20050853 Ver 1_Complete File_20050516

W AT ?RQG
?( r
O ? 'C
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
June 16, 2005
DWQ# 05-0853
Guilford County
Mr. Bill Yearns
Bevill Lakes Farm, LLC
14 Wedgewood Court
Greensboro, NC 27403
APPROVAL of 401 Water Quality Certification with Additional Conditions
Dear Mr. Yearns:
Bevill Lakes Farm, LLC has our approval, in accordance with the attached conditions, to place permanent fill in
115 linear feet of perennial stream and to place permanent fill in 0.08 acre of wetlands in order to construct a
road crossing for the Bevill Lakes Farm residential development located on Bevill Oaks Road in Guilford
County, as described in your application received by the Division of Water Quality (DWQ) on May 16, 2005.
After reviewing your application, we have determined that this fill is covered by General Water Quality
Certification Number 3404, which can be viewed on our web site at http://h2o.enr.state.nc.us/ncwetlands. This
Certification allows you to use Nationwide Permit Number 14 when it is issued by the U.S. Army Corps of
Engineers. In addition, you should secure any other applicable federal, state or local permits before you
proceed with your project, including (but not limited to) those required by Sediment and Erosion Control, Non-
Discharge, and Water Supply Watershed regulations. Also, this approval will expire when the accompanying
404 permit expires unless otherwise specified in the General Certification.
This approval is valid only for the purpose and design that you have described in your application. If you
change your project, you must notify us in writing, and you may be required to send us a new application for a
new certification. 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 wetland fill for this project (now or
in the future) exceeds one acre, compensatory mitigation may be required as described in 15A NCAC 2H .0506
(h). For this approval to be valid, you must follow the conditions listed in the attached Certification, as
well as the additional conditions listed below:
The following impacts are hereby approved as long as all other specific and general conditions of this
Certification are met. No other impacts, including incidental impacts, are approved:
Amount A roved Plan Location or Reference
Streams 115 linear feet Unnamed perennial tributary to the Haw
River, located off Bevill Lakes Road,
Guilford County; reference: Bevill Lakes
Farm Site Plan

N hC
oarolina
Ntumlly
North Carolina Division of Water Quality
Wetlands Certification Unit 1650 Mail Service Center Raleigh, NC 27699-1650 Phone [phone] FAX [phone]
2321 Crabtree Blvd. Raleigh, NC 27604-2260 Internet httpl/:h2o.enr.state.nc.us/ncwetlands
Customer Service Number: 1-877-623-6748
An Equal Opportunity/Affirmative Action Employer-50% Recycled/10% Post Consumer Paper
Mr. Bill Yearns
Page 2,
June 16, 2005
Amount Approved Plan Location or Reference
Wetlands 0.08 acre Riparian wetlands adjacent to an unnamed
perennial tributary to the Haw River, located
off Bevill Lakes Road, Guilford County;
reference: Bevill Lakes Farm Site Plan

