20051168 Ver 1_Complete File_20050627

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Leighton Blount
3525 South Memorial Drive, Suite E
Greenville, NC 27834
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
August 16, 2005
DWQ Project # 05-1168
Beaufort County
Subject Property: Blount 4
SR 1004, Aurora, NC
Approval of 401 Water Quality Certification with Additional Conditions
Dear Mr. Blount:
You have our approval, in accordance with the attached conditions and those listed below, to place fill
within or otherwise impact 0.08 acres of wetlands for the purpose of constructing driveways to access
Lots 4, 3 and 2 at the subject property, as described within your application dated June 24, 2005, and
received by the N.C. Division of Water Quality (DWQ) on June 27, 2005, with additional information
received by the N.C. Division of Water Quality (DWQ) on August 3, 2005. After reviewing your
application, we have decided that the impacts are covered by General Water Quality Certification
Number(s) 3402 (GC3402). The Certification(s) allows you to use Nationwide Permit(s) NW 18 when
issued by the US Army Corps of Engineers (USACE). In addition, you should obtain or otherwise
comply with any other required federal, state or local permits before you go ahead with your project
including (but not limited to) Erosion and Sediment Control, Non-discharge, and other 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 LAMA 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
404/CAMA Wetlands 0.08 (acres) PCN
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: http://h2o.enr.state.nc.us/ncwetlands
Nose Carolina
Ntura!!y
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
Leighton Blount
Page 2 of 3
August 16, 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 w/n Wetlands or Waters
Sediment and erosion control measures shall not be placed in wetlands or waters to the maximum
extent practicable. If placement of sediment and erosion control devices in wetlands and waters
is unavoidable, they shall be removed and the natural grade restored within six months of the date
that the Division of Land Resources has released the project.
5. Diffuse Flow (Review)
All constructed stormwater conveyance outlets shall be directed and maintained to flow in a
diffuse manner at non-erosive velocities through the entire protected stream buffers without re-
concentrating. If this is not possible it may be necessary to provide stormwater facilities that are
considered to remove nitrogen. Additionally, a stormwater management plan for this project shall
be provided to this Office before any of the impacts approved herein are conducted. The plan
shall specify all stormwater discharge points, plan details, and calculations to indicate that diffuse
flow through the protected buffers or nitrogen removal as described above will be achieved.
6. Certificate of Completion
Upon completion of all work approved within the 401 Water Quality Certification or applicable
Buffer Rules, and any subsequent modifications, the applicant is required to return the attached
certificate of completion to the 401 Oversight/Express Review Permitting Unit, North Carolina
Division of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650.
Leighton Blount
Page 3 of 3
August 16, 2005
7. Deed Notifications
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 401/Wetlands Unit web site at
http://h2o.enr.state.nc.us/ncwetlands. The text of the sample deed notification may be modified
as appropriate to suit to this project.
Violations of any condition herein set forth may result in revocation of this Certification and may result in
criminal and/or civil penalties. The authorization to proceed with your proposed impacts or to conduct
impacts to waters as depicted in your application and as authorized by this Certification shall expire upon
expiration of the 404 or CAMA Permit.
If you do not accept any of the conditions of this Certification (associated with the approved wetland or
stream impacts), you may ask for an adjudicatory hearing. You must act within 60 days of the date that
you receive this letter. To ask for a hearing, send a written petition, which conforms to Chapter 150B of
the North Carolina General Statutes to the Office of Administrative Hearings, 6714 Mail Service Center,
Raleigh, N.C. 27699-6714. This certification and its conditions are final and binding unless you ask for a
hearing.
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 or Ian McMillan in the Central Office in
Raleigh at 919-733-1786 or Kyle Barnes in the DWQ Washington Regional Office at 252-946-6481.
AWK/ijnt
Enclosures: GC 3402
Certificate of Completion
cc: USACE Washington Regulatory Field Office
DWQ Washington Regional Office
DLR Washington Regional Office
File Copy
Central Files
Sincerely,
bra
Alan W. Klimek, P.E.
