20050277 Ver 1_Complete File_20050214

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Certificate of Completion

DWQ Project No.:

US -02.17

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County:

~JA--KS

Applicant:

Project Name:

Date of Issuance of 401 Water Quality Certification:

Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules, and any
subsequent modifications, the applicant is required to return this certificate to the 401/Wetlands Unit, North
Carolina Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650. This form may be
returned to DWQ by the applicant, the applicant's authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.

Applicant's Certification

I, I(A,ze-cJ N, C L/V:.. K . , hereby st~~~\that, to the best of my abilities, due care and
diligence was used in the observation of the construction such'tI111t the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.

Signature: ~~{Su\\.... Qj, d-'0'_

Date:

If"" -'
'1 - J 0 - O~

Agent's Certification

I, , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.

Signature:

Date:

~~~~uwm@

MAY 3 ' 2005

If this project was designed by a Certified Professional

\\ DENR - WATER QUALITY
ETU.Nos NJD STORM'r"ATER BRAF:.:'!
I, , as a duly registered Professional (i.e.,
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized to
observe (periodically, weekly, full time) the construction of the project, for the Pennittee hereby state that,
to the best of my abilities, due care and diligence was used in the observation of the construction such that
the construction was observed to be built within substan4al compliance and intent of the 401 Water Quality.
Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.

Signature:

Registration No.:

Date:

Michael F. Easlcy, Governor

William G. Ross Jr., Sccrctary
North Carolina Department of Environment and Natural Resources

Alan W. Klimek, P.E. Director
Division of Water Quality

February 25,2005

DWQ Project # 05-0277
County: Wake

Karen Nielsen Clark
6221 Garrett Road
Raleigh, NC 27606

Subject Property:

939 Ralph Drive, Cary, NC 27511
Lynn Branch [03-04-02, 27-43-3, WS-III, NSW]

APPROVAL of Neuse River Buffer Rule (15A NCAC 02B .0233) Authorization Certificate

Dear Ms Clark:

You have our approval, in accordance with 15A NCAC 02B .0233 and any conditions listed below, to
impact approximately 1,710 ft2 of Zone 1 and 1,100 fe of Zone 2 of the protected riparian buffers for the
purpose of stabilizing the banks of stream with jute matting and vegetation at the subject property as
described within your application dated February 13,2005. 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.

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 authorization and approval letter and is thereby responsible
for complying with all conditions. This approval requires you to follow the conditions listed below.

The Additional Conditions of the Certification are:

1. Impacts Approved

The following impacts are hereby approved as long as all of the other specific and general
conditions of this Certification (or Isolated Wetland Permit) are met. No other impacts are
approved including incidental impacts:

Buffers

Plan Location or Reference

2. Diffuse Flow

An additional condition is that all stormwater shall be directed as diffuse flow at non-erosive
velocities through the protected stream buffers and will not re-concentrate before discharging into
the stream as identified within 15A NCAC 2B .0233(5).

N~~carolina
IValllrall!/

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]/lnlernet: htto://h2oenr.state.nc.us/ncwetlands

An Equal Opportunity/Affirmative Action Employer - 50% Recycled/l0% Post Consumer Paper

Karen Nielsen Clark
Page 2 of2
2/25/05:

3. Certificate of Completion

Upon completion of all work approved within this authorization, 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.

Any disputes over determinations regarding this Authorization Certificate (associated with the approved
buffer impacts) shall be referred in writing to the Director for a decision. The Director's decision is
subject to review as provided in Articles 3 and 4 of G.S. 150B. This Authorization Certificate shall
expire five (5) years from the date of this letter.

This letter completes the review of the "No Practical Alternatives" determination under 15A NCAC 2B
.0233. If you have any questions or would like a copy of the buffer rules, please call [phone].
This letter does not authorize any impacts to either Waters of the United States or Waters of the State.
Please contact the US Army Corps of Engineers (USACE) or NC Division of Water Quality (DWQ) if
any impacts are proposed to either of these waters.

Sincerely,

0c~1{~

Alan W. Klimek, P .E.

AWKldae

Enclosures:

Certificate of Completion

cc: Eric Kulz, DWQ Raleigh Regional Office
DLR Raleigh Regional Office
File Copy
Central Files

Filename: 050277KarenClark(Wake)buffer only

~[g@[gDW[g~

FEB 1 4 Z005

WETlANDS NjD STORM....ATER BAAllCH

Office Use Only:

Form V crsion May 2002

USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/ A".)

I. Processing