2. Appropriate sediment and erosion control measures which equal or exceed those outlined in the most
recent version of the North Carolina Sediment and Erosion Control Planning and Design Manual or the
North Carolina Surface Mining Manual (available from the Division of Land Resources at NCDENR
regional offices or the central office), whichever is more appropriate, shall be designed, installed and
maintained properly to assure compliance at all times with the North Carolina water quality standards
that are applicable to Class C, NSW waters as described in 15A NCAC 02B.0211 Fresh Surface Water
Quality Standards For Class C Waters. Such measures must equal or exceed the requirements specified
in the most recent version of the North Carolina Sediment and Erosion Control Manual. These
measures must be maintained on all construction sites, borrow sites, and waste pile (spoil) sites,
including contractor owned and leased borrow pits, which are associated with this project.
3. 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 measures in wetlands or waters is unavoidable,
they shall be removed and the natural grade restored within six months of the date that the project is
completed or, if applicable, within six months of the date that the project is released by the North
Carolina Division of Land Resources.
4. 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.
5. The culvert required for this project shall be installed in such a manner that the original stream profile is
not altered (i.e. the depth of the channel must not be reduced by a widening of the streambed). Existing
stream dimensions (including the pattern and profile) are to be maintained above and below the location
of the culvert. The culvert shall be designed and installed to prevent head cutting of the stream. If the
culvert becomes perched, the appropriate stream grade shall be re-established or, if the culvert is
installed in a perched manner, the culvert shall be removed and re-installed correctly. The Applicant
must submit a plan and receive written approval from this Office to address any head cutting that will
occur as a result of this project (e.g., use of cross vanes downstream of the culvert).
6. Where riprap is required for energy dissipation and scour protection, it shall be limited to the minimum
dimensions specified by appropriate engineering calculations. Riprap may only be used below the
normal high water level. The original grade and elevation of the stream's cross-section must be
maintained. Riprap placed in the stream bottom must be inserted into the bottom matrix to a depth
sufficient to provide the thickness of riprap required for scour protection. The elevation of the stream
bottom must not be increased by the placement of riprap. Placement of riprap must not result in
destabilization of the streambed or banks upstream or downstream.
Mr Bill Yearns
Page 3,
June 16, 2005
7. Energy dissipation and sheet flow must be provided for all discharges of stormwater before such
discharges reach stream channels or wetlands.
8. The proposed project must comply with the local water supply and stormwater management ordinances
of Guilford County approved by the N. C. Environmental Management Commission.
9. All construction activities associated with this project shall minimize built-upon surface area, direct
stormwater runoff away from surface waters, and incorporate best management practices to minimize
water quality impacts. If concrete is used with any fill material, it shall not be allowed to come in
contact with surface waters until it has cured. If any stormwater must be collected for discharge into a
stream channel, it shall not enter the stream as a point source, but shall be slowed and discharged as
sheet flow prior to entering the riparian buffer on either side of the stream.
10. Upon completion of the project, the Applicant shall complete and return the enclosed "Certificate of
Completion" form to notify NCDWQ when all work included in the §401 Certification has been
finished. This certificate should be sent to the 401/Wetlands Unit of the NC Division of Water Quality
at the address listed on the form. Along with the Certificate of Completion form, please send
photographs upstream and downstream of the culvert site to document correct installation,
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You
must act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition
which conforms to Chapter 150B of the North Carolina General Statutes to the Office of Administrative
Hearings, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its conditions are final
and binding unless you ask for a hearing.
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 Daryl Lamb in the DWQ Winston-Salem Regional Office at 336-771-
4600, extension 293.
Sincerely,
Alan W. Klimek, P.E.
AWK/cdl
Attachments
cc: Todd Tugwell, U. S. Army Corps of Engineers, Raleigh Regulatory Field Office
Winston-Salem DWQ Regional Office
Central Files
Wetlands/401 File Copy
William E. Mitchell, William E. Mitchell Associates, 1903-C Ashwood Court, Greensboro, NC 27455
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
June 16, 2005
DWQ# 05-0853
Guilford County
Mr. Bill Yearns
Bevill Lakes Farm, LLC
14 Wedgewood Court
Greensboro, NC 27403
APPROVAL of 401 Water Quality Certification with Additional Conditions
Dear Mr. Yearns:
JUN 2 2 2005
DENR - WATER QUALITY
WETLANDS AND STORMWATER BRANCH
Bevill Lakes Farm, LLC has our approval, in accordance with the attached conditions, to place permanent fill in
115 linear feet of perennial stream and to place permanent fill in 0.08 acre of wetlands in order to construct a
road crossing for the Bevill Lakes Farm residential development located on Bevill Oaks Road in Guilford
County, as described in your application received by the Division of Water Quality (DWQ) on May 16, 2005.
After reviewing your application, we have determined that this fill is covered by General Water Quality
Certification Number 3404, which can be viewed on our web site at http://h2o.enr.state.nc.us/ncwetlands. This
Certification allows you to use Nationwide Permit Number 14 when it is issued by the U.S. Army Corps of
Engineers. In addition, you should secure any other applicable federal, state or local permits before you
proceed with your project, including (but not limited to) those required -by Sediment and Erosion Control, Non
Discharge, and Water Supply Watershed regulations. Also, this approval will expire when the accompanying
404 permit expires unless otherwise specified in the General Certification.
This approval is valid only for the purpose and design that you have described in your application. If you
change your project, you must notify us in writing, and you may be required to send us a new application for a
new certification. 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 wetland fill for this project (now or
in the future) exceeds one acre, compensatory mitigation may be required as described in 15A NCAC 2H .0506
(h). For this approval to be valid, you must follow the conditions listed in the attached Certification, as
well as the additional conditions listed below:
The following impacts are hereby approved as long as all other specific and general conditions of this
Certification are met. No other impacts, including incidental impacts, are approved:
Amount Approved Plan Location or Reference
Streams 115 linear feet Unnamed perennial tributary to the Haw
River, located off Bevill Lakes Road,
Guilford County; reference: Bevill Lakes
Farm Site Plan

