clean Water
Act and the Tar-Pamlico riparian buffer protection rule as described within 15A NCAC 213 .0259. If you
have any questions, please telephone Cyndi Karoly at 919-733-9721 or Deborah Edwards at 919-733-
9502.
Sincerely,
AWKIdae
Enclosures: GC 3495
Certificate of Completion
cc: USACE Raleigh Regulatory Field Office
DWQ Raleigh Regional Office
DLR Raleigh Regional Office
File Copy
Central Files
er=_41 ? T44
Alan W. Klimek, P.E.
Filename: 041711Mason(Nash)40I+buffer
01/27/2005 09:03 9192694463 MASONS TILE SERUI%E PAGE 01/10
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MASONS TILE SERUICE PAGE 02/10
01/27/2005 09:03 9192694463
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Division of ''f+'tJ'ater Quality
Department of Environmental and Natural Resources
401 OversigbYExpress Permit, Prograin Development and
Transportation Permitting Units
Street .Address: 2321 Crabmoo Boulevard. Suite 250
Ralcig?t, NC 27604-2260
MaUbig A444=.6 1650 Mall Service. Center
Raleigh, NC 27699-1650
+ContactWarmaVon: Phone #t: 919-733.1786
Fax #: ' 919-733-6893
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Fax To: 1 i<a y v ?- (--X C''ti5..,f; Fax
Company: Date: zt? --
NuMber of Pages hlcluding corer sheet:
Notes or special instructions:
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JAN-27-2005 THU 07:36 TEL:[phone] NAME:DWQ-WETLANDS P. 2
01/27/2005 09:03 9192694463 MASONS TILE SEP,UICE PAGE 09/10
. 1
11 OMEC Use Only; !roan vmio© May IW2
USACLAction ID No. DWO No. t`a c.? , 7
(tt any Fardoukr 2trm is not kvli"bla to oils k.'Q4 Pk"' c"ter?°No't lAppi?tx?ble"
1. Processlug
1. Checb till of the VproNmi(s) reque?ud fbr this pzs'ec-t:
1171 Section 404 Fe merit Ripanaan or Watershed 13uffcr P?vlrs
Section 10 Permit [] Isolated Wetland Permit tram DVVQ
9.401 Water Quality Certification
Natioawide, Regional or General PMnh Number(s) RNueged: f 12=_4 ?i_
3. it this notification is 40101y a COU=y copy because writrcn approval for dw 40] CL-UMuUon
is sot reyuircd. clic:clc here: ?]
4. If payr=nt into the North Carolina Wcttauds Resrorato a program (NCKrltl'; is pro
posed for
mit&llion of impacts (verify avaRnbility with NCWRP prior t4 submittal of PCN), c;ojLPlcW
section Vill UQ chock here: 0
5. If your projezt is located is any of North Carolina's twenty coastal oountiea (listed on page
4), and the project is within u North Carolina Division of Cowl Mara; cinert Area of
Eavimaincntal Cou=u (see the top of page 2 for farrher details), cbock lure: 11
R. Applicant Information
1. Owns'l&plicmA Inf moatiou
Mailing
Telephanu Number:.
E-mail Addr"u-_
Fax
2. Agw/Consultant 14ormution (A signed and dated copy of the Agent Authorization letter
must be atmcbod if the Agent has signatory authority fbr tho owner/applicant.)
Name:
Company Afffli4lon:
Mailing Addtr;w,:
Tc4hono Number, _ Fax. Number; E-mail Addross:__ _
Page 3 of 12
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r:
E699ML616 SiltJtillShl-OP10:410c1? 8i : t i 5E02-52-Nt3f
NAME: DWO-WETLANDS P. 9
81/27/2805 09:03 9192694463 MASONS TILE SERUICE PAGE 58/10
t . A
(It. Prolect Information
Attach a vicinity map Gleamy Showing tho locations of the property with respect to 10CU,
landxuarits such as towns, rivers. and roads. Also provide a detailed site pier showing property
boundaries and developtinent plaw in relation to surrounding pr pwies. Both tho Viciuity Maly
and site plan roust iacluda a scale and north arrow. The specific footprints of all building.,
imWrvious u°urfaces, or ether facilities must be included. If possible, the nwps and pleas should
include the appropriate USUS TapograpE is Quad Map =d MRCS Soil Survey wiztt iho property
bouod,arios outlined. an drawings, or ohor maps may be included at the applicant's di;t- t,ric i,
so long as the property is clearly defined, For adminiswative and &tributiou purposes, tho
USAGE requires inif'urmatioa to be submitted on sheets no larger than 11 by 17-inch for=t;
hawzwr, DWQ stay accept papcawcuk of day six. . DWQ prefers .E,tl.l?iize somu-act qn
drawings rather than a sequontW shoot version of the full-sizo plans. If full-size plans ure
reduced to a small scale such that the ,final version is illegible, the applic= w,i,ll bo inronned that
the pw}ect "% tce^N placed .psi hod = 1 d=4henbla mVs area .proi% cd.
1. Name ofproject; ;4
2. U11. ProjtCt Number or State Projoet Number (NCDOT Only):
3. Pcopetty (dcw.ificativa Number (Tax PIN): '? Qr? $-? I
4. Location
Couatp ,/VA5,# NoarcGt Towrz_??J"E ?
Subdivision mane (include phar.Oot numbor):
Diroctiens to site (inchide road mzmbers, landmarks, etc,
5. Site coordinates, if available (MI or LaVLoug);
(Note -If pmJect is linear, such as a road tar utility tine, attach a sheet i1?F,L scp t;uc:fy Bets tl r
coordinates for each emssing of a distinct waterbody.)
6. Property size (acacs):r__lC?
7. Nearest body ofwamr (atma vc-r ooundloccanilake): Z4,F J 1 ,z-
8. RivcrBasin:_/? ?! llr
(Note -- this must bo ono of North Carolina's sGYcz1=n k4guatcd major river basins, Thu
River S sin p is available at ktct,:i;rt:c,.er?r ;arr.itc.t=s;'u„m?re?,rr?i .l
p. Do=ribc; the existing conditions on tho site and general land use in the vicinity of the: project
at the t1we gethis applicadan: ,?11T lS???f G c ?1' 1h t?` It i ?
Pago b of 12
6/2 :d £9bbt?9:0i
JAN-27-2005 THU 07:38 TEL:[phone]
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HAME:DWO-WETLANDS Pi. 8
01/27/2005 09:03 9192694463 t,1ASONS TILE SERUICE PAGE 67/10
W.
V.
c ?
10. Dcscribc the. overall projcc;t in detail, including the typo of equipment to be tuel:
Plll.kAr7n T/) AQG i„rTtse, t a e ,,,.. _ .. _ -
1_ Bahia theputposc of the proposed work-
Prior Pt uJect Iilstory
if jurisdictional dt:temziwioas and/or permits have been rcqs-red and/or attained for dh -;
project (iuluding all prior p-s of the wino aubdivisiou) in the past, plcr 0 e,p"aim Inaluda
the USAC,E Action Il) Number, DWQ Project Number, application date. and date permits and
ccrtificatio: s were issued or withdrawn. Provide plroDuwpics of previously issued p4amits,
certifications or other usofui infalmatioa. Describo preyi=ly approved wetLuod, rtrarri and
bufTrr impact,, along with Associated mitigation (where upplicable). If this is a NCDOT prrqu"
list a .-d describo permits issued for pziar scgmcut3 of flee same T.I.P. project, alczg with
construction zuh dule?-
future Projoct ft us
Are any future permit requests anticipntW fl,r this pmjct t9 If ro, descnbo the naticilnitcd wade,
and provide justification for the exclusion of this work; from the current pppiictitign.
V1. Proposed Iaspact9 to W000 Pf the United Ststo dWuters of the State
It is she appliew'? ({)r age'nes) resp0ml-bility to det"Mine, do.1%W10 and map all impacts to
w4tlands, open water, and stream thermals =0s ,used with. the project, The applicaat must also
provide justification fot these impacts in Saetxga VII bolow. All ptopeacd iinpucrs, pcrmanpnt
and temporary, must be listed herelu, and must be cl=ly identifiable on an accompanying slay
plan. All u etLmds and water, and all dtretuna (mtcrmittent and perennial) must be shown on a
delineation map, whether or not impacts are prvpo3W to these system:. Wetland and stream
evaluadan and delineation forms should be included as appaTziate. Photo hs tnay be
includW 4 life applic,3 Vs discretion, if this proposed iravact is strictly for wetland or stroam
mitid tion, list and describe the impact in Section 'gill below. if additional space is needed for
listing or descsipdoa, pie.uie ntWch a scparato shat.
Page 7 of 12
6/;,;d 295t76926:01 VF-.q9rPJAZA cf 4i-lizRi-i,-m1:wnM4 FT.:T.t CM;?-Ca-WHr
JAIJ-27-2005 THU 07:38 TEL:[phone] NAr1E: DWQ-WETLANDS P: 7
01/27/2005 09:03 9192694463 MASONS TILE SERUICE PAGE 06/10
. I
1- Provide a lvritton dt:smigfioa of the proposed impacts-
420.41 F-RMLMA!?
2. Individually list wcftnci imposts bclaw:
&tkuxi Irnpttct of f oulaw withiu Dish to
Silo Num5a Type of tmpda* tcirprsct WO-year Floodpla nt" Neared stmam Tm., of W"Clgnd-so
KbCateonunanl i.,...,., I.--_-?
" LW Caoh =9-1 sb ly sad idcrstif5r =Waruy Ictpaas, Imrp" im3uda.1>IIt are mt t cnitcct to: ania ctcaritt?, l'J ?iiat',
exuVILon, flood a& dit tFf drairw?, c!¢ Fer damx, =P.=tr]y list impacts dae to bn1h Kbr- a wtd s7m iici
•• 100.Y- flaad wn% W_ MkdLrwd, throagh the Ftxh:rsl FZCTMCy b&Ar._=Wt ASWc.yrs (FWAA) Flood Jn==Qte Rate M:,po
Colino at at ca fEMA -?pplnrcd loci} ilotfdptain rti Mx{+s uC 2aatk b 1ftWq}'1 th FEb1k Msf, $crrkc l mRcr at t-3tx -.;.y•9616. or
?iolin i+r?i ?; t,y. c •????. ?., ..
+?? Litt a wedwd typo that best dcacn'bc4 svdUTvi in bo tsRVXW (c g., llahw ? m t4 boccx?l Walmd, O"Va pmcl,
C`W- Bdy, boa,etc.) ladicrtc if wdlaad is imiAkd(dmmmil--dwofituttution to be m:de by USAGL+ wily).
List tho total acreage (estimutccl) t)f 3ii vBiSting 1 stlunciti on the property-
Total area of wetland impact proposed
3. 1u&viduaUy.6,t till itltermimmt and petctmiat strenn ittlpsLn3 below:
Sitvatu xn pgct
situ Number
ituti4at6on
Typo of ftnP=t* Lge^tla of
Imrzt
tbct
Stream Natue*• Aveaa?a wiattb C'Mmud
of stty 1nterini
BaTato lrn (tea s c?
I
r V
of ..
ttMtt
1
rt rxlc Lu+s t c=nn:ly and Lucs tfy tesapofwy WimOm GcP" 1ALI c 7. b,d = got Lul= W culvettS and 2s:4e7ated ssp•=g,
dams tscputtk-ly list impaLn do to boot s=ttto and Awlag), id=t1w (it>tlude haem fat before oat aft= and act IosdEa:M%
cu4x2aaaa BGtlvideo (cxuiC:tt WA lip-rap, r?a T.,rA CAb=;, M), "CWriZIaII, di1d1irtd1ft 1.sJ ;ning, au. If !trnun =1crcatioo it
Arcpo?cYi. Pistts and pinfika sho+riug the linear fflotprirt fur both tFte efigica)
aaArcbxx ud sua?m ruui he iaedadrAL
e* ShcaW ARa Um ba tucna OA USGS tpppS?r{sd;e melts- if a ream Las an name, llct y Ur (untamed UWU=).) to the =,r"
dUwr,gtj=u jAa p;d s-a-mva into whkb k ttous. USGS maps = avaf4bia ttucwyh lire USES at i-aXl ii;: J(.t?. or M144 at
Sc.cPi internet sius sl:e alines direct dowgfoad and ptintitix 6r USGS maps (e.y_ uy111 Itll .1(_ttC fiK7x
t?.•?_rn my r h t t? cce. I.
Cumulative itvacts (linear distuara in feet) to ulI strcttms alt site:
Page 8 of 12
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JAN-27-22005 THU 07:38 TEL:[phone]
?689<.?.t 6Tf SWRil191'l-?ihlQ:!?Q?? 6S : T T S00c7.'-S2-Ntir
NAME:DWO-WETLANDS
01/27/2005 09:e3 9192694463 MASDNS TILE SERUICE PAGE 05/10
4. Ittdivittually Est all open water Impacts (including lakes, Ponds, e3tamtie4, founds, Atlantio
Oc=u land Any othar water of the U.S.) below:
Opc'a Wens ltnpect # AnEa of Name of WucerboQ Typo of I'Vdwybody
Sisa Number Typo offrr t cs y j1a1u? Ausscl. ?,?u bo
indtvaW on map) (mss) (if app?k) wry. and,
1
° Litt ese1? impact ccp:?ta:y slid idcaufy zcm}wtzvy uup.ctY, t?? :neII,bi? bnt acs tilt '.imitrct !o: cJa, oxcavetlnn, dredriu?
t'o?ding. ?raic?gr, bnlYLeaaa, sd:.
5. Pond Creation
If consuuouon of a pond is proposed, associated wcd=d and =am impacts should bq
iacludcd above in the wwlm d mid m=m impact scctious. Also, tho pruposO pond shQiild
be described hire and illustrated on any camps included with t VS appiieatinn_
pond to be created in (check all that apply). Q uplands M =can Q wetlands
OcWnni`be tb.e method of C0=4VOi0a damtambaut ment, onavadon, in4ullatiou of
draw'-down valve or spillway, ctr-):
PropWecl ttsa or purposo of pond (cg,, livegtoc'k watoring, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.)' ,
Size of watetslied drat:aing W pore xp=W pond 5urfaco area:
vu. Inrpna-t Justiideadon (Avoidance and MLd tion1
Spceificalty dascnn`be measures taken to avoid t.'te proptased Impacts. It may bo 'tlseful to p:v,y%c
information related to site o=traint9 such as trpogruphy, building ordin4arca , pwosmbility, and
fnancial viability of the projett. The applfcaw may attach drawings of alterno ve, luwcr-impact
site layouts, a d explain why thm design options were not feasible. Also discuss how impacts
were minimized once am desired sito plan was developed. if applicable; discuss coAstnuction
=hasques to be followed dUring constructlon to mdu¢c impacts.
YD 5 xoL> Q'U'O 510,y
VIM lViitigsaun
DWQ ,- In accordaact with 15A NCAC 2H 0500, mitigation may be rcquirad by the NC
Division of Water Quality for projects involving grouter than or equal to one acre of impat,w to
freshwater wetlauds or greater tlaau or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12
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JAN-27-2005 THU 07:37 TEL:[phone]
i
ZG892a6i6 SQW 113M-U1a.'WCPJ.J
O?:II ?QF32-S2-tJ?ll'
NAME:DWQ-WETLANDS P. 5
01/27/2005 09:03 9192694463 MASONS TILE SERVICE PAGE 04/10
tJSACF -- !n accurdati= with the Fhi l Notice Of L,stts w and Modification of Nwioawida
Permits, published in the Federal Register on March 9, ZWO, mitiPfiQn will bo required when
neccUary to t.nsttro the adverse effects to the aquatic cnvirronmcnt are mini=l. Factors
including size and type of proposed impact and function and reIatM, v due of tho impaoted
aquatic rewumo will be 99n4derW in dctawining acceptability of appropriato and practicabla
mitigation ca prvpoml Examples 0 mitigation that muy be appropriate; and practicable incluk,
but arc not limited to: wducing the size of the project; tAabHzhiag and mai.tlmining, wadand
and/or upland vegetated buffers to protect open water such ay stz ,. and replacing loxsrs of
aquatic resotucc function:, and vatucs by creatit" resturirtg, cuh- acing, or prmrving similar
functions and values preferable in the same wata,shed
if miti&tatYon is =quircd far Ul is PmjOQt4 a copy of tho mitigation plan mast bo attachW iu order
for USAGE or DWQ to consider the application Complete for procrosing. Any appiia anon
lacking a required mitigation pW or NCWRP eoncunsnca sJ? b4- plxc:cd on b9W as
in.comptetc. An applimit may also choose to =viow the curmat guide firww ror stroum rr:ttoration
in DWQ'$ Dtia Technioa.l Guide for strc= Work iu North Caro aa, availablo at
I?Itn?l; t,?c-,.?;nr.tate.r?c.U`YIIS; ??'e?dndCrStJRlait2,^..}7tcul.
1. Provide a brief description of the propusod mitigation plan. The description alioul,d provide
as much inf*=40n as possible, inelualins? bat not lime{ to: aicc location (attach dirirtioss
and/or map, if offsitc), aPfcotcd strram and rit er basin, typo and amnnnt (a4ccagt lliucar fact)
Of mitigation proposed (rustoratian, cnhanCemeat, creation, or preservation), a plan viow,
presnrvatinn mocbazu3m ('9- dcC4 lu ictdons, Conservation casemrt cto.), rmd a
description of tho = = site conditions and proposed method of construction. Pteasc atmc:h
a separate slicer if morn space is needed
2. Mitigatioa may also be made by pay=at into the North Carolina Wctlat & Rwroration
Program (NCW"). Piea©e mote it is the applicam's regOnsibihty to conmcr the NCWRP at
[phone] to determine availability aad to =quest writtca mpproval ofmitia aeoii prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, chew, the, NCWRP mite at h1tp:.,j 2rr,cnr.stste If use of
the NCWRP is proposed, please alrt=k the approprf= box on pago throe and pmvidv the
following informatioa:
Amount of sum mitigation requested (disc fent):
Amount of lmffer mitiption roquestcd (square fevt);
Amount ofRlparian wetland mitigation requested (ucres):
Amount of Nan-riparian wetland mitiption requc5ted (ACr );
AmoAmt of Coastal wetland mitigation requested (ate):
Paso tU Uf 12
biL d 4:9titJ6926 :0l ?58?;!SS'l ?i? Qraa?l l ?t a_Fr r r •,.rov , nn. v * -
JAN-27-2005 THU 87:37 TEL:[phone] NAME:DWO-WETLANDS P. 4
01/27/2005 09:03
M
Y,
9192694463