~

1. Check all of the approval(s) requested for this project:
D Section 404 Permit '0
D Section 10 Permit 0
D 401 Water Quality Certification

2. Nationwide, Regional or General Permit Number(s) Requested: AJJ tA-

Riparian or Watershed Buffer Rules
Isolated Wetland Permit from DWQ

3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: D

4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts (verify availability with NCEEP prior to submittal of PCN),
complete section VIII and check here: D

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: 0

Applicant Information

1. Owner/Applicant Information
'/ ., "\ , I 1
Name:"" ,','-_.t> ,v ':~J -; ~,L. ~ ~, N
Mailing Address: it: 7. 7 I 0 /\ ,'~ ~ (~
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Telephone Number: \lii h) ~ 0";'- {7~~Lt. Fax Number:
E-mail Address:

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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:

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
US ACE 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: /(:.(-1 (1)1..~ ('/c{..,-,,! €? 9] 'I J(;.1I('-1/))-.
I
. I", ", \. .

, 2.', T.I.P. Project Number, NCMA or State Project Number (NCDOT Only): i\.) / \4- . / .
~ Property Identification Number (Tax PIN): 0 '1 LJ. H '( S / '7 ,3 C{J-;-)

4.

(r)u

5. Site coordinates, if available (Lat/Long; D/M/S format): N I \~
(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.)

.v;

Property size (acres):

().t\ll

7. Nearest body of water (streamlriver/sound/ocean/lake):

8. River Basin: \'-) ~k\ ~
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h20.enr.state.nc.us/admin/maps/.)

9. Describe the existing conditions on the site and
at the time pf this application: ,-' t ~ j"'}
OCt l~c) ! ~~rl \ ~/J 'h) 5/1.,

Page 6 of 12

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-'Jt.;t; (1 / p ,) () 5 I~"?v

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IV.

Prior Project History

./ .:

If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and.
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
, constructi?n scl;edyles.. , ,1.} .
.'). ( C' ck /) fJ") iX:- u;, 1"-

V.

Future Project Plans

Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.

VI. Proposed Impacts to Waters of the United StateslWaters 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 VIII below. If additional space is needed for
listing or description, please attach a separate sheet.

Page 7 of 12

1. Provide a written description of the proposed impacts:--1lj \A-

2. Individually list wetland impacts below:

Wetland Impact Area of Located within Distance to
Site Number Type of Impact* Impact 100-year F1oodplain** Nearest Stream Type ofWetland***
(indicate on map) (acres) (yes/no) (linear feet)

*

List each impact'separately and identify temporary impacts. Impacts include, but arc 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 FEMA-approvcd local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
onlinc at httD://www.fema.gov.
List a wetland type that best dcscribes wctland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolatcd (dctermination of isolation to be made by USACE only).

**

***

List the total acreage (estimated) of all existing wetlands on the property: )V II/t-
Total area of wetland impact proposed: J'l,l V-\-

3. Individually list all intermittent and perennial stream impacts below:

Stream Impact Length of Average Width Perennial or
Site Number Type of Impact* Impact Stream Name** of Stream Intermittent?
(indicate on map) (linear feet) Before Impact (please specify)

List each impact separately and identify tcmporary impacts. Impacts include, but arc not limited to: culvcrts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear fcet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, ctc. If stream relocation is
proposed, plans and profiles showing the Iincar footprint for both the original and relocatcd 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 thc nearest
downstream named strcam into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
wWW.lISf!S.l!OY. Several internet sites also allow direct download and printing of USGS maps (e.g., WWW.toDozone.com,
www.mapqllest.com. etc.).

*

Cumulative impacts (linear distance in feet) to all streams on site: N) \A-

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 Area of Name of Water body Type of Waterbody
Site Number Type of Impact* Impact (if applicable) (lake, pond, estuary, sound,
(indicate on map) (acres) bay, ocean, etc.)

* List caeh impact separatcly and idcntify temporary impacts. Impacts include, but arc not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, ctc.

5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included al)ove 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): D uplands 0 stream 0 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 stormwatcr requirement, etc.):

Size of watershed draining to pond:

Expected pond surface area:

VII. Impact Justification (A voidance and Minimization)

Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options wcre not feasiblc. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to b~lo.l1o\;Ved durin. g construction to ~e. due,e impacts.
'. J) L ).\A.-k'/~f /tJ. '\ '/a--a /).;t/r"3;4)..... I~ /~iJ1(-
, .) ~

VIII. Mitigation

DWQ - In accordance with 15A NCAC 2H .0500, mItIgation may be rcquired 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

US ACE - 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 US ACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
http://h20.enr.state. nc. us/ncwetl ands/ strm gi de. h till l.

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 seNafe~eet if more space is needed.

2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCEEP, check the NCEEP website at http://www.nceep.net. If use of the NCWRP is
proposed, please check the appropriate box on page three and provide the following
informati on:

Amount of stream mitigation requested (linear feet): 0
Amount of buffer mitigation requested (square feet): ~
Amount of Riparian wetland mitigation requested (acres): C::I
Amount of Non-riparian wetland mitigation requested (acres): a
Amount of Coastal wetland mitigation requested (acres): CJ

Page 10 of 12

IX. Environmental Documentation (required by DWQ)

Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land? No (v(
Yes D r\

If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPAlSEPA)?
Note: If you are not sure whether a NEPAlSEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes D No 0

If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEP A or SEP A final approval letter.
Yes 0 No D

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
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify f\.) ~ 9. \. "JL )?
Yes ~ No 0 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 Multiplier Required
(square feet /acres) Mitigation
1 \ I I D .ft to- 3
2 \ \ ~ CJ .ft 2. 1.5
Total 2 c:; \ ~ -ft "to-

*

Zone I extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.

Page 11 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 / Enhancemcnt, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or .0260.

XI. Stormwater (required by DWQ)

Describe impervious acreage (both eXIstmg and proposcd) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstrram from the property.
l'-..)Lh-
I

XII. Sewage Disposal (required by DWQ)

" ~ I. .

Clearly detail thc ultimate treatment mcthods and disposition (non-discharge or discharge) of
was~tl~enerated from the proposed project, or available capacity of thc subject facility.

,

XIII. Violations (required by DWQ)

Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes !Xl No D

Is this an aftcr-the-fact permit application?
Ycs){L No D

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 Endangcred and
Threatened Species, acccssibility problems, or other issucs outsidc of the applicant's control).

- .

'b ~ ;:.,I\l~'\,~u...;, ''2,0 0 !;-
Applicant/Agent's Signature / Date
(Agent's signature is valid only if an authorization letter from thc applicant is provided.)

Page 12 of 12

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FE8 1 4 2005

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Office Use Only:

W8t%~: :.Nb~~~ORIAWi\1ER BRAllCH

Form Version May 2002

USACE Action ID No. D\VQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/ A".)

I. Processing

1. Check all of the approval(s) requested for this project:
D Section 404 Permit "0
D Section 10 Permit D
D 401 Water Quality Certification

2. Nationwide, Regional or General Permit Number(s) Requested: !\JJ t4-

Riparian or Watershed Buffer Rules
Isolated Wetland Permit from DWQ

3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: D

. 4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts (verify availability with NCEEP prior to submittal of PCN),
complete section vrn and check here: D

~

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: D

Applicant Information

1. Owner/Applicant In o,~agon
Name: . r\:.,-'G.. ,'0
Mailing Address: l

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:

Telephone Number:
E-mail Address:

Fax Number:

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
US ACE 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. Nameofproject: ,f:.U1Aht...- ('IJ @ 9J9 I(~~ l)r.

"'; ".'," " f

. 7T.I,P, Project Number, NCMA or State Project No~ber (NCDOT Only): \\1114- " . '.,
../3. Property IdentIfIcatIOn Number (Tax PIN): 0 1 t,;..?, Il 1 5 I '7 /3 OOl)

."; !'

4.

5. Site coordinates, if available (Lat/Long; D/M/S format): N I ~IT
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
/ coordinates for each crossing o~ a distinct waterbody.)

I~ 6. Property size (acres): 0 . t\(t

7. Nearest body of water (streamJriver/sound/oceanllake):

8. River Basin: ~\ ~^/\ Sr<--
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h20.enr.state.nc.us/admin/maps/.)

9.

Page 6 of 12

11. Ex p1aiV th~urpose of the Y"::lSed work: t! ",1:, J /1 ~ A () :iJ ~-... - i<lfJsluij ,,J.
~iM1!{ ~ 'j1Jnfldl.,~ "k e e,

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, .'
I . I ;.. . 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
. constructi?~edAles. '1 . Ji )k' '-i. . ~