No` Carolina
Naturally
North Carolina Division of Water Quality
Wetlands Certification Unit 1650 Mail Service Center Raleigh, NC 27699-1650 Phone [phone] FAX [phone]
2321 Crabtree Blvd. Raleigh, NC 27604-2260 Internet htto/I:h2o.enr.state.nc.us/ncwetlands
Customer Service Number: 1-877-623-6748
An Equal Opportunity/Affirmative Action Employer- 50% Recycled/10% Post Consumer Paper
'\ir. Bill Yearns
Pagel.
June 16, 2005
Amount Approved Plan Location or Reference
Wetlands 0.08 acre Riparian wetlands adjacent to an unnamed
perennial tributary to the Haw River, located
off Bevill Lakes Road, Guilford County;
reference: Bevill Lakes Farm Site Plan
I
2. Appropriate sediment and erosion control measures which equal or exceed those outlined in the most
recent version of the North Carolina Sediment and Erosion Control Planning and Design Manual or the
Xorth Carolina Surface Alining Manual (available from the Division of Land Resources at NCDENR
regional offices or the central office), whichever is more appropriate, shall be designed, installed and
maintained properly to assure compliance at all times with the North Carolina water quality standards
that are applicable to Class C, NSW waters as described in 15A NCAC 02B.0211 Fresh Surface Water
Quality= Standards For Class C Waters. Such measures must equal or exceed the requirements specified
in the most recent version of the North Carolina Sediment and Erosion Control Manual. These
measures must be maintained on all construction sites, borrow sites, and waste pile (spoil) sites,
including contractor owned and leased borrow pits, which are associated with this project.
1 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 measures in wetlands or waters is unavoidable,
they- shall _be removed and the,_natural grade restored_within_six months of the date that the project is
completed or, if applicable, within sic months of the date that the project is released by the North
Carolina Division of Land Resources.
4. 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
Bianagement Practices" shall be performed so that no violations of state water quality standards,
statutes, or rules occur.
5. The culvert required for this project shall be installed in such a manner that the original stream profile is
not altered (i.e. the depth of the channel must not be reduced by a widening of the streambed). Existing
stream dimensions (including the pattern and profile) are to be maintained above and below the location
of the culvert. The culvert shall be designed and installed to prevent head cutting of the stream. If the
culvert becomes perched, the appropriate stream grade shall be re-established or, if the culvert is
installed in a perched manner, the culvert shall be removed and re-installed correctly. The Applicant
must submit a plan and receive written approval from this Office to address any head cutting that will
occur as a result of this project (e.g., use of cross vanes downstream of the culvert).
6. Where riprap is required for energy dissipation and scour protection, it shall be limited to the minimum
dimensions specified by appropriate engineering calculations. Riprap may only be used below the
normal high water level. The original grade and elevation of the stream's cross-section must be
maintained. Riprap placed in the stream bottom must be inserted into the bottom matrix to a depth
sufficient to provide the thickness of riprap required for scour protection. The elevation of the stream
bottom must not be increased by the placement of riprap. Placement of riprap must not result in
destabilization of the streambed or banks upstream or downstream.
Mr. Bill Yearns
Page 3,
June 16, 2005
7. Energy dissipation and sheet flow must be provided for all discharges of stormwater before such
discharges reach stream channels or wetlands.
8. The proposed project must comply with the local water supply and stormwater management ordinances
of Guilford County approved by the N. C. Environmental Management Commission.
9. All construction activities associated with this project shall minimize built-upon surface area, direct
stormwater runoff away from surface waters, and incorporate best management practices to minimize
i water quality impacts. If concrete is used with any fill material, it shall not be allowed to come in
contact with surface waters until it has cured. If any stormwater must be collected for discharge into a
stream channel, it shall not enter the stream as a point source, but shall be slowed and discharged as
sheet flow prior to entering the riparian buffer on either side of the stream.
10. Upon completion of the project, the Applicant shall complete and return the enclosed "Certificate of
Completion" form to notify NCDWQ when all work included in the §401 Certification has been
finished. This certificate should be sent to the 401/Wetlands Unit of the NC Division of Water Quality
at the address listed on the form. Along with the Certificate of Completion form, please send
photographs upstream and downstream of the culvert site to document correct installation.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You
must act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition
which conforms to Chapter 150B of the North Carolina General Statutes to the Office of Administrative
Hearings, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its conditions are final
and binding unless you ask for a hearing.
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 Daryl Lamb in the DWQ Winston-Salem Regional Office at 336-771-
4600, extension 293.
Sincerely,
Alan W. Klimek, P.E.
AWK/cdl
Attachments
cc: Todd Tugwell, U. S. Army Corps of Engineers, Raleigh Regulatory Field Office
Winston-Salem DWQ Regional Office
Central Files
Wetlands/401 File Copy
William E. Mitchell, William E. Mitchell Associates, 1903-C Ashwood Court, Greensboro, NC 27455
de: 05-0853 Bevil Lakes Farm S/D
Subject: Re: 05-0853 Bevil Lakes Farm S/D
From: Daryl Lamb <[e-mail]>
Date: Thu, 16 Jun 2005 15:09:49 -0400
To: Laurie Dennison <[e-mail]>
Laurie,
Actually I requested that information from the applicant's consultant after doing the site visit. The PCN
did not account for the presence of wetlands or the area of wetland impacts. I had them amend the PCN
by including a stream/wetlands delineation map and by changing Page 8 to reflect the 0.08 acre impact.
They sent me a copy as well as sending you the required seven copies. Since I already had the
information in hand, I went ahead and drafted the authorization. Thanks for contacting me about it..
Best regards,
Daryl
Daryl Lamb
NC DENR Winston-Salem Regional Office
Division of Water Quality
Winston-Salem, NC 27107
Voice: [phone] ext 293
FAX: [phone]
On 6/16/2005 2:40 PM, Laurie Dennison wrote:
Daryl:
On 6/13 we recvd a modification to this project in terms of the delineation of wetlands.
They've now included 0.08 ac of forested wetlands which was not on the original project. I read
your staff report notes & did not know if this would impact the issuance at all. I have updated File
Maker to reflect the wetland impact.
Laurie D
Daryl Lamb <Daryl.Lamb a NCmail.net>
WSRO
NC DENR
1 of 1 6/16/2005 3:24 PM
MEMORANDUM
TO: John Dorney Regional Contact: NO Lamb
Non-Discharge Branch WQ Supervisor: Steve Tedder
Date:
SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS
Facility Name Bevill Lakes Farm S/D c/o Bill Yearns County Guilford
Project Number 05 0853 County2
Recvd'From APP Region Winston-Salem
Received Date 5/16/05 Recvd By Region
Project Type Residential: roadway crossing
Certificates Stream Stream Impacts (ft.)
Permit Welland Wetland Wetland Stream Class Acres Feet r-
Type Type Impact Score Index Prim. Supp. Basin Req. Req.
NW14 Stream O Y O N ?- 16-(1) NSW 30,601. F-F 115.00 115.00
r- OTH WT ON ' F-F-F-F 30,601. 0.08 F- r-r?
Y O N ???F F_ F_ I (
Mitigation Wetland
MitigationType Type Acres Feet
Is Wetland Rating Sheet Attached? O YO N Did you request more info? *Y ON
Have Project Changes/Conditions Been Discussed With Applicant? Q Y O N
Is Mitigation required? O Y * N Recommendation: O Issue 0 Issue/Cond O Deny
Provided by Region: Latitude (ddmmss) 361435 Longitude (ddmmss) 794434
Comments:
A site visit was made on 06/08/2005. The project area is 93 acres in size and consists of
pastureland and forested tracts. The surrounding land use consists of low-density residential areas
and farmland. The proposed development will consist of 93 residential lots and associated streets.
Total impervious area at build-out is projected to be 8.5 acres or 9.2% of the total development area.
The proposed streets within the development are required for access to all building lots and for
access to an existing county road,. as required by the county. Street alignment has been designed to
minimize stream and wetland impacts. The proposed impacts are associated with a single road
Gros. ' g on an unnamed perennial tributary to the Haw River. This crossing will place fill in 115
linear feet of stream and consist of a culvert, endwalls, and associated rip rap energy dissipater
pads. This crossing will also impact 0.08 acre of adioining riparian wetlands through the placement
of roadway fill. The applicant has made an acceptable effort to avoid and minimize impacts. No
other impacts are proposed planned. There are no
cc: Regional Office Page Number 1
Central Office
Facility Name Bevill Lakes Farm S/D c/o Bill Yearns County Guilford
Project Number 05 0853 Regional Contact: Daryl Lamb
Date: 6/16/2005
Comments (continued from page 1):
mitigation or riparian buffer requirements associated with the proposed fill. Stormwater management
will be through the use of vegetated roadside swales and sheet flow from the lots. No engineered
runoff controls will be utilized. WSRO will issue authorization to use WOC: #3404. with additional
conditions. for this fill.
cc: Regional Office
Central Office Page Number 2
1. Wetland Impacts
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***
a.c oV. F4640V
? V(
b, og hJo A03. To ur- ppm"b-rzv
1?1V E ?