MASONS TILE SERUICE
EnVlrontricntQ DOCUnXntatlon (tra;alraired by,DWQ)
PAGE 03/10
Do" the pwjcct involve an exprndiWrC of pablic (fodemllstata) ilmdR or the uses of p-ubli4
(federallsmtc) land?
Ye:; [] l?to [
If yes, does the project require pmparatioon Of an eaviroumonr- dgcunwnt pursuant to tho
rcquirctucnts. Of the National or North Caralinu EnvironmCntol Policy Act (IrSMSEFA)?
Notes If YOU are not sure whct4r a NEE'AMPA docuu=t is required, call Mire SEpA
coordinator at 919) 733-5053 to review current thresholds for euyiv a tntttl documentation.
Y" at
No 0
if yes, hues the 410c=ent ruv'cw beat 5uali=d bye 1110 Soar ClcJrin9hOusc7 if s4, plausc atmch at
Oop7 a t1tGNEPA ar Sf3i'Afmd approyal It=,
Yes 0 NOM
P"poSCd Impacts as Riparian and Watershed I3nffers (rcqulred by DWQ)
It is the applicatat'a (or assays) ttvottsibility to dctcrminc, dolineatc and map ull irnpwW tc
nquired state and 1=1 buffers asrooiateci with tha project. ills applit~tnC uiuSC also ?ovidcr
just?icution for thssa impacts in Section Yti above. All proposed Lupneu mast be kestrel her*,.
and must be Wally idea it3able on the aocompatxymg site phut. All bulFem must ba shown on at
map, Whctltnr or not impacts we pmpa 3 to the ulfW. Cot7eaponaicnce fr 'n tho D1YQ
Regional Of&x may be included as appropriate. Photofmphs may also be included at thn
appli= ,- di=:tiion,
Will the project impact t '- buffers idcutificd within 15A NCAC 28 .0233
(Nc=), 15A NivA . 59 ter-P 15A NCAC 2B .0250 (Randleman Rules and
water SulY Btr ltcgili>ztnwta), or laji?l#
Yes No El VYou;=Wured "mss", Provide the following information:
ld L6t tho ;iq=o fs# =4 ac-ecaagO of iutpact to Catch lane Of the rillarian buffers, tF b-affor .
mitigation is rcqum:d corulate ft required amount of miti&' ion by 3PP1Ym$ ttk; buf'for
multipliers.
Zone* Impact g?ivitad
s rcd Mta^
X Q 3
2
Total
ZQW L Cttead$ OTA 3t! La pcrpendffulur &wu near bZak of Cha=4. ZQ= t
cOCt ds an
3ddkloaal 20fif?= the cci'-eorz= t.
Page 1I of 12
I
G/O!d £0-t7t7632G:O.L E603M) AD; Cd1"4-taan4-.F#An< n-,.rt
JAN-27-2005 THU 07:37 TEL:[phone] NAME:DWQ-WETLANDS P -?
01/27/2005 09:03 9192694463 MASONS TILE SEF,UICE PAGE 10/10
Y 11. .1
if buffcar miti?ptioa is requires, pleusu discuss -what type ogmiti3atiam is proposed (i.e., Donation
of I luparty, Com=vunvu ExbU=t, RTanan 8uffer.Rcsiorauon / Enhanzement, ,Presmttion or
Paymt:ut iota tha Riparian Buffer Rratoration Fund). Please attach all rppmpriato iaformauou as
idrntifcd wiUgn 15A NCAC 28.0242 or .02613.
Xt. Sta7rmwater (required by DW4Q)
Dwuibo hmpervious S =I;c (both txiatiug and ptupo4rd) venue total aowx8o 01) tho Srtc.
Discuss stormm'aler commis proposed in ord(to prat=t aurfaca Watcrs and vice =ds
duwmtm= from, thn property.
X1.1. Smagre LUSPOSa1(rcgzared by D'WQ)
Cl=ly detail rho ultirmte t=tmout atelhods and disposiz (nor.-diac?rgv vx &acbarge) of
tiYuww4w gemeramd fi= the prvpwcd project, or availabla capacity of dia subject fhoitiry.
;j7 r
4.
MIL Vlalatiom (rcquimd by DWQ)
h tlris site in violadon of DW Q Weamd Ruks (I 5A NCAC 2H .05W) or any Butfur Ruleg`t
Yes [] No ip
4 this au after-thtrfad permit application?
Yes [] No P
XIV. OM.-e Ctrcamstsuccs (OpdumJ):
It is the appllcat ev ruvonsibility to submit she application rufrWientty in advance of desired
construction datc?R to allow pmcc3aing tiruo for tbcm paumim However, an applicant =y
choose io list c=t aurt3 &wociatod with cotsstruc&n or se4uenci4S that ntay impose limits .
work schedules draw-do m schedWes for laLu*, dates assaciawd with Bu&nmtvd and
Threatened Species, acc=ibility problems or other islsucs outside of the applicant's control).
13 lrl"Ou?
'"Applicant/Agent's Sigttataru I?ate
(Agent's sigzr W= is valid only if AR authotmtioxu letter from the vplicant is provided.)
Pays 12 of 12
6i6:d icb 926;01 f'ff39t'i:'1Fit; Cr"4'11-44-FW2LJnM-t r-7•rr L.-
JAN-27-2005 THU 07:39 TEL:[phone] NAME:DWO-WETLANDS Pi 10
MEMORANDUM
TO: John Dorney Regional Contact: Michael Horan
Non-Discharge Branch WQ Supervisor: Ken Srhllster
Date:
SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS
Facility Name Barry & Gloria Nlason
Project Number 04 1711
Recvd From APP
Received Date 10/22/04
Project Type bulkhead
Recvd By Region
County Nash
County2
Region Raleigh
Certificates Stream
Permit Wetland Wetland Wetland Stream Class Acres Feet
Type Type Impact Score Index Prim. Supp. Basin Req. Req.
Waters PT -@N
F__[_28--(36) WSIV BCANS 30,302. 0.00 F-
Mitigation Wetland
MitigationType Type Acres Feet
Is Wetland Rating Sheet Attached? 0 Y 0 N Did you request more info? 0 Y 0 N
Have Project Changes/Conditions Been Discussed With Applicant? 0 Y 0 N
Is Mitigation required? 0 Y 0 N Recommendation: 0 Issue 0 Issue/Cond 0 Deny
Provided by Region: Latitude (ddmmss) Longitude (ddmmss)
Comments:
Issue Michael Horan)

