20050471 Ver 1_Complete File_20050315

Certificate of Completion

DWQ Project No.:

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County:

fieri tord

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(705

Applicant:

Project Name:

Date of Issuance of 401 Water Quality Certification:

Apr: \

1\ '2OcJr
I

Upon completion of aILVlQ!~~pproved within the 401 Water Quality Certification alld Buffer Rules, and any
subsequent modifications, the appl!fa.ntis~Iequired to retumthis certificate to'the-401/Wetlands Unit, North
--.=----"":".,-c€arolina Divls15iu)LW-8.~Ql;.ality) 1650 Mail-Service Center, Raleigh; NC,~2"7699~1650~~~iIis-fornTmay~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, 4el'\(J tQ.Q..I{ 1 \c.. , 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 bwlt
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and spec' ications, and other supporting materials.

~

Date: o;~1 ~- Of>

Signature:

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 40 1 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.

Signature:

Date:

~~@~DW~~

SEP 1 8 Z006

If this project was designed by a Certified Professional

DENR - WATER QUALITY
WETlANDS AND STORMWATER 8fW.:CH
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 Permittee 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 C?f the 401 Water Quality .
Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.

Signature:

Registration No.:

Date:

~~

cosvstemt

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PROGRAM

RECEIPT

!ff@@@O'iY/@/iil
APR . /!;
1 9 20D5
WEn.;;f'/R. w",
Ds AND sr'Jff,!t9PAl.ITY
-. ....'f.11FR 8IiANcH

April 14, 2005
DWQ#: 05-0271
COE#: 200510627

Sanford Corbell
4318 Carrenda Lane
Kitty Hawk, NC 27949

Project:
County:

4318 Carrenda Lane
Dare

The North Carolina Ecosystem Enhancement Program (NC EEP) has received a check in the amount of
$3,069.00, check number 3139, as payment for the compensatory mitigation requirements of the 401 Water
Quality Certification/Section 404 permit issued for the above referenced project. This receipt serves as
notification that the compensatory mitigation requirements for this project have been satisfied. Please note that
you must also comply with all other conditions of this certification and any other state, federal or local
government permits or authorization associated with this activity.

The NC EEP, by acceptance of this payment, acknowledges that the NC EEP is responsible for the
compensatory mitigation requirements associated with the project permit and agrees to provide the compensatory
mitigation as specified in the permit. The NC EEP will mitigate for 0.12 acres of non-riparian wetlands in
Cataloging Unit 03010205 of the Pasquotank River Basin.

Payments to the Ecosystem Enhancement Program are not reimbursable unless a request for reimbursement is
received within 12 months of the date of this receipt. A letter must accompany requests for reimbursement from
the permitting agency stating that the permit and/or authorization has been rescinded.

If you have any questions or need additional information, please contact Carol Shaw at 919-733-5205.

.

g. ~//

illiam D. Gilmore. PE ~
Director

cc: Cyndi Karoly, Wetlands/40l Unit
Doug Huggett, Division of Coastal Management
William Wescott, USACOE-Washington
Kyle Barnes, DWQ Regional Office-Washington
File

RMtorUtj... E~... ProtectUtj Our State,

A7A
NCDENR

North Carolina Ecosystem Enhancement Program, 1652 Mail Service Center, Raleigh, NC 27699-1652/919-715-0476 I www.nceep.net

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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

April 11, 2005

DWQ Project # 05-0471
Hertford County

Henry Revelle
Post Office Box 357
Murfreesboro, NC 27855

Subject Property:

SR 1175 (Parker's Fisher Road), Winton, NC

Approval of 401 Water Quality Certification with Additional Conditions

Dear Mr. Revelle:

You have our approval, in accordance with the attached conditions and those listed below, to place fill
within or otherwise impact 0.01 acres of wetlands and 50 feet of streams for the purpose of constructing
an access road at the subject property, as described within your application dated March 10,2005 and
with additional information received by the N.C. Division ofYvater Quality (DWQ) on AprilS, 2005. 1 ..
After reviewing your application, we have decided that the impfcts are covered by General Water Quality
Certification Number{s) 3404 (GC3404). The Certification{s) allows you to use Nationwide Permit{s) 14
when issued by the US Army Corps of Engineers (USACE). ill 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, and Non-discharge 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:

Amount Approved (Units) Plan Location or Reference
Stream 50 (feet)
404/CAMA Wetlands 0.01 (acres)

N~!thCarolina
/Va/ural/II

401 OversighVExpress Review Permits Unit
1650 Mail Service Center, Raleigh, North Carolina 27699.1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone]/ FAX [phone]/lnternet: htto://h2o.enr,state.nc.us/ncwetlands

An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper

".

Henry Revelle
Page 2 of3
April 11, 2005

"

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.
c. For borrow pit sites, the erosion and sediment control measures must be designed, installed,
operated, and maintained in accordance with the most recent version of the North Carolina
Surface Mining Manual.
d. The reclamation measures and implementation must comply with the reclamation in
accordance with the requirements of the Sedimentation Pollution Control Act.