VM MU UVL LLLWtC4 LO; MCCnUM= Clearing, graamg, W4
* t 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.sov.
•*# List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: O, (a 53 AC, .
Total area of wetland impact proposed: D. M Ac,
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
indicate on ma
i
Type of Impact*

GuLV?irr' # Length of
Impact
linear feet
l5
Stream Name**

UT - "AV! RIVER Average Width
of Stream
Before Impact
1o' Perennial or
Intermittent?
leasespecify)
PenYANtAl-

_ w? tbs `by SOIL

- - - •-nt v t J .« w. u.i?au3 uiViuuc, otu are no[ lllTlltea to: CU1Ver73 and associated tip-rap,
flooding), relocation (include linear feet before and after, and net loss/pin),
t( gablons, etc.), excavation, ditching/straightening, etc. If stream relocation is
t for both the original and relocated streams must be included.
Lps. If a stream has no name, list as UT (unnamed tributary) to the nearest
15 i?v 1 ?? IS maps are available through the USGS at 1-800-358-9616, or online at
S lirect download and printing of USGS maps (e.g., www.topozone.com,
e in feet) to all streams on site: 5
. D
JUN 1 3 2005
EN?sT7&RTM
Page 8 of 12 . s?NCN
I. Wetland Impacts
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
Who) Distance to
Nearest Stream
linear feet
Type of Wetland***
a.L ot=; ADJ. T
o UT-
Ma
r-O1ZE5TQ7
us
i-t\1 E K

* T ict ma r1, --f-
- n ..,.el.. ..,i :.t,....:C. a__._
k- °`'k" uwa7 auu aucuuaY ?auipcuUuy unpaets. 1mpaCTS mCruoe, Out 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 h":/hvww.fema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater matA forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: O, G 53 AC, -
Total area of wetland impact proposed: O, CS Ac.
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
indicate on ma
1
Type of Impact*

CULV Rj- Length of
Impact
linear feet
115,
Stream Name**

UT - ttavt lZ1VER Average Width
of Stream
Before Impact
tb' Perennial or
Intermittent?
leasespecify)
tAt-

List * earl impart r rnarnt^1v ..A M -..*:A. .e....
r-- --r---•r --••- ---j -"'.w-Y uuYcwta. 1upu-3 rnciuue, our 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, gablons, 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.uses.eov. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.toRgzone.com,
www.mapquest.com etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 1 l 5.
Page 8 of 12
1. Wetland Impacts
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es n
o Distance to
Nearest Stream
linear feet
Type of Wetland***
a.t- of b, 08 -
lVo ADJ. '
fo U7' -
14 &
FOKEs1,47
1 g
p-tv E R

i T ;et Danl.. ..? .. «.?..t. ..,1 :.t.....'c. a ?
.. k-k k"&Q car ruau iucuuiy LMUF niiy nnpaCi& impacts include, bit are not limited to: mechanized Cleari
ng, grading, fill,
* * excavation, flooding, ditching/draiaage, etc. For dams, separately list impacts due to both structure and flooding.
100-Year floodplains are identified through the Federal Emergency Management Agency's (FFMA) Flood Insurance Rate Maps
(FIRM), or MAA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at hitp://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.)
List the total acreage (estimated) of existing wetlands on the property: 0-G 53 AC, .
Total area of wetland impact proposed: 0.08 Ac.
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
indicate on ma
1,
Type of Impact*