TVVI\ CC
cc: Regional Office
Central Office Page Number 1
SENDING CONFIRMATION
DATE JAN-25-2005 TUE 11:21
NAME . DWQ-WETLANDS
TEL [phone]
PHONE : [phone]
PAGES : 9/9
START TIME : JAN-25 1118
ELAPSED TIME : 02' 56rt
MODE : ECM
RESULTS : OK
FIRST PAGE OF RECENT DOCUMENT TRANSMITTED...
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?KR •I:0'?t>Tr.`n,,?;ry,wnuWi^"Iw'•?ulay .? :?
r.-J't? AfV -.,Yi
W AT FqQ Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
> -i
Alan W. Klimek, P.E. Director
Division of Water Quality
Division of Water Quality
Department of Environmental and Natural Resources
401 Oversight/Express Permit, Program Development and
Transportation Permitting Units
Street Address: 2321 Crabtree Boulevard, Suite 250
Raleigh, NC 27604-2260
Mailing Address: 1650 Mail Service Center
Raleigh, NC 27699-1650
Contact Information: Phone #: [phone]
Fax #:
Fax To:
Company:
yi 1?Cv ??? C sct?1
919-733-6893
Fax #: 1 I cl - 2 (,R - :-) ? CD7)
Date: ZS C»
Number of pages including cover sheet:
Notes or special instructions:

0
9 + ? ? -1-2-, Q' Lo C CVV-P C?- R ? t cN?kf V-< clk' n .?
< V\"-

?
4010versighUExpress Unit ?neCarolina
t?rra!!?
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/ncwettands
An Equal Opportunity/Affirmative Action Employer-50% Recycled/10% Post Consumer Paper
r
Office Use Only: Form Version May 2002
USACE Action ID No. DWQ No. 0 y P7 / /
(If any particular item is not applicable to this project, please enter "Not Appiicaoie or Niri .)
1. Processing
1. Check all of the approval(s) requested for this project:
G(] Section 404 Permit ?] Riparian or Watershed Buffer Rules
? Section 10 Pen-nit ? Isolated Wetland Permit from DWQ
401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: C/2 R )OD lkh
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: V1
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), 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: ?
II. Applicant Information
1. Owner/Aiplicant Information
Name: 1?y ltl (?'LU?/A /??}-Sa
Mailing Address: 0 [?X /
Telephone Number:
E-mail Address: (.
t
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:
E-mail Address:
Fax Number:
S CT
G
Page 5 of 12
III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project:
2. T.I.P. Project Number or State Project Number (NCDOT Only): 1 V LIf
3. Property Identification Number (Tax PIN): ?`7_317 QJU Y43 /'7
4. Location
County: Nearest Town: kd(iXY 1(?ClN
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.):
5. Site coordinates, if available (UTM or Lat/Long):
(Note - if project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): /,, 1_3 A C R C_-5-
7. Nearest body of water (strea fiver/ ound/ocean/lake): T,4.C T ?/c 2
8. River Basin: TA)-?- 2 r,&g
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at htth;!ill2o.enr.st;tte.nc.us,' 1(1111in!m:ips .)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: l D r /5 L'L 6A/: ) i T// ? J -LL /d G
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used:
11. Explain the purpose of the proposed work: % n e S;OP s-// ;3 011A1 69p/?_
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 1D Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
V1. 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. The applicant must also
provide justification for these impacts in Section V11 below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must 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.
Page 7 of 12
7V R?' D ?DOSiT? OAJ /? ?/ aPDU4l1
1. Provide a written description of the proposed impacts: PI'Lli CT" sy2p F L./N
.62AR FRO-Slow
2. Individually list wetland impacts below:
Wetland hnpaet
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(es/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***

I

* List each impact separately and identify temporary impacts. 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.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
WIRM1. or FENIA-approved local Iloodplain maps. Maps arc available through the FGMA slap Service Center at 1-800-358 -9616. or
online al 11110: a.tcn;:tc...
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property:
Total area of wetland impact proposed:
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent'?
(please secifv

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, 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.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downsu•cam named stream into which it flows. USGS maps are available through the USGS at 1-800-35`-9616. or online at
.c n;c L10"' Several internet sites also allow direct download and printing of USGS maps (c... u,i +n,n_c ,m.
Cumulative impacts (linear distance in feet) to all streams on site:
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Name Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.)

rl? c G , pay uc- 4A tc

" List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredguig,
flooding, drainage, bulkheads, etc.
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.): - r
Size of watershed draining to pond: xpected pond surface area:
Vll. 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.
TD S TUP C ? U S1o,y AJO _?' &L / Z E
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.
Page 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, 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 USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP 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
httn:- h???.?nr.?t:?te.nc.u5?nc??etl??nds%strm??ide.hU»i.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
in
711- 71
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at httna,h2o.enr.stat?.nc.us'??rrin&X.11tm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet)
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federaUstate) funds or the use of public
(federaUstate) land?
Yes ? No
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 docwnentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact rot ri arian buffers identified within 15A NCAC 213 .0233
(Neuse), 15A NCAC B .0259 (Tar-Pamlic , 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or o er (please identify, )?
Yes P No ? If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
zone* Impact
(square feet Multiplier Required
Mitigation
3
2 1.5
Total 2150Q
Gone 1 extends out 3u Ycet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
Page 1 I of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate infonnation as
identified within 15A NCAC 2B .0242 or.0260.
M. Stormwater (required by DWQ)
Describe impervious acreage (both 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.
I 5 jrgL C /%UC
Xll. 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 (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No r7l
Ifl-i
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12

Office Use Only:
Processing
(If any particular item is not applicable to this project, please enter "Not Y -
1.
II.
1. Check all of the approval(s) requested for this project:
FO Section 404 Permit
Section 10 Permit
[] 401 Water Quality Certification

(ACC t (("s
C-,
X50;,
Riparian or Watershed Butter Rules
Isolated Wetland Pen-nit from DWQ
2. Nationwide, Regional or General Permit Number(s) Requested:, 9 7 86619 ?[7
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: VI
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), 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
Enn ironmental Concern (see the top of page 2 for further details), check here: ?
Applicant Information
1. Owner/A licant Information
Name:-??u???, ... U? /t-/r4S1?/v
Mailing Address: ttS CT
C.
a,)
Telephone Number: Fax Number:
E-mail Address: 0 C,?O/ • CLJy-v-)
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: ? c--j
VV1?1 L'?? Ll `f D
0 2004
Telephone Number: Fax Number:
-'dVATER QUALITY
E-mail Address: ;^,.n„,,3 T^ n
..?t?AiER sRAttcN
Pagc 5 of 12
. +
111. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed 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, UWQ 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:
2. T.I.P. Project Number or State Project Number (NCDOT Only): N#
3. Property Identification Number (Tax PIN): ?''73'7 6 dO S6 /
4. Location
County: 4/AS19 Nearest Town: kd(?Xy /`104/lY
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.):
Site coordinates, if available (UTM or Lat/Long):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): Z, 1.3 ACi
7. Nearest body of water (strear ivcr/ ound/ocean/lake): r/4,C Z / l/Ep.
8. River Basin: T-4)? 21 ?
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at linp:% .)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: 4,0 7 /S icAlea) i 7-// Pagc 6 of 12

10. Describe the overall project in detail, including the type of equipment to be used:
11. Explain the purpose of the proposed work: hUA/a9pj S-
i9FTW CZYv LAND Odin `J !:7`r n 7`o U12119 ji?R0. S AO A/
RIJ,Al /
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe pen-nits issued for prior segments of the same T.I.P. project, along with
construction schedules.
l
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.
IV/ It-
V1. 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. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must 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 Vill below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
TP PE- jZDOSIF&O &-)AJ Z:Z!K,-Al 42,60(Z?1)
1. Provide a written description of the proposed impacts: P,?OTECT ! /&RL Z_ 1A
2. Individually list wetland impacts below:
Wetland Impact
Site Number
(indicate on ntap)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(es/no) Distance to
Nearest Strcanm
(linear feet)
Type of Wetland***

I
V
l
o

* List each impact separately and identify temporary impacts. 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.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM). or FENIA-approved local Iloodplain neaps. Maps are available through the FLNIA Map Scnice Center at 1-800-358-96 16. or
online at i,nn „u,c i n ._,
*'* List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property:
Total area of wetland impact proposed:
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
(indicate on ma
Type of Impact* Len-Ith of
Impact
(linear feet)
Stream Name** Average Width
of Strcam
Before Irn act Perennial or
Intermittent?
(please secif
??1 Pr

List each impact separately and identity temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and atler, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditch ing/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
dowtsucam named ;urcanl into which it Ilomm . USGS maps are available through the USGS at 1-800-358 -9616. or online al
_. •._ , . Several Internet sites also ailoa direct download and printing of USGS map:
Cumulative impacts (linear distance in feet) to all streams on site:
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number
(indicate on ma)
Type of Impact* Area of
L ipact
(acres)
(if applicable) Name Watcrbody Type of Watcrbody
(lake, pond, estuary, sound,
bay, ocean, etc.)
o 72q2 az
LL G 6,9

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. 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.): 4i 4
/V /IF
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): Is
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.
TL STOP 6 O 5,40AI AA/OJ S /?/? iZE W Z&c
V111. Mitigation
DWQ - In accordance with 15A NCAC 211 .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.
Pare 9 of 12
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, 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 USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP 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
11t1wih2o.cnr."tate.11c.11 Smc%%c1 I:111ds/!'t nw!ldc.himl.
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at lltth:ih???.cnr.statc.nc.u?%??ri??in?lc?.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet)
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federaUstate) funds or the use of public
(federal/state) land?
Yes ? No
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 ?
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 ?
Y. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact rotcckd- riparian buffers identified within 15A NCAC 213 .0233
(Neuse), 15A NCAC ?I3 .0259 (Tar-Pamlic , 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or o er (please identify, )?
Yes P No ? if you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
zone* Impact

(square feet) Multiplier
Required
Miti,,ation
I ?Q 3
2 4060 rL 1.5
Total O
' Gone 1 cxtcnus out 3U teet perpcnarcular from near bank of channel; Lone 2 extends an
additional 20 feet from the edge of "Lone 1.
Page 1 I of 12
if buffer miti?tyation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
Y1. Stormwater (required by llWQ)
Describe impeivious acreage (both 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.
IN 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.
Ylll. Violations (required by llWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No P
Is this an after-the-fact permit application?
Yes ? No P
YIV. 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).
,//)7d
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Pa-c 12 of 12
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V,ETUJNR WATER U UT