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 wIn 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 40 1/W etlands Unit, North Carolina Division of Water Quality,
1650 Mail Service Center, Raleigh, NC, 27699-1650.

6, Deed Restriction

Deed notifications or similar mechanisms shall be placed on all retained jurisdictional wetlands,
waters and protective buffers in order to assure compliance for future wetland, water and buffer
impact. These mechanisms shall be put in place prior to impacting any wetlands, waters and/or
buffers. approved for impact under this Certification Approval and Authorization Certificate. A
sample deed notification can be downloaded from the 40 1/W etlands Unit web site at
http://h2o.enr.state.nc. us/ncwetlands.

.....

r

Henry Revelle
Page 3 of 3
April 11, 2005

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 t~e 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.

This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water
Act. If you have any questions, please telephone Cyndi Karoly in the Central Office in Raleigh at 919-
733-9721 or Eric Kulz or Mike Horan in the DWQ Raleigh Regional Office at 919-571-4700.

A WK/cbk/bs

Sincerely,

r\ ~i!H

: ) ,.~ (

Enclosures:

GC 3404
Certificate of Completion

cc: US ACE Raleigh Regulatory Field Office
DWQ Raleigh Regional Office
DLR Raleigh Regional Office
File Copy
Central Files

Filename: 05-0471 Henry Revelle (Hertford) 401

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Michael F. Easley, Governor

William G. Ross lr., Secretary
North Carolina Department of Environment and Natural Resources

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

March 28, 2005

DWQ Project # 05-0471
Hertford County

CERTIFIED MAIL: RETURN RECEIPT REQUESTED

Henry Revelle
Post Office Box 357
Murfreesboro, NC 27855

Subject Property:

SR 1175 (Parker's Fisher Road), Winton, NC

REQUEST FOR MORE INFORMATION

Dear Mr. Revelle:

On March 15,2005, the Division of Water Quality (DWQ) received your application dated
March 10, 2005 to impact 0.01 acres of wetlands and 50 feet of streams to construct the proposed
access road. 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. Plan Details

Please provide a map showing all wetlands on the lot so it can be determined whether
wetland fill will be needed for the house construction. - .

Please respond within three weeks of the date of this letter by sending this information to me in
writing and Tom Steffens or Kyle Barnes of the DWQ Washington 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 Ms. Cyndi Karoly or Mr. John Dorney

N~{thCarolina
/Votl/rnlly

401 OversighVExpress Review Permits Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone]/ FAX [phone]/lnternel: htto://h2o.enr.state.nc.us/ncwetlands

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

Henry Revelle
Page 2 of2 ,. 4<~
March 28,2 005

at 919-733-1786 if you have any questions regarding or would like to set up a meeting to discuss
this matter.

Sincerely,

~\(~

Cyndi Karoly, Supervisor
401 OversightJExpress Review Permits Unit

CBK/bs

cc:

Tom Steffens or Kyle Barnes, DWQ Washington Regional Office
US ACE Washington Regulatory Field Office
File Copy
Central Files

Filename: 05-0471 Henry Revelle (Hertford) On Hold

. p:"'J ::. r!':;....;
/:" i\ u lUU)

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

March 28, 2005

DWQ Project # 05-0471
Hertford County

CERTIFIED MAIL: RETURN RECEIPT REQUESTED

Henry Revelle
Post Office Box 357
Murfreesboro, NC 27855

Ffl, E i:
- ~,

Subject Property:

SR 1175 (Parker's Fisher Road), Winton, NC

REQUEST FOR MORE INFORl\tIA TION

401 iSSUED

Dear Mr, Revelle:

On March 15,2005, the Division of Water Quality (DWQ) received your application dated
March 10, 2005 to impact 0.01 acres of wetlands and 50 feet of streams to construct the proposed
access road. 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. Plan Details

Please provide a map showing all wetlands on the lot so it can be determined whether
wetland fill will be needed for the house construction.

Please respond within three weeks of the date of this letter by sending this information to me in
writing and Tom Steffens or Kyle Barnes of the DWQ Washington 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 Ms. Cyndi Karoly or Mr. John Dorney

NbrthCaroIina
;Vall/folly

401 Oversight/Express Review Permits Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone]/ FAX [phone]/ Internet: hltp://h2o.enr.state.nc.us/ncwetlands

Henry Revelle
Page 2 of2
March 28,2 005

at 919-733-1786 if you have any questions regarding or would like to set up a meeting to discuss
this matter.

Sincerely,

~,/I~~

Cyndi Karoly, Supervisor
401 Oversight/Express Review Permits Unit

CBK/bs

cc: Tom Steffens or Kyle Barnes, DWQ Washington Regional Office
USACE Washington Regulatory Field Office
File Copy
Central Files

Filename: 05-0471 Henry Revelle (Hertford) On Hold

PAYMENT
RECEIVED

Office Use Only:

050 .
DWQNo. 471

I.

Processing

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

2. Nationwide, Regional or General Permit Number(s) Requested: p.J" t;,\)'r'\ v..J ; A~ ,'-\

401 iSSUED

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: 0

4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal ofPCN), complete
section VIII and check here: 0

I
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

II.