GULV£RT Length of
Impact
linear feet
?(rj,
Stream Name**

UT -'E4aUl RIVER Average Width
of Stream
Before ]m act
lOr Perennial or
Intermittent?
leasespecify)
1 1CENNIAL

* list each impact R marati-ly AnA iflwnt. ry fn i?
---+ - ° --_..---? -T-- j -F--- -14- -Laude, out are not limitell 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, gablons, eta), excavation, ditching/straightening, eta 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.uses.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozoiie.com,
www.mapgtiest.com.
j Cumulative impacts (linear distance in feet) to all streams on site: 1 l 5
Page 8 of 12
1. Wetland Impacts
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
loo-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***
FL L o b, 08, ?o ADJ. To UT. Co sTq?

* List each iMnAf-t CP T%AM#-Iv on.i
- - r--_ __r---••y ••••• •••?•w? awuk-y uuyat-Ls. uUF"i3 mr-mue, Out are not limited to: mechamzed clearing, grading, fill,
# t 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
(MM), 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.¢ov.
List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: 0. G 53 AO .
Total area of wetland impact proposed: D, oa Ac.
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
indicate on ma
i
Type of Impact*

cUL11 9 Length of
Impact
linear feet
l5
Stream Name**

UT -haul Ft1VEK Average Width
of Stream
Before Impact
16' Perennial or
Intermittent?
leasespecify)
MtcENHtAlt-

List each impact s eparately and identify tPmmrar., ;,,,,,a - .... a_ : _,-.J_
- -- -. ---•, -.-, ??r»rw• -&F-Qk, HIL ?uuei ma are nor limited to: culverts and associated rip-mP,
des (separately list Impacts due- -t-
both structure and flooding), relocation (include linear feet before and after, and net lass/gain),
stabilization activities (cement wall, rip-rap, crib wall, gablons, etc.), excavation, ditching/straightening eta 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.uses.eov. Several interact sites also allow direct download and printing of USGS maps (e.g., www.to zone.com
wtivw.mamuest.com etc.1
Cumulative impacts (linear distance in feet) to all streams on site: 1 t 5
Page 8 of 12
1. Wetland Impacts
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***
a.t_ ote. AOV AY
b, o8
NO
ADJ. To Ur-
FpKE:51,Ev
1?1V E il.

....i...... a. k-.µ'a7 µ+µ+ Z."u+y waipwaq uapwL& impacts include, nut are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditchirWdrainage, etc. For dams, separately list impacts due to both stricture 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:/hvww. fema. g`v.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: O, G 53 AC, .
Total area of wetland impact proposed: 0.06 Ac..
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
indicate on ma
i
Type of Impact*

GUt vE # Length of
Impact
linear feet
115
Stream Name**

UT - Vt&\9 RIVER Average Width
of Stream
Before Impact
t0' Perennial or
Intermittent?
leasespecify)
P?T.ENNtb.t_

* Ust each unnar? " narntwly and ;.io. .41. •e.....,....._.:?__ ?
---- ---r--• --C'-?"'Y "`•" ...v..u,J wuiyv,w y urrpzwts. tmpa.cas include, out 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, gablons, eta), excavation, ditching/straightening, eta 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.uses.¢ov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mm uest.com. etc.).
Cumulative impacts (linear distance in feet) to all streams on site: l t 5
Page 8 of 12
1. Wetland Impacts
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
loo-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***
tt.c. ot.
b.09
?o
ACJ. To
UT-
ppKESMO
41\1EK

"" t"" • "! ++?+w+7 ?u .uwuay +cutput?uy unpac?s impacts mcluoe, Out are not IMuted 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 OMIA) 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.)
List the total acreage (estimated) of existing wetlands on the property: 0.4053 AC, .
Total area of wetland impact proposed: 0.013 Ac,
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
indicate on ma
i
Type of Impact*

cut V Ri- # Length of
Impact
linear feet
1 l5
Stream Name**

UT -- RAM RIVET, Average Width
of Stream
Before Impact
IOT Perennial or
Intermittent?
leasespecify)

1'e1GE 14 tit A.lr

i Ust each imnact s mnrntely Anel ifwntifi,
- --- c--- __1__1 "'•" •"`+....•, -k '-.7 --P-- uupuuu include, our 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, gablons, eta), excavation, ditching/straightening, eta 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 1400-358-9616, or online at
www.uses.eov. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.toRozone.com,
www.mapquel.com etc.).
Cumulative impacts (linear distance in feet) to all streams on site: l 15
Page 8 of 12
I. Wetland Impacts
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***
- ILL ott- F44DV 'Ay b, 0$ ttj0 A03. To UT- COKBbi- 2
fU?l E R

h ' I.
* List c
ea unpac 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 FF.MA Map Service Center at 1-800-359-9616, or
online at h!W://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.)
List the total acreage (estimated) of existing wetlands on the property: O. G 53 AC, .
Total area of wetland impact proposed: D. 05 Ac.
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
indicate on ma
i
Type of Impact*

CULVERT Length of
Impact
linear feet
Stream Name**

VT --viAw RtvER, Average Width
of Stream
Before Impact
l0? Perennial or
Intermittent?
leasespecify)
P?T.Et1Nth.L