~~~~~~ ~,/;f~:!t' If}: j:,:, :r;;:::'~ ~~ :71~ :J ~':tD~
L__ _ _ t! .i.11l!."-IJ fry 12 ~ /YYlI tho '{S
. - I
V. Future Project Plans

Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.

VI. Proposed Impacts to Waters of the United StateslWaters 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 VIII below. If additional space is needed for
listing or description, please attach a separate sheet.

Page 7 of 12

1. Provide a written description of the proposed impacts:~ \-Pr-

2. Individually list wetland impacts below:

Wetland Impact Area of Located within Distance to
Site Number Type of Impact* Impact lOO-year Floodplain** Nearest Stream Type ofWetland***
(indicate on map) (acres) (yes/no) (linear feet)
'. , --c- '.

,.. .' List each impact' separately and identify temporary impacts. Impacts include, but are not limitcd to: mechanized c1caring, grading, fill;
excavatlon;flooding, ditching/drainagc, ctc. For dams, separatcly list impacts due to both structure and flooding,
** 100-Year floodplains arc identified through the Fedcral Emcrgency Managemcnt Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through thc FEMA Map Service Center at 1-800-358-9616, or
online at http://www.fema.gov.
,..,..,.. List a wetland type that bcst dcscribcs wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolatcd (determination of isolation to be madc by USACE only).

List the total acreage (estimated) of all existing wetlands on the property: 'tV 11/1-
Total area of wetland impact proposed: 1'1! {-\;- .

3. Individually list all intermittent and perennial stream impacts below: .

Stream Impact Length of A verage Width Perennial or
Site Number Type of Impact* Impact Stream Name** of Stream Intermittcnt?
(indicate on map) (linear feet) Before Impact (please specify)

,.. List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associatcd rip-rap,
dams (separately list impacts due to both structurc and flooding), rclocation (include linear feet bcforc and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, ctc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both thc original and relocated streams must bc included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named strcam into which it flows. USGS maps arc available through the USGS at 1-800-358-9616, or online at
wWW.USgS.gov. Several internct sites also allow direct download and printing of USGS maps (c.g., WWW.topozone.eom,
www.mapqucst.com. etc.).

Cumulative impacts (linear distance in feet) to all streams on site: N) \IT-

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 Area of Name of Water body Type of Water body
Site Number Type of Impact* Impact (if applicable) (lake, pond, estuary, sound.
(indicate on map) (acres) bay, ocean, etc.)

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavatIon, dredgmg,
flooding, drainage, bulkheads, etc.

5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
inc~u,ded a1?ove 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): 0 uplands 0 stream 0 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.):

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
te~hniques to b~fo lo~ced du 'ng co struction to ~duc:.e imp~cts.
I ~, . ~ ~ A ~

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 NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical' Guide for Stream Work in North Carolina, available at
h up:/ Ih2o.enr. state. nc. us/ncwetlands/strm gi de.h tml.

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 seNal~eet if more space is needed.