Applicant Information

1. Owner/ Applicapt Informati~m \
Name: \-\(",..('\/. R~Je\ e...
Mailing Address: I VI,) !I'll)>" "ZS')
Nt" r ~~~ \, 6,,/<) Iv L
)

.l~'6(~

.)'1] - 7. '7 '? - 4 '71 L Fax Number: J )-2.-
\.-.~ " r. e. r e '" e\ k \; ,.,,:, \ ~ ~.. \ ... (0 lY'\
I

$'1i?- t;"/f 9

Telephone Number:
E-mail Address:

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
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:

ACcess ld("-'\

\-0

\f ~ ~ (h/\\-~ c...\

\01-

2. T.I.P. Project Number or State Project Number (NCDOT Only):

jJ/A
I

3. Property Identification Number (Tax PIN):

{"C10lj3549 CS-

4. Location
County: \-\e\-t~i)("~ Nearest Town: Lv,'" \-<0 Y"
Subdivision name (include phase/lot number): AI /A
Directions to site (include road numbers, landmarks, etc.): A\~ fre> V I 1""-; k }JJ'-+l.. /) f
l\ S I \X D -+.c .> t rk+( r,.;., cl tL / I) \" ( fL Iu.' , ~ ,c.\ h<'"(( r:?")~,,,)

5. Site coordinates, if available (UTM or Lat/Long): N/A
(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):

S. I q 0\

Cl( re ('

7, Nearest body of water (stream/river/soundJocean/lake):

C h..o <..1.'\ '"'

{Z~ver-

8. River Basin: CholJv\ '"
(Note - this must be one of North Carolina's seventeen designated major river basins, The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)

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\."~"velOr~L( L..),JoJcllc..I"L/!. '"1'hen_ Qr(....
3 c) -Tkt> r ~ Q ,,,'\..(, ~ i'r--.. -\-\-. L 1/ ~ L i'..... .-\- '1 '

Page 6 of 12

10. Describe the overall project i detail, including the type of equipment to be used: T~ ~
;\""( ,....~,..,,~ o~ ~\\ frol""\ o+{'~~k '('0. L~ e+-L,., ~ 0--'\,(
;"')~"\t,,,-\-'o__ o\- po-?"" C\.T .s+r(v........ (rd\('-""), Ebv:p""",,,+ j../:f(
I"-C\J,.\t' d"""f \-,""(K.<.. ~f'-.\ \n;,,\\r\\\2.('\.-o rlC{.: l..",.{ c,).......r,d-
f., \ l ,
,

11. Explain the purpose of the proposed work:
r\(~.J ""~... -<' \ 0-\ .

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b 1""''1

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 TJ.P. project, along with
construction schedules. IV /4

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.
BVI-\~;'''j f')-""\~ -6, hul'"\~.

VI. Proposed Impacts to Waters of the United States/Waters of the State

It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. 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:
+; \, \'-. ~~ \Jt-\-\....""^).

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0+

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 of Wetland* * *
(indicate on map) (acres) (yes/no)- (linear feet)
(~) F:\\ \e~\ \\.."-'" ~ 7'/ 0 (\ 0 o ' Ri\i~r;,,~ 1"..(\ nu,"" I-
>!" <,,\.re.. \

*

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 FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://www.fema.gov.
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: 1 0..( c e...
Total area of wetland impact proposed: Ie} , h" _ ),,.) c.. ( r(..

~r~fQ)(.

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 Intennittent?
(indicate on map) (linear feet) Before Impact (please soecify)
(1) f;R i'--.iklL.{..:r,,, SD' Ui tv C"~\J" ~. r\\;1 jl -1~ \^l'-e \. f~re"",;.....1

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
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.USgs.gov, Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.maPQuest.com. etc.).

*

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

....
So

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 ofImpact* Impact (lake, pond, estuary, sound,
(indicate on map) (acres) (if applicable) bay, ocean, etc.)

*

List each impact separately and identitY 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): 0 uplands 0 stream D 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
techniques to be followed during construction to reduce impacts.
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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
http://h2o.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
a separate sheet if more space is needed.
.- f'" ~ e... D ('+ 'l\}'A~ ';';0
+.:> -\-..... ,"" ~ W\ p" c-:\ ~.A 0\"<.' c,.:'l 'A/;- -\-l.-
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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 http://h2o.enr.state.nc,us/wrp/index.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 (federal/state) funds or the use of public
(federal/state) land? ~
Yes 0 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 (NEP A/SEP A)?
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 0 No 0

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 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 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 Requ~ents), or other (please identify )?
Yes 0 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 Multiplier Required
(square feet) Mitigation
I 3
2 1.5
Total

*

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

Page II of 12

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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 storm water controls proposed in order to protect surface waters and wetlands
downstream from the property,
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XII. 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.
tv/A
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XIII. Violations (required by DWQ)

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

Is this an after-the-fact pe~pplication?
Yes D No ~

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).

')1 7/ ~ 5-10-0'

APPlica~ent'~ Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

Page 12 of 12

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