• last each impact s e aratel and 'dent' t
P Y ; 1fY emporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
d= (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, gablons, 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.uses.Qov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.maRgiiest.com.
Cumulative impacts (linear distance in feet) to all streams on site: 1 t 5
Page 8 of 12
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99 L2 N81-19 5a 29.71 100
100 L3 N4n 13 21. 101
101 L4 N80'1 1 2,.05 102
102 Lb SE8"26 19.3 103'
103 L8 SE2'1 09 16
104 L7 5365 06 31.78 105
105 L6 573'4 25. 106
106 L9 SS974 47- 107
107 L10 03 55
18 L11 N41^'30S& 20.38 109
109 L12 N 22 I&W 110
110 L13 N46'I 17.OF 111
111 L14 H76*3 1259
112 Lib NOV0 42 4173 113 H 0
113 H DAM Lib N53405 77.24' ST CH TT DA)o
ST CH TT DAM L17 N46'19 b 7. 114 IT DAM
114 TT DAM LIS NM 14 20. 115
15 L19 S87'44 20 14.82
116 L20 Sa9'1a 5b 112. 11
11 L21 S78 21 32.75' 118
116 L22 S49'6 09 2t.10'
119 L23 S6 23.15 120
12 L24 SM 06 31.66 21
121 L25 NO=29 12.21 122
L28 568'1 23.48 123
3 L27 S80'34 15.13 124
5 538' 35 15.9 125
125 L29 5387 39 13 28 126 TT CH
128 TT CH L30 S47Z b 11.2(Y CH CL 3' DEUNEA
CL DELINEA L31 SY4 16 41.19 9a END
TT DAM L32 NE450'02 2E.26 CH ?l 3'
3' L33 S8 1 30.W CH CL 2'
CL L34 N76 4 11 39.05 98 CL '
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CH CL 2' L40 S75'S5 41 E 10.81 CH CL
CH CL 3 L41 N59'4914 E 49.38 '
CH CL L42 S81n5 E 42.05 NO FLAO
NO FLAG L43 S26'20 31 E 23.14 CH CL
CL 3 L44 S80104 E 24.48 CH CL 3 DELINEA
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IDDMFICAMgN NUN BEARING DISTANCE M7lF1CATiON
219 go Lt N601 52 14.31 99
99 L2 NSMO56 29.71 100
100 L3 N48'0 13 21. 101
101 L4 MO 1 28.05 102
102 L5 Sb876 19 103'
103 LB 582'1909 16
104 L7 S361506 31.78 105
105 LS 473'4 25. 106
106 L9 S5974 42. 107
107 LID 03 55
108 L11 N413 20.35, 109
109 L12 N7 W 22 1 &20Y 110
110 L13 N40-1 MOW
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11 L14 N763 1
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112 L15 N81'0 42 41.43 113 H D
L16 N5"S4 0S 77.24 CH 7T D
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114 TT DAM L18 N32-02'I 4 20. 115
15 L19 S87'44 20 14.82
116 L20 S89'I6 55 112 117
117 L24 57811 32.78' lill
118 L22 S493 09 21.16
119 L23 58 23.15 120
129 L24 S86'3406 31.65' 121
121 L25 Nb07929 12.21 122
122 L26 Sn6'1 23.48 123
127 S60'34 13.13 124
in L28 539' 35 15.9 125
125 L29 S3b'2 39 13.25 126 TT CH
126 TT CH L30 54735 b 11.20' CH CL 3' DCUN
CL DM MEA L31 Sr4 16 41.19 98 END
§j CH TT DAM L32 N84 28.28 CH CL 3
g! CL 3' L33 S8 1 30.00' CH CL 2'
Cl. L34 N78-42'11'E 39.05 '
-OHM 2-' L35 s743104 E 23 31 CH CL 2'
L35 563'2523 17.
CH CL L37 514'101 19.44? CH CL '
CH CL 3' L38 S6 E 26.8y CH CL V
CH CL L39 S8 2 2&W
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CH CL 2
CH CL 2' L40 05-U'41 E 10.81 CH CL
CH CL 3 L41 N59'4914 E 49.38 CH CL 3,
CH CL L42 S8t'25 E 42 05 NO FLAG
NO FLAG L43 S2S 20 31 E 23.14! 1 CH CL
Cl 3 L44 WOW= 24.46 CH CL 3 DELNEA

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100 L3 NO 13 21. 101
1D1 L4 N809 1 25.05 102
102 L5 S88"2B 19 103'
103 LS S82'19 09 ? 16 104
104 L7 S38-570-61V 31.76 105
105 L8 573'4 25 108
105 L9 559'24 42. 107
107 L10 03 S&W We
108 L11 N4130w03 20.35 109
109 L12 N7',W2-2sW- -I&W 11"
110 L13 N489 17.06' ill
11 L14 N763 12.6V 112
112 L15 N61'042 41.45 113 H D
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114 TT DAM L18 N3 14 20. 115
15 L19 587'4420 14.82
116 L20 589'18 5b 112.90 117
117 L21 S78 21 32.78 lie
118 L22 S49"6 OO 2t.16 119
119 123 58 23.15 120
120 L24 56634 OB 31.66 21
121 L25 N60'2929 12.21 122
122 126 S88'I 23.48 123
3 L27 S60'34 15.13 124
L28 539' 35 15.9 123
125 L20 5387 39 13.26 126 TT CH
128 TT CH L30 54735 b 11.21Y CH CL 3' N
CL DELMEA L31 53'4 16 4119 98 0
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CN CL 3' 1.33 S6 1 30W CH CL V
CL L34 N76 4 11 39.05 '
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L38 S6 E MAT CH CL '
CH CL L39 28 50
CH CL 2' L40 S76'85 41 E 10. 61 CH CL
CN CL 3 L41 N59'4914 E 49.38
CH CL L42 S81n8 E 42.05 NO FU10
NO FLAG L43 S2820 31 E 23.14 CH CL
CH CL 3 L44 S80104 '23-E 24.46' 1 CH CL DEUNEA