2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCEEP, check the NCEEP web site at http://www.nceep.net. 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): 0
Amount of buffer mitigation requested (square feet): ~
Amount of Riparian wetland mitigation requested (acres): ~
Amount of Non-riparian wetland mitigation requested (acres): C)
Amount of Coastal wetland mitigation requested (acres): CJ

Page 10 of 12

IX. Environmental Documentation (required by DWQ)

Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land? rvr
Yes 0 No R

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 NEP A/SEP A document is required, call the SEP A
coordinator at [phone] to review current thresholds for environmental documentation.
Yes 0 No 0

If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEP A or SEP A final approval letter.
Yes 0 No 0

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 prpject. The applicant must also provide
justification for these impacts in Section vn 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
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water SuppllJuffer Requirements), or other (please identify ,,) l? 9. ^ <;JL )?
Yes iii No 0 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 Multiplier Required
(square feet /acres) Mitigation
1 \ I I D .f-t ~ 3
2 \ \ ~ u ft z. 1.5
Total 2 ~ \ ~ -+1:- "t-

*

Zonc I extcnds out 30 fcet perpendicular from near bank of channel; Zonc 2 extends an
additionaI20 feet from the edgc of Zone 1.

Page 11 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 information as
identified within 15A NCAC 2B .0242 or .0260.

XI. 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
dow~ti~rom the property.

I

XII. Sewage Disposal (required by DWQ)

'. ~ I' .

. .:

Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
=;;r!~nerated 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 2H .0500) or any Buffer Rules?
. Yes ~ No D

Is this an after-the-fact permit application?
Yes)(L NoD

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).

'~D J;-
Applicant/Agent's Signature / Date
(Agent's signature is valid only if an authorization letter from the applidtlnt is provided.)

Page 12 of 12

'70 \? 0 i e I()

I J..o '5 ~ h~ ~;t

:~
q,
..1?0o
l-
'"
,-1
-
t;)
~ N
-::t ~
~ '^
~
<V .......,...
.~ (V
.q ~
-t (i)

III. Project Information

"
r# ,. ,: ~ ...

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 infonned that
the project has been placed on hold until decipherable maps are provided.

1. Name of project: ,f:vu~ ('1J @ 93 C; If.~~ Dr,

" }T.I.P. Project Number, NCMA or State Project Number (NCD~T Only): \J 114- . ,
/'3. Property IdentIfIcatIOn Number (Tax PIN): 0 1 L.:$. 1\ 1 'J I '7 /3 ooD

. c.; I"

4.

5. Site coordinates, if available (Lat/Long; D/MIS format): N I ~f.t
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
/ coordinates for each crossing o~ a distinct waterbody.)

IV 6. Property size (acres): () "t\(t
'--.

7. Nearest body of water (streamlriver/sound/oceanllake):

8. River Basin: \,-l-ec\ ~
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h20.enr.state.nc.us/admin/maps/.)

9.

Page 6 of 12

11. Explai~ the purpose ofthe l'r,::sed work: t ~ t 1/ fA 0 :>'Ih.
IJ M1!{ d.. 7?11J (jlJd l.~ Jj e e,

iJ)lJd,u "J.

IV.

Prior Project History

. J ~

If jurisdictional detenninations and/or pennits have been requested and/or obtained for this
project (including all prior phases of the samc subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date pennits and
certifications were issued or withdrawn. Provide photocopies of previously issued pennits,
;..' 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 pennits issued for prior segments of the same T.I.P. project, along with
construction sCQedyles. ;p ~ ~

7jf,u:,;;~~ j,,;;):1-j~:II!.I:;:/:rt::::/~t::.;~~ /:1 C;/J::/'i
jJ/JrJA. fJtl.e~1t{,0 -t1-J f2"M11'fh'ns 8'
Future Project Plans

V.

Are any future pennit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.

VI. Proposed Impacts to Waters of the United StateslWaters of the State

It is the applicant's (or agent's) responsibility to detennine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. Thc 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 (intennittent 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

1. Provide a written description of the proposed impacts:~l \A-

2. Individually list wetland impacts below:

Wetland Impact Area of Located within Distance to
Site Number Type of Impact* Impact 100-year Floodplain** Nearest Stream Type ofWetIand***
(indicate on map) (acres) (yes/no) (linear feet)
. '.