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CENR - WATER QUALITY
1 TIP
rum tdA JUT -'10114 kt t l Ylnvs' lash sao.ue boil U s00k iY; - 1 m0 hUd. CS NO STORPXNATER BMICH'
Office Use Only:` Form Version May 2002
USACC Action 11) No. DWQ No.
any pnriicular item Is not applicable to this pro ect. please enter "Not Applicable" or '
i. Processing 310 'ki 1. Check all of the approval(s) requested for this projectaP"-
Section 404 Permit Riparian or Watershed Duffer Rules
Section 10 Permit ? Isolated Wetiand Permit from DWQ
401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested:. q-7TOU X40.
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 Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRI' prior to submittal of PCN), complete
section V111 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: []
11, Applicant 1tlformntlon
icant Information
Telephone Number: Fax Number: c
E-mail Address:
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
hunt bo nitachod If tho Agent has ®lgnatory authority for rho owner/applicant,)
Name:
Company dMillatlon:
Mailing Address:
'telephone Number: Fax Number:
N30 3 at 13
Ill. Project Information
Attach a vicinity ntap clearly showing the location of the property with respect to loca
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing proper(}
boundaries and development plans in relation to surrounding properties. Both the vicinity may
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 shoulc
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-' 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: it' )Mr
2. T.I.P. Project Number or State Project Number (NCDOT Only):1 0tr
3. Property Identification Number (Tax PIN): 3!:2,`37Qr0 4?i=3 >7
4. Location
County: 4 Nearest Town:
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.):
S. Site cnordinnics, if nvailnble (UTM or Lal/Long):
(Note - If project is linear, such as a roac?or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct watcrbody.)
fi. Property size C _ E --- - ..._-.__.M
7. Nearest body of water. (stream ever/ ound/ocean/lake):?"?/?
9. River Basin:, ?114, P
(Note - this must c one of North Carolina's seventeen designated major river basins, The
Rivvr linsin +nup is avulinbta at I+ltp://h2o.enr.stata.nc.us/udmin/tnups/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at thr tints o('this npplic+ttion: L'.L2Z .IS_.??--.L'?_.cL!
t'autt r or 1
iY? _ _Qit,rL?
10. Describe the overall project in detail,
ing the type of equipment to be used:
11. Explain the purpose of the proposed woric: T,r?
IV. Prior Project History
V.
If jurisdictional determinations and/or permits have been requested and/or obtained for th
project (including all prior phases of the same subdivision) in the past, please explain. Incluc
the USACC Action ID Number, DWQ Project Number, application date, and date permits ar
certifications were issued or withdrawn. Provide photocopies of previously issued permit
certifications or other useful information. Describe previously approved wetland, stream at
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT projec
list and describe permits issued for prior segments of the same T.I.P. project, along wii
construction schedules.
? ey&
Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated worl
and provido JuatIllcation far ilia oxclualon of Oda work from the currant 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 mapall impacts I
wetlands, open water, and stream channels associated with the project. The applicant must ah
provide justification for these Impacts in Section VII below. All proposed impacts, permanci
and temporary, must be listed herein, and must be clearly identifiable on an accompanying sit
plats. All wetlands and waters, and all streams (intermittent and perennial) must bo ahown on
delineation map, whether or not impacts are proposed to these systems. Wetland and streat
evaluation and delineation fonns should be included as appropriate. Photographs may E
included at the applicant's discretion. If this proposed impact is strictly for wetland or strew
mitigation, list and describe the impact in Section VIII below. If additional space Is needed fc
listing (it dcsctiptiau, pl=r- attach a -,cp ratC slmct.
Page 7 of 12
1. Provide a written description of the proposed impacts: j t CT S /4D C' E=
?-1?1f? f/?r?M PvS?o ?v
2. Individually list wetland impacts below:

Weiland Impact
Site Number
(Indicate n map)
Type of Impact* Area o
Impact
(acres) Located within
100-year Floodplain"
(yes/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland*

I

• List each impact separately end identity temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, ter.
excavation, flooding, ditching/drainage, ate. For dams, separately list impacts due to both structure and flooding.
•• 100-Year floodplains arc idcntifled through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Map
(FIRM), or FEMA-approved local floodplain maps. Maps cre available through the FEMA Map Service Center at 1-800.338.9616, o
online at liti://www.renia.ttov.
•+• List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond
Carolina Bay, bog, ate.) Indicate if wetland is isolated (dcterminetion of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property:
Total area of wetland impact proposed:
3. Individually list all intermittent and perennial stream impacts below:
W),
9trearn mpact
Site Number
(indicate on map)
Type of Impact* ennt t o
Impact
(linear feet)
Stream Name**
06 veraao Width
of Stream
Before Impact Perennial or
intermittent?
(please specif )
NJ/Pr

IA%I melt Impael s paralaly rind identify temporary impccu, lmpwcu Include, but ere not limited toe culverts Ana a socirlca rip-Mr,
dams (separately list Impacts duo to both structure rnd Eioodln3), rclocatlon (tncluda linear fat before and after, and net los3tgatn)
atnhilITA110n flolvilica (cement vvnli, rip•rep, crib well, g biona, ate,), czcnvation, ditchinT alralghicning, etc. If are-un relouttlon I
lirnliite4d, rylat+s Arid r?rui W Rhpwhrg thhe Ilnc»r ftratptir,t rip t »th the crl fllna) cad rate: stc:t ;tic=s must be Inaludcd.
Stream names can he found on USGS topographic maps. If a st=-m has no nnme, list r,s UT (unnamed tributary) to tha newrtui
downsiream named Riteam into which it flows, usaa mtps are available thmuah the IIS03 Gt I•Ilon•3?I1.9Ejirs, or unllpr s
www.uses.Aov. Several Internet sites also allow direct download and printing of USGS maps (e.g., www.topoWne.com
www.mapaucst.corni, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:-
pa,fo 0 of 11
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlar
Ocean and any other water of the U.S.) below:
Open Water Impact

Si(e Number

(indicate on trap) _

Type of Impact*
rea o
Area-of-
Impact
(acres)

Name of Waterbody

(if applicable)
Type of ater o y

(lake, pond, estuary, sound
bay, ocean, etc.)

-
6-P _
P /r
2- . UCy a C- Ls> r •?

tsl cac i impact separately an tdenu y temporary Impacts. Impacts Include, but are not limited to: fill, excavation, r g
flooding, drainage, bulkheads, etc.
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should
included above in the wetland and stream impact sections. Also, the proposed pond shot:
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands [] stream [J wetlanc
Describe the method of construction (e.g., dam/embankmcnt, excavation, installation
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pon
local stormwater requirement, etc.): ,_L
Size of watershed draining to pond: Expected pond surface area:
VII.
Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to ovoid the proposed impacts. It may be useful to provit
information related to site constraints sucfi as topography, building ordinances, accessibility, m
fltintteial viability of tho project. The applicant may attach drawings of altornatlve, lower-itnpa
site layouts, and explain why these design options were not feasible. Also discuss how impac
were minimized once the desired site plan was developed. If applicable, discuss constructic
techniques to be followed during construction to reduce impacts.
VIII. Mitigation
DWQ . In accordance with 15A NCAC 21.1 .0500, mitigation may be required by the Nt
Division of' Water Quality for projects involving greater than or equal to one acre of Impacts t
ft"lmmu w"'Al€tw% tit gleatef than w qu l to ISO linzr (W to total imlx:ctT% M Tvac"Mi
streams.
lle.1e 9 of 12
USACE - in accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, publishcd in the federal Register on March 9, 2000, 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 USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP 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
p: 1 o.enr.state.ne.us/ncwetlands/ trmgide.htm1.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., decd restrictions, conservation casement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed. ,
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to datermina availnbility and to rQqucat written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRI', cheek the NCWRP webslte at http://h2o.enr.state.nc.us/wrp/lndex.htlu If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following lnformation:
Amount of stream mitigation requested (linear feet):
Ammunt 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):
Gage 10 nF I J.

IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/s(ate) land?
Yes ? No
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 tile SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected_.riparian buffers identified within 15A NCAC 2B .0233
(Neuga), 15A NCA I3 20 59 (Tnr-P I " , 1 SA NCAC zD .0250 (Randleman' Rules and
Water Supply Buffer equlremen s , or other (please identify _ ____)?
Yes X- No [_] If you answered "yes", provide the following Information:
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.
olslol.=Zone•? (square feet) Multiplier Mitigation
Required'
-- - ?
.
3 w
Z r dCIU .? 1.5
Total
-A
/O CIDU ,
lone I extcn rout 30 feet perpendicular from near bank orctiannel; Zone 2 exlenth an
m(iilinnni 20 co rrom the edge or Zone 1.
NO I I of 12
% .A
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.
Is this site in violation of WQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes [] No
Is this an after-the-fact permit application?
Yes [] No [?\
Other Circumstances (Optional): I
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-dawn schedules for lakes, dates associated with Endangered and
Thrcntened Species, accessibility problems, or other issues outside of the applicant's control).
n) a-,,I)-..
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Duffer Restoration / Enhancement, Preservation or
payment into the liiparinn l3uffer Restoration Fund). please attach all appropriate information as
identified within 15A NCAC 213 .0242 or.0260.
X1. Storritvvater (required by DWQ)
Describe impervious acreage (both 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.
XI1. Sewage Disposal (required by DWQ)
XIII. Violations (required by DWQ)
XI V.