Jun 10 05 11:23a
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101 L4 NW 1 26.05 102
102 L5 58878 1953 103
103 L8 sa2'19 o9 $.V 04
104 L7 536'5 08 31.78 105
105 L8 S73'4 25.67 106
106 L9 $5974 42. 107
107 L1Q 03 mw 122
108 1-11 N41 05 20.35 109
109 L12 N7-022W 1
110 L13 N46'1 17.
11 L14 N763 12.69 1
112 L15 Na1O 42 41.43 113 H DAM
113 H DAM L18 N5"44 05 77.24 CH TT D
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114 TT DAM L18 N3 14 20. 115
15 L19 S87'44 14.8
116 L20 589'18'55E 112 117
117 L21 57871 32.76' lie
18 L22 S49'5 21.18' 1 jig
119 L23 S8 231W 120
1 L24 S8634O6 31.86 21
121 L25 N60'2929 1221 122
L28 S86'1 23.48 123
123 L27 S60*34rWE 13.13 124
L23 539' 33 15.9 123
125 L29 5387 39 1326 126 TT CH
126 TT CH L30 S4733 3 11.2 3' N
CL DELINEA L31 S3'491a 41.19 98 D
CH TT DAM L32 N84 28.26 CH 41. 3'
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NO MG L43 52870 31 E 23.14 CH CL
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100 L3 N4R t3 21. 101
101 L4 NSWIS'If-W 28.05 102
102 L5 588"28 19.32 103
103 L8 5829 09 18
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108 L9 S5974 42 107
107 L10 S4nrO3'W 55
108 L11 N41'30rM 20 33
109 L12 N 22 1&2(f 110
110 L13 N489 17.Cd III
11 L14 H76-3 12.89 1
112 Us N6V0 42 41.43 113 H 0
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118 L20 S891866 112.
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117 L21 S7871 --3
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119 123 Sa 2316 120
120 L24 58814 OB 31.68' 121
121 L25 r2-9V - 12.21
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128 SWIIWSdt 23.48 123
L27 S8014 15.13 124
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125 L29 5387 39 13.28 128 TT CH
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Triage Check List
Date:
To
5/19/05 Project Name: Bevill Lakes Farm s/d
60-day processing time: 5/16/05 7/14/05
Daryl Lamb, Winston-Salem Regional Office
DWQ#: 05-0853
County: Guilford
FILE Gayy
From: Cyndi Karoly Telephone : [phone]
The file attached is being forwarded to your for your evaluation.
Please call if you need assistance.
? Miniinization/avoidance issues
? Buffer Rules (Meuse, Tar-Pamlico, Catawba, Randleman)
? Pond fill
Mitigation Ratios
? Ditching
? Stream length impacted
? Stream determination
Wetland determination and distance to blue-line surface waters on USFW topo maps
? Are the stream and or wetland mitigation sites available and viable?
? Check drawings for accuracy
Is the application consistent with pre-application meetings?
Cumulative impact concern
El
Comments: As per our discussion regarding revision of the triage and delegation processes,
please review the attached file. Note that you are the first reviewer, so this file will need to be
reviewed for administrative as well as technical details. If you elect to place this project on hold,
please ask the applicant to provide your requested information to both the Central Office in
Raleigh as well as the Asheville Regional Office. As we discussed, this is an experimental, interim
procedure as we slowly transition to electronic applications. Please apprise me of any
complications you encounter, whether related to workload, processing times, or lack of a "second
reviewer" as the triage process in Central had previously provided. Also, if you think of ways to
improve this process, especially so that we can plan for the electronic applications, let me know.
Thanks!
MAY 1 ?005