*. List 'each impact'separately and identify temporary impacts. Impacts includc, but arc not lmutcd to: meehanlzcd c1earmg, gradmg, fill;.
excavation: flooding, ditchihg/drainage, etc. For dams, separatcly list impacts due to both structurc and flooding, .'
** 100-Year floodplains are identified through the Federal Emcrgency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approvcd local floodplain maps. Maps are available through the FEMA Map Service Centcr at 1-800-358-9616, or
onlinc at http://www.fema.gov.
*** List a wctland type that best dcscribes wctland to be impactcd (e.g., freshwater/saltwater marsh, forcsted wctland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wctland is isolated (dctermination of isolation to be made by USACE only).

List the total acreage (estimated) of all existing wetlands on the property:jV J tPt-
Total area of wetland impact proposed: 1'1 l A:-

3. Individually list all intermittent and perennial stream impacts below:

Stream Impact Length of Average Width Perennial or
Site Number Type of Impact* Impact Stream Name** of Stream Intermittent?
(indicate on map) (linear feet) Before Impact (please specify)

List each impact separately and identify temporary impacts. Impacts include, but are not limitcd to: culverts and associated rip-rap,
dams (separately list impacts due to both structurc and flooding), relocation (include linear fect bcforc and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposcd, plans and profilcs showing the lincar footprint for both the original and relocatcd strcams must be includcd.
** Stream names can bc found on USGS topographic maps. If a strcam has no namc, list as UT (unnamed tributary) to the ncarest
downstream named stream into which it flows. USGS maps are available through thc USGS at 1-800-358-9616, or online at
wWW.USgS.gov. Several internet sites also allow direct download and printing of USGS maps (c. g., WWW.topozonc.com,
www.mapquest.com. etc.).

Cumulative impacts (linear distance in feet) to all streams on site: N) \iT

*

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 Area of Name of Water body Type of Water body
Site Number Type of Impact* Impact (if applicable) (lake, pond, estuary, sound,
(indicate on map) (acres) bay, ocean, etc.)

* 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 al;>ove in the wetland and stream impact sections. Also, the proposed pond should
be described hen~ and illustrated on any maps included with this application. ; .
Pond to be created in (check all that apply): D uplands D stream 0 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.):

Size of watershed draining to pond:

Expected pond surface area:

VII. Impact Justification (A voidance and Minimization)

Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. 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 b7Jfo lowe du 'ng co struction to ~duq,e imp~cts. /J J
I ,,""-k'..- J . Jr;~ -:h, ~ e () '~e

VIII. Mitigation

DWQ - In accordance with 15A NCAC 2H .0500, Ill1tlgation 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 NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical" Guide for Stream Work in North Carolina, available at
http://h20.enr.state.nc.us/ncwetlands/strmgide.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
~ale~eet if more space is needed.

2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCEEP, check the NCEEP website at http://www.nceep.net. 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): C:-i
Amount of Non-riparian wetland mitigation requested (acres): a
Amount of Coastal wetland mitigation requested (acres): CJ

Page 10 of 12

IX. Environmental Documentation (required by DWQ)

Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land? (V(
Yes D No R

If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPAfSEPA)?
Note: If you are not sure whether a NEP AfSEP A document is required, call the SEP A
coordinator at [phone] to review current thresholds for environmental documentation.
Yes D No D

If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEP A or SEP A final approval letter.
Yes D No D

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 prpject. 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
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Suppltluffer Requirements), or other (please identify N (? ~ ^ V- )?
Yes ~ No D 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 Multiplier Required
(square feet /acres) Mitigation
1 \ I I D .f'-t t.- 3
2 \ \ ~ CJ .ft 'Z. 1.5
Total 2 <:J , ~ -ft "to-

*

Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.

Page 11 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 information as
identified within 15A NCAC 2B .0242 or .0260.

XI. 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
dow~~ti~rom the property.

I

XII. Sewage Disposal (required by DWQ)

, , ~ I'. ;. I ,

Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
was;::ttJJ,!!nerated 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 2H .0500) or any Buffer Rules?
. Yes ~ No D

Is this an after-the-fact permit application?
Yes ft.l. No D

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
(Agent's signature is valid only if an authorization letter from the appli

''2.0D !.l

Page 12 of 12

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