_ - )a -Vq
tJ Applicant/Agent's-Signature' Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 or 12
Triage Check List

Date: ? Project Name.
DwQ#: O ? / iI I /
County: /(/e?
To: ? ARO Kevin Barnett
? FRO Ken Averitte
? MRO Alan Johnson
RRO Mike Horan
From:
? WaRO Tom Steffens and Kyle Barnes
? WiRO Noelle Lutheran
? WSRO Daryl Lamb
Telephone : (919) 3 ?, " 5Gy'?>
The file attached is being forwarded to Your 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
uffer 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: (Alir

Ta-
L PcA,), oixLA?
?? /?A
FRO11 :Mason's Tile Service Inc
TO: Rob Riding
PagQS: 9
FAX 140. :2524462217
oq-711
AM
Dec. 06 2004 10:40AM P1
Q
DEC 0 6 2004
DEI R - WATER QUAUIY
V,a1WID3 NOSTQ?u+i;i?TERa'u O
From: Barry & Gloria Mason
Dato: December 6, 2004
Q Comments:
Fallowing are copies of the corrected application for the Bulkhead.
The one sent to you 11-24-04 had a check for $275.00 attached which I have
discovered is not required. The original application included a check for $200.00
which has been paid by my bank to you.
I will be stopping payment on the $275.00 check sent to you in error. Please
note to whomever it may concem that this was sent in error.
I would also tike to add : Michael Horan, Environmental Specialist with the
Raleigh Regional Office came over to help us complete the application with the
correct moasurements left off on the original. He has put the Buffcr Markers in
1laco.
Thank You For Any Help You May Give In Quick Processing Of This Application.
Gloria Mason
DEC-6-2004 HON 10:16 TEL:[phone] NAME:DI,1Q-WETLANDS
P.
1
FROM :Mason's T i l e Service Inc FAX [10. :2524462217
Dec. OS 2004 10:40AM P2
Office Use Only:
USAGE Action 10 No. _ _D_WQ No. I
- - - - (lf +rny particujar item is not applicable to this project, pica.9c enter
1. Processing
Fwm Ve sion May 2002
q_/ r) ( / -
ot Applicable" or "N/A".)
1. Check all of the approval(s) requested for this project:
Section 404 Pcrrnit Riparian or Watershed Buffer Rules
Section 10 Permit lsolated Wetland Permit from DWQ
401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested; Z C!J 9?i'(?D ?'Ct
3. if this notification is solely a courtesy copy because written approval for the 401 Certification
is not required. check here: V3
4. if payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section Vlll 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 Concert tree the top of page 2 for further details). check here: ?
11. Applicant information
Ownev lieant information
Name: ?1 l r .USE 1A
Mailing Address: ! r h_ 6-4
Telephone Number: -
E-mail Address: [
Fax Number.
Jd CT
!? G
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:
Telcphone Number:
E-mail Address:
Fax Number:
P•agc 5 of 12
DEC-6-2004 HON 10:17 TEL:[phone] HAME:DWQ-WETLAHDS P. 2
FROM :Mason's Tile Service Inc FAX 110. :2524462217 Dec. 06 2E04 10:40AM P3
Ill. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
So long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-sizc plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has bccn placed on hold until decipherable maps are provided.
1 _ Name of project:
2, T.I.P. Project Number or State Project Number (NCDQT /Ii4
3. Property ldentification Number (Tax PIN): ?9 317 6 da .5-6 / I
4. Location
County: AIAS# Nearest Town: ?C7CI CSC y 1 L/ j
Subdivision name (include phase/lot number).
Directions to site (include road numbers, landmarks, etc.):
5. Site coordinates, if available (UT111 or Lat/Long):
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): /, 13 ACR E5'
7. Nearest body of water (strca ,river' ound/ocean/lake): 4, R rz
8. River Basin: Z . 2) rep,
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at i_?:t
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time ofthis application:/ D Ir /S 2_ F_ _t3P,.ED 1,(21. i W ?/L)r _.CC 1NG
/ F5 /t3 CLVC_f -
Page 6 of] 2
GEC-6-2004 NON 10:17 TEL:[phone]
NAME: DWQ-WETLAIIDS P.i 3
FROM :11ason's Tile Service Inc FAX 110. :2524462217 Dec. 05 2004 10:41AM P4
10 Describe the overall project in detail, including the type of equipment to be used: 11. Explain the purpose of the proposed work:
_?
1V. 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. lncludc
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
V. Future Project Plans
Are any future permit requests unticipated for this project? If so, describe the anticipated work.
and provide justification for the exclusion of this work from the current application.
V1. 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 rnup all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must 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 Vill below. If additional space is needed for
listing or description, please attach it separate sheet.
Page 7 of 12
DEC-6-20014 MON 10:18 TEL:[phone] NAME:DWQ-WETLANDS P. 4

FROM :Mason's Tile Service Inc
1. Provide a written desc
FAX HO. :2524462217 Dac. 06 2004 10:41AII P5
of the proposed impacts: PRIME CE S &R e LINE
2, individually list wetland impacts below:
Wetland Impact
Site Number
(indicate on iris
Type of Impact* Arca of
Impact
(acres) Located within
100-year Floodplain"
eslno Distance to
N=st Stream Type of Wetlunds's
(linear feet)
I

T -List each impact separately and ideluify temporary impacts lmpacts include, but arc not lim:tcd to: mcchamaed clearing, grading, fill,
excavation, flonding, ditehing<'drainage, etc. Ford3rns, separately list impacts due In butte structure and f ood'inb.
100-Year floodplains rue identifial through the Federal Fruergency Mattagement Agency's (FEMA) Flood Insurance Rate Maps
tFIRh11. tic FEA1A-apptnied local Ilomlplain reap.. Map, arc Iva iLtblc through Qtc FCMA Mill Scoio? Center at 1-MYI-338.9616.or
online
*« List a wetland type that best &wribcs wetland to be in4tauted (e_G, frmhwatcdsaUwtrta marsh, forested wclland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wctland is isolated (dctcrmination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property:
Total area of wetland impact proposed:
3. individually Est all intermittent and perennial stream impacts below:
Stream linpact
Site Number
(indicate on ma) ._.
Type of Impact' Length of
Impact
(linear feet)
Stream Name" Averagu Width
of Stream
Before Impact Peremial or
Intcrmittzatt?
lease , cell'

1

tt Llil aaak ilrrnoi napu.ulalp DAA idMAkA,, ismp apavy imp itAa. 1rlpdbl! 111010' dJ, L l ,, ,. 1 l...a.,l 1... ,..L ,tom ?, nl oaou. luic.l JN-ruN,
dams (separately list impacts duc to both structure and flooding), relocation (include linear feet before and alter, and net loss'7jain),
stabilization activities (ccrumt wall, rip-rap, crib wall, gabicns, etc-), excavation, ditch irVstraightening, cic. It stream relocation is
proposed, plans and pmfilcs showing the linear footprint for boils the original and relocated streatus must be included,
k* stream names Can be tmild. an USGS topogr.phic reaps. If a strum has no name, list Qs UT (unnamed tributary) to the nearest
elm%m-trc-am o.mcd stream into trhich it (knts. USGS nlapc aiv available tluoulh 1110 USGS at I-Sf1u-3i8-VAIf? 01" onlinc al
Scscnl intcnict silo alas allow direct dcmid std and printing of USGS maps le r ,
Cumulative impacts (lineur distance in feet) to all streams on site:
Pape R of 12
DEC-6-2004 HON 10:18 TEL:[phone] NAME:DWO-I,JETLAhdDS
P.I S
FROM : rla son's T i l e Service Inc FAX 110. :2524462217 Dec. 05 2004 10: 42AN F6
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Area of Type of Waterbody
Open Water Impact * Name of Waterbody (lake, pond, estuary, sound,
Site Number Type of Impact Impact (if applicable) bay
oct an, etc.
(indicate on Wrap) (acres)
GC G ?.
cnr N l Lln
+ i.iht each impact separately and identify temPorsry impacts. Impacts include, but ate not Dnitcd to: till, excav:+tion, dred$inf,
flooding, dra nagc, bulkheads, rec.
5. 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/embanlanent, 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.): _ `r
Size of watershed draining to pond: ?xpccted pond surface area:
VIl. 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 desilm 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.