Office Use Only: DENRA N - DWATESTOR B '?,, R k ion October 2001
VYETIAMDS H
USACE Action ID No. DWQ No. 0 5 0 8 5 3
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
L Processing 7 A% n V,% FIL E UUP
1. Check all of the approval(s) requested for this project:
Q Section 404 Permit
? Section 10 Permit
Q 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: N WP 14
3, If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (see section VIII -- Mitigation), check here: ?
IL Applicant Information
2.
1. Owner/Applicant Information
Name: 4/c, Mg. t 51U_ `(1;Aiz.11S BF-VILL L A KSS FA MI LLC_
Mailing Address:__ 14 WS%F_W 0 > C601;-'r
.G.
Telephone Number: 33Co - 442 -t O 21 Fax Number•_?3 6 - 2 94 - 4-%GG
E-mail Address:
Agent 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: BILL MtTG4SLL
Company Affiliation:W I LLxAM s. M1' RsLL ,ss..5??6Gt?.-TFzS
Mailing Address: 19015-C, ASHWOOD CoU1Z-r
6V_i r SSORo, N.G. 27455
Telephone Number: ?3 G -54-0 - 0060 Fax Number 33rd -540 - 0060
E-mail Address:
Page 5 of 12
M. 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: 5"LL LXY-EIS r-,A.RM SU15D1V1510Q
2. T.I.P. Project Number or State Project Number (NCDOT Only): tMA
3. Property Identification Number (Tax PIN): Ac L - tb - G4b - e,17 - o t
4. Location
County: G UlLFD1ZV Nearest Town: B lzOW V SUMMIT
Subdivision name (include phase/lot number):_5S%ALL 1-A5iS FAX-M - LOTS 26 27
Directions to site (include road numbers, landmarks, etc.): A-r Et4p OF PA.vtT. aF
8t~v u- 6AYs Kokt7 - s .1z . 2.503 - apex. 756, 56VT"SA-ST
5. Site coordinates, if available (UTM or LatUng): "A
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing ofa distinct waterbody.)
6. Describe the existing land use or condition of the site at the time of this application:
UNG(S'rUt?6ED lcSI?VEVtrLOpE17
7. Property size (acres): !)3 AO .
8. Nearest body of water (stream/riverlsound/ocean/lake): HAM RIVE1Z
9. River Basin: CAPE FGAR
(Note = "thi.s must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at httl2://h2o.enr.state.nc.us/admin/maps/.)
Page 6 of 12
10. Describe the purpose ofthe proposed work: RoA4;PWM GRoS51t1G To b4cssS
-ff -
1 1. List the type of
Bt)1. -yc
to be used to construct the project: ` 1CACK GKt-loE,
(ZOh1T 044 LCA VSI? '
IV.
12. Describe the land use in the vicinity of this project: PZEStMIAMAL.
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
construction schedules.
W/A
V. Future Project Plans
VI.
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:
N/4
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. Wetland Impacts t4 /A
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within
100-year Floodplain**
es/no Distance to
Nearest Stream
linear feet
Type of Wetland***

- 1.15L Cacn unpaGL separately and idenury 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.y;,ov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, beg, etc.)
List the total acreage (estimated) of existing wetlands on the property:
Total area of wetland impact proposed:
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
indicate on ma
Type of Impact* Length of
Impact
linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
lease specify)
GtILV£ItT' UT --Vt .Vl RIVER l0' m rF-YANIAL-

.....y,«. o?jrwaL?ay Lulu 1uc1u11y Lautpvrary 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, gablons, etc.), excavation, ditching/straightening, eta 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.uses.ROV. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapguest.com. etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 1 t 5
Page 8 of 12
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S. M /A
Open Water Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres
Name Wate)
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.

i i ! _.L
,As? cau, unp= separdety and identify temporary impacts. impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, eta
4. Pond Creation N /A
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 a plication.
Pond to be created in (check all that apply): ? uplands a stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VIL Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these 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.
OWNER KE&UMEP B`l 6001Nr Y TO MXY-S GROSSItJG. W 6KDVV. TO CONtSEc.T
76 E?.45T1tSG MA r.> " F-61, WB Ly- SA4rE-1%J /A.CGrrSs Issorms •. USING
Mb.X. 6FZA2R55 I MU.S. Fits. K>?r9'D. B`( NG?T? UsttSG Ef?lb ??f5 Ag
>=6rG14 r=Nb OF PIPE `[b MWIMI7
5 Gt3L\l6KT LS 0134
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.ne.us/ncwetlands/strmRide.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.
N/Q .. tbil'T FEeL MMc-ATiorS
Is ?u5-n?t ?p
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at hffp://h2o.enr.state.nc.us/wrD/index.htm. If
use of the NCWRP is proposed, please check the appropriate box on page three and provide
the following information: lam( /A
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 (DWQ Only)
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes [] No Q
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (DWQ Only) 1,4/A
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
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify ??
Yes ? No ® If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet
Multiplier
Re
Required
Mitigation
1 3
? 1.5
Total
7 s / =- - -'
.. L&w a cn?ciu?s 0" Ju 'cc' peT mcucular UOm near bank Of channel; Zone 2 extends an
additional 20 feet from the edge of zone 1.
Page I 1 of 12
Lf 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.
oc&r v' Et. Aw( Mrnc-AT,arJ
ks 9F-CSsS4,rY
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
'[bTTk. AIWA, = 93 ac.. As5vm5 4, coo S.p IMMZ.N1td05 AKSM-D-r-A 93 Lam
8.5,e?G• = 9.2°l • RutspFF "F -MP To V-aWStDS Vvrc tss /StjEC-T FMS 6pr-
tOMMa.1oRt ' DT R ?
oF
i 'rY ALSD PASSE s 'TH Rot1G K 2 EXtsT PO t4D S - htD
X11. Sewage Disposal (DWQ Only) KUtsoFF co-S-rro rs 13 5 E V
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.
1WP1VIRlAL SEf"nc, TANK SYSTEMS r-ble Edr-L' l n-r
X1II. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No Q
Is this an after-the-fact permit application?
Yes ? 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).
4
4-2--Vl -
????
Appiicant/Ageni s Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12

CURVE DATA
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(TOPOGRAPHIC) GEOL ;GICAIL SURVEY
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