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 aerc of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
Page 9 of 12
GEC-6-2004 r101A 10:19 TEL:[phone] NAr1E:DWQ-WETLANDS
i
P. 6
FROM :Mason's Tile Eervice Inc FAX NO. :2524462217 Dec. 06 2CO4 10:42A11 P7

USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary. to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposcd 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 USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP 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
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation casement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
Av
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at ',;;r1 if use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet): I-
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):
Pagc 10 of 12
i
DEC-6-2004 HOH 10:19 TEL:[phone] NAME:DWQ-WETLANDS P. 7
FROM :Mason's Tile Service Inc
FAX N0. :2524462217 Dec. 06 2004 10:4:;Ah1 F8
LX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ? No r?l LfAJ
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 arc not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
if yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
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 V11 above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers trust 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.
Will the project impact rot ,tcd riparian buffers identified within 15A NCAC 213 .0233
(Neuse), 15A NCAC B .0259 (Tar-PamhiC? 15A NCAC 213 .0250 (Randleman Rules and
Water Supply Buffer Requirements), or o cr (please identify_)?
Yes W No ? if you answered "yes", provide the following information:
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.
Zones Impact
(square feet)
1 6 Q ?,1 s
2 , f
Total ?j
Muitipliea Required T
Miti atiun
3
1.5
Zone I extends out 30 eet pctpendcular fivm near bank of channel; Zone 2 extends an
additional 20 feet from the edge ofZone 1.
Page I 1 of 12
DEC-6-2004 MON 10:20 TEL:[phone] NAHE:DWQ-b1ETLANDS P:. 8
FROM :111ason' s Tile Service Inc
FAX 140. :2524462217 Dec. 06 2004 10:43Aht P9
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B.0242 or.0260.
M. Stortnivater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
do,ATutrcam from the properly.
Xll. 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.
A) 174
Yin. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes 0 No Ig
is this an after-the-fact permit application?
Yes ? No P
X[V. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Pagc 12 of 12
DEC-6-2004 110N 10:2220 TEL:[phone] NANE:DWQ-k1ETLANDS P. 9
?0F W ATFRQ 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
October 28, 2004
DWQ Project # 04-1711
Nash County
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
Barry W. & Gloria B. Mason
Post Office Box 61
Elm City, NC 27822
Subject Property: 6177 Williams Court, Rocky Mount, NC
REQUEST FOR MORE INFORMATION
Dear Mr. & Ms. Mason:
/? On October 22, 2004, the Division of Water Quality (DWQ) received your application to impact 0.004 acres of
A waters to construct the proposed bulkhead. The DWQ has determined that your application was incomplete and/or
provided inaccurate information as discussed below. The DWQ will require additional information in order to
process your application to impact protected wetlands and/or streams\on the subject property. Therefore, unless we
receive the additional information requested below, we will have to move toward denial of your application as
required by 15A NCAC 2H.0506 and will place this project on hold as,incomplete until we receive this additional
information. Please provide the following information so that we may continue to review your project.
Additional Information Requested:
1. Please complete Sections X, XI, XII and XIII on the application.
2. Please provide a signed copy of the application.
Please respond within three weeks of the date of this letter by sending this information to me in writing and Mike
Horan of the DWQ Raleigh Regional Office. If we do not hear from you within three weeks, we will assume that
you no longer want to pursue this project and we will consider the project as withdrawn.
This letter only addresses the application review and does not authorize any impacts to wetlands, waters or protected
buffers. Please be aware that any impacts requested within your application are not authorized (at this time) by the
DWQ. Please call Bob Zarzecki or Ms. Cyndi Karoly at 919-733-1786 if you have any questions regarding or
would like to set up a meeting to discuss this matter.
Sincerely,
G
Cyndi Karoly, Supervisor
401 Oversight Unit
CBK1bs
cc: Mike Horan, DWQ Raleigh Regional Office
USACE Raleigh Regulatory Field Office
File Copy
Central Files
Filename: 04-1711 Barry and Glrola Mason (Nash) On Bold
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] /Into met htt o://h 2o. en r. state.ne.us/ncwetlands
t Carolina
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Use Only:
OSACE Action 11) No.
(it any pnrt?a
1. Processing 11
DWQ Nop 4 .1 -11
to tills nroicct, p CE30 enter 'Nat Pp ca
Form Version May 2002
or
I. Check all of the approval(s) requested for this project:
[ Section 404 Permit ? Riparian or Watershed Duffer Rules
Section 10 Permit ? isolated Wetland Permit from DWQ
401 Water Quality Certification
2. Nationwide, Regional or Ocncral PermitNumbcr(s) Itequcsted:./.Cj,
3. If this notification is solely €i courtesy copy because written approval for tho 401 Certification
is not required, check here: ?
4. If payment into tho North Carolina Wetlands Restoration Program (NCWRP) is propoccd for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section V111 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 Notch Carolina Division of Coastal Management Area of
Environmental Concern (set: the top of pgc 2 for further details), check here: ?
11, Applicant Information
1. Owncr/A licant Info
Name:
Mailing AddrewL
't'elephone Number: Fax Number: ? -
E-mail Address:
2. Agent/Consultant Information (A sign--d and dated copy of the Agent Authorization letter
tnuat ha nitachcd if ilia Agent has ai¢natory authority for ilia owner/applicant,)
Name:
Camp M111latlon'.
Mailing Addre.?.s:
't'elephone Number: Fax Number:-
U'-mall Addreaa;.. ;

Ill. Project Information
Attach a vicinity ntap clearly showing the location of the property with respect to loca
landmarks such as towns, rivers, and roads. Also provide a detailed site plate showing propert}
boundaries and development plans in relation to surrounding properties. Both the vicinity mat
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 shoule
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
houndaries 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 j purposes, the
USACL requires information to be submitted on sheets no larger Wan 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:_ At .Ii?r
2. T.I.P. Project Number or State Project Number (NCDOT Only): (Y
3. Property Identification Number (Tax PIN):_ 3.7.370C`U Si3 Y7
4. Location
County: 4,?, H Nearest Town: Roo y- ,'t ouj-,. T
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.):
9.
5. Site cnordinatea, if available (UTM or Lat/Long):
(Note - if project is linear, such as a roadaor utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
f. Properly size (acre,s):.?
7. Nearest body of.water. (stream -v rt ound/ocean/iakc): 7-AiF j .1 V C ?.
River Basin:.;,(<?C?'
(Nate - this must a one of North Carolina's seventeen designated major river basins.
Itivor Ilasin inap Is uvailable at http://h2a.c nr.statt:.nc.us/admen/tnup ?/.)
The
Q. Describe the existing conditions on t6c site and general land use in the vicinity ,of the project
lit the lime of, this applientiow,(D
?S?icuc _
i)tiv (i or 1 ?
ill. Project Infor'rnation
:;
Attach a vicinity map clearly showing the location of the property with respect to loca
landmarks such as towns, rivers, and roads. Also provide a detailed site plarn showing propert}
boundaries and development plans in relation to surrounding properties. Both the vicinity mar
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` 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:_ 1O A-
2. T.I.P. Project Number or State Project Number (NCDOT Only): ?Lr
3. Property Identification Number (Tax PIN): 17 3`0(1) Sj3 J7
4. Location
?CX?y ,'t-IOCa? 7`
County: X41" A Nearest Town:
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.):
5. Site coordinntes, if nvailnble (UTM or Lat/Long):
(Note - If project is linear, such as a road?pr utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
(. Property size (acres):...J,-L1
7. Nenrest body of water (stream tom/ ound/ocean/luke): 7-PP, 9. Rivcr Basin%7_.- 114,sta-
(Note ._ this must be one of North Carolina's seventeen designated major river basins. The
RKcr Ilnuin trap Is uvullable at Iittp://h2o.cnr.state.ite.us/admin/tnups/.)
r?. Describe the existing conditions on t6c site and general land use in the vicinity of the project
Pont? c or 12
1 1. Explain the purpose of the proposed work: ??? 7-A Gf_?(i [?(?/?f'1•? s
0677L_?A/ /aAiLo -Mi2 Lt1AT?P Td L/0/Q El?ns,?/?.z? 24444
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for tk
project (including all prior phases of the same subdivision) in the past, please explain. Inclui
the USACC Action ID Number, DWQ Project Number, application date, and date permits as
certifications were issued or withdrawn. Provide photocopies of previously issued permii
certifications or other useful information. Describe previously approved wetland, stream ai
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT proje4
list and describe permits issued for prior segments of the same T.I.P. project, along wi
construction schedules.
V. Future Project Plans
Are any future permit requests anticipated for this project? If to, describe the anticipated wor
And provida juntil cation for tho oxoluslan of thla work mint tho ourrwst uppilontlan.
VI. Proposed Impacts to Waters of the United States/Waters of the State
it is the applicant's (or agent's) Wponsibility to determine, delineate and map all impacts
wetlands, open water, and stream channels associated with the project. The applicant must al;
provide justification for these impacts in Section VII below. All proposed impacts, permano
and temporary, must be listed herein, and must be clearly identifiable on an accompanyiog si
plan. All w©tlands and waters, and all streams (intermittent and perennial) must bo shown on
delineation map, whether or not Impacts are proposed to these systems. Wetland and strea
evaluation and delineation forms should be included as appropriate. Photographs may I
included at the applicant's discretion. If this proposed impact is strictly for wetland or strew
mitigation, list and describe the imp--ct In Section VIII below. If additional space is needed f
listiaLl car &SUIpticat?, p1=0 attcch a czPa o ftzt.
7 of 12
10. Describe the overall project in detail, including the type of equipment to be used:
1. Provide n written description of the proposed impacts:-LDPL) Tt CT e-:-
2. Individually list wetland impacts below:
Weiland Impact
Site Number
(indicate on map)
Type of impact* Area o
Impact
(acres) Located within
100-year Floodplain••
(yes/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland+i•

• List each impact separately and identify temporary impacts. Impacts include, but arc not limited to: mechanized clearing, grading, tit.
excavation, flooding, ditching/drainage, etc. For dams, scpzralely list impacts due to both structure and flooding.
100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Map
(FIRM), or FEMA-approved local floodplain mops. Maps cm available through the FEMA Map Service Centex at 1-800-338.9616, c
online at I)ttv://www.renia.gov.
••• List it wetland type that best describes wetland to be Impacted (e.g., freshwater/saltwater mush, forested wetland, beaver pond
Carolina Day, bog, ctc.) Indicate if wetland is Isolated (dactminction of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property:
'T'otal area of wetland impact proposed:
3. Individually list all intermittent and perennial stream impacts below:
Stream mnaet
Site Number
(indicate on map)
Type of Impact* enat t a
Impact
(linear feet)
Stream Name••
t o varaaa Width
of Stream
Before Impact Perennial or
Intermittent?

)
(please "cif

• List melt Impact scpnratcly and Identiry Icmporcry im NcU. imp: cU Incluotn but tat not Innitea to, cuivens and efsoa»ica rip-rap
dams (separately fist Impacts due to both structure cndAoodin3), relocation (include linear feet berare cnd after, cnd net lovVgaln)
atnhilirrillan nNivitlcit (cement wall, rip-rap, crib wall, gtbiona, ctc.), cxcavation, ditchinahlralghtcning, ctc. If stream rolocztlon i
lmiptwd, plans Rntl ptulil,4 drawing the linear fhalprlnl Iu t cth tha eilainal end ral"mcd arc==s must be lnaluded.
•" Strcnm nnmcs can he found on USGS topographic =pz. Iris strewn hta no name, lint ra UT (unnamed tributary) to tho nczvoi
downeircarn named sttcam Into which it flown. tism mtris era nvallchle thmugh the lvma at 1.8AA•3Jil•irditi, ar unlrna a
www.usrs.ttov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.tono1nne.Rom
www,mrPaucst.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:,
N'r,43 0 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atla;
• Ocean and any other water of the U.S.) below:
Open Wntcr Impact
Site Number

(indicate on map)
Type of Impact* Area of
Impact

(acres)
Name

Watc)
of ody
(if applicable ) Typc of ater o y

(take, pond, estuary, souni
bay, ocean, etc.)
i
TAe CP

?st tae ? impact separately an ? ent? y tcrnporary impacts. Impacts Inc u e, but are not m led to: fill, excaval on, r g
flooding, drainage, bulkheads, etc.
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should
included above in the wetland and stream impact sections. Also, the proposed pond shot
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): C] uplands 0 stream [) wetlam
Describe the method of construction (e.g., darn/cmbankment, excavation, installation
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pot
local stormwater requirement, etc.): ,
Size of watershed draining to pond:.-. Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to ovoid the proposed impacts. It may be useful to provil
information related to site constraints sucft as topography, building ordinances, accessibility, w
financial vinbility of tho project. Tho applicant may attach drnwingo of altornativo, lowor-linpa
site layouts, and explain why these design options were not feasible. Also discuss how impac
were minimized once the desired site plan was developed. If applicable, discuss constructit
technique3 to be followed during construction to reduce impacts.
G
V111. Mitigation
DWQ - In accordance with 15A NCAC 2FI .0500, mitigation may be required by tho N
Dlvislon of Water Quality for projects involving greater than or equal to one acrd of itnpacta
Ctie,Imata WWavida ov tI've-M f ilrm P,1 rqum.i to 159 Mic za ft.t d total imir.ttR to ?.
streams.
PC-a. 9 of 12
USACI - In accordance with the Final Notice of Issuance and Modification of Nationwide
11ei:mits, published in the Fedcral Register on March 9, 2000, 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 NCWRP 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 'T'echnical Guide for Stream Work in North Carolina, available at
littp:Hli2o.enr.state.nc.us/ncwetlands/s(rLnaide.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
4
2. Mitigation may also be trade by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to dotermina availability and to roquout written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NUWlU1, check the NCWRP website at litlp://h2o.enr.state.ne.us/wrp/Index.htJLJ If use of
the NCWRi' is proposed, please check the appropriate box on page three and provide the
following Information:
Amount of stream mitigation requested (linear feet):__
Amount of buffer mitigation requested (square feet);_?T
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
1lnlomit (if Coastal wetland mitigation requested (acres),___
ha4e 10 nr IJ.
IX. Environmental Documentntion (required by DWQ)
Does the project involve an expenditure of pU-
Yes b1? (federal/slate) funds or the use of public
(federal/slate) land? ? No M,
If yes, does the project require prepr tion CPyan environmental document pursuant to the
requirements of the. National or No?th Carplina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whet[Fr a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes [] No ?
If yes, has the document review been finalized by the State Clearinghouse? tf so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed Impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the,
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 213 .0233
(Ncuao), 15A NCAC 213 .0259 (Tar-Pamlico), I SA NCAC 213 .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify _ ?
Yes ? No ? If you answered "yes", provide the following lnlbrmation:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
'^ . Zone* (squa c¢feet) Multiplier Mitigation
I 3
2 1.5
Total ,
i - ' .one 1 exicnda out 30 feet perpendicular From near bank or channel; Zone 2 extends nn
nddilinnat Zo feet frnrn the edge of Zone t.
Faas I I of 12
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
r l;nyment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stornnwater (required by DWQ)
Describe impervious acreage (both 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.
XI1. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 211.0500) or any Buffer Rules?
Yes ? No ?
Is this an after-the-fact permit application?
Yes ? No ?
XIV. Other Circumstances (Optional): 16
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time fbr 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 Spccics, accessibility problems, or other issues outside of the applicant's control).
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Pago 12 of 12
DWQ# CL" tl 11 Date 10/?I'Zb L/ Who Reviewed: QZ
Plan Detail Incomplete
? Please provide a location map for the project.
? Please show all stream impacts including all fill slopes, dissipaters, and bank stabilization on the site plan.
? Please show all wetland impacts including fill slopes.on the site plan.
? Please indicate all buffer impacts on the site plan.
? Please indicate proposed lot layout as overlays on the site plan.
? Please indicate the location of the protected buffers as overlays on the site plan.
? Please locate all isolated or non-isolated wetlands, streams and other waters of the State as overlays on the site plan.
? Please provide cross section details showing the provisions for aquatic life passage. -
? Please locate any planned sewer lines on the site plan.
? Please provide the location of any proposed stormwater management practices as required by GC
? Please provide detail for the stormwater management practices as required by GC
? Please specify the percent of project imperviousness area based on the estimated built-out conditions.
? Please indicate all stormwater outfalls on the site plan.
? Please indicate the diffuse flow provision measures on the site plan.
? Please indicate whether or not the proposed impacts already been conducted. 2
Avoidance and/or Ivliriimization Not Provided
? The labeled as on the plans does not appear to be necessary. Please eliminate the or provide a0ditiooal
information as to why it is necessary for this project.
? This Office believes that the labeled on the plans as can be moved or reconfigured to avoid the impacts to the
. . Please revise the plans to avoid the impacts.
? This Office believes that the labeled on the plans as can be moved or reconfigured to minimize the impacts to the
Please revise the plans to minimize the impacts.
? The stormwater discharges at the location on the plans labeled will not provide diffuse flow through the buffer because
Please revise the plans and provide calculations to show that diffuse flow will be achieved through the entire buffer. If it
is not possible to achieve diffuse flow through the entire buffer then it may be necessary to provide stormwater management
practices that remove nutrients before the stormwater can be discharged through the buffer.
Other
? The application fee was insufficient because over 150 feet of stream and/or over 1 acre of wetland impacts were requested. Please
provide $ . This additional fee must be received before your application can be reviewed.
Please complete Section(s) n the app it ca on.t X It I X111
Please provide a signed copy of the application.
? Please provide copies of the application, copies of the site plans and other supporting information.
N ltigation
? of compensatory mitigation is required for this project. 'Please provide a compensatory mitigation plan. The
plan must conform to the requirements in 15 A NCAC 2H.0500 and must be appropriate to the type of impacts proposed.
? Please indicate which 404 Permit the USACE would use to authorize this project.
v Complete ite`ns 1 2 and 3 Also complete A. Signature
item 4 if Restricted Delivery is desired.
0 Print your name and address on the reverse
so that we can return the card to you.
0 Attach this card to the back of the mailpiece,
or on the front if space permits.
Article Addressed to:
Barry W. & Gloria B. Mason
Post Office Box 61
Elm City, NC 27822
DWQ# 04-1711 - Nash
? Agent
? Addressee
B. Received by (Printed Name) C. Date of Delivery
D. Is delivery address different from item 0 ? Yes
If YES, enter delivery address below: ? No
3. Service Type
jq Certified Mail ? Express Mail
? Registered P Return Receipt for Merchandise
? Insured Mail ? C.O.D.
4. Restricted Delivery? (Extra Fee) ? Yes
2. Article Number 7004 1160 0002 2706 6431
(Transfer from service label)
PS Form 3811, February 2004 Domestic Return Receipt
UNITED STATES POSTAL SERVIC,LY `
First-Class Mail..
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print youLDame, address, and ZIP+4 In this box •
NC DENR Division of Water Quality
401 Oversight Unit
2321 Crabtree Boulevard, Suite 250
Raleigh, NC 27604
rl 1 if i?flllt3lIillfllifllltIll IIIll III IIll tifIf IIfill IIII MIN II