Filename: 051168131ount4(B eaufort)401
WA
? =1
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
July 11, 2005
DWQ Project # 05-1168
Beaufort County
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
Mr. Leighton Blount
3525 South Memorial Drive, Suite E
Greenville, NC 27834
Subject Property: Blount 4 - NWP 18
Aurora, Beaufort County, NC
REQUEST FOR MORE INFORMATION
Dear Mr. Blount:
AUf; Z i
DEAR :l E t .
On June 27, 2005, the Division of Water Quality (DWQ) received your application dated June
24, 2005 to impact 0.08 acres of wetlands to construct the proposed installation of two 24"
culverts to facilitate construction of a driveway to provide access to lots 4/3/2. 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 a$ incomplete until we receive this additional information. Please provide the following
information so that we may continue to review your project.
Additional Information Requested:
1. Please provide a County Soil Survey and USGS topographic map with your project
,/ boundaries located.
2. Your project is located in the Tar-Pamlico River Basin and within the 20 coastal counties.
According to the Riparian Buffer Rules, a 50' buffer shall begin at the landward limit of
coastal wetlands as defined by the Division of Coastal Management. Your project is
proposing impervious road surfaces in addition to potentially needing a general major
variance for lots 1-7. Please provide a determination from CAMA that supports this area is
not a coastal wetland.
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: htto://h2o.onr.state. naus/ncwetlands
No `hCarolina
,Naturally
An Equal Opportunity/Affirmative Action Employer- 50% Recycled/10% Post Consumer Paper
Leignton Blount:
Page 2 of 2
July 11, 2005:
3. Please show all wetland impacts including all fill slopes, dissipaters, and bank stabilization
on the site plan @ a I"=50' scale. If these wetland impacts are located in coastal wetlands,
please indicate the location of the protected buffers as overlays on the site plan and please
indicate all buffer impacts on the site plan as well.
Please respond within three weeks of the date of this letter by sending this information to me in
writing and Tom Steffens 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 Domey
at 919-733-1786 if you have any questions regarding or would like to set up a meeting to discuss
this matter.
Sincerely,
?a' b-? cf&w Cv\?
Ftf) Cyndi Karoly, Supervisor
401 Oversight/Express Review Permits Unit
CBKlijm
cc: Leighton Brown, 3525 South Memorial Drive, Greenville, NC 27834
Nom Steffens, DWQ Washington Regional Office
USACE Washington Regulatory Field Office
Doug Huggett, DCM
File Copy
Central Files
Filename: 051168BIount4(B eaufort) OnHoldMoreInfo
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North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Michael F. Easley, Governor Charles S. Jones, Director William G. Ross, Jr., Secretary
20 July 2005
Mr. Layton Blount
3525 S. Memorial Drive
Suite E
Greenville, NC 27834
Mr. Blount,
At your request, I revisited the four lots grouped together off SR1004 (Hickory Point Rd.),
adjacent to South Creek, near the Town of Aurora, in Beaufort County to determine if the
locations for the proposed driveways were located in coastal wetlands or not.
The proposed location for the driveway access to Lot #4 does not impact coastal wetlands. The
proposed location for the driveway access for Lots #2 and #3 lies just south of the flagged
boundary of the coastal wetlands and therefore, does not impact coastal wetlands. The coastal
wetland boundary was flagged 11 May 2005.
If you have any questions regarding this determination you may contact me on my direct line
number, 252-948-3950.
Sincerely,
Mike Thomas
Field Representative
NC Division of Coastal Management
943 Washington Square Mall, Washington, North Carolina 27889
Phone: [phone] FAX: [phone] Internet: www.nccoastalmanaeement.nett
51C,N*A*R4j?
SiGflf*A *A NA
LEIGHTON BLOUNT
Owner
[e-mail]
3525 South Memorial Dr. Office 252 321-7446
Suite E Fax [phone]
Greenville, NC 27834 Mobile [phone]
"Inde endentlyOwnedand erated"
Project: 20051168
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Subject: Project: 20051168 _YCL) "_
From: Laurie Dennison <[e-mail]>
Date: Thu, 14 Jul 2005 07:56:10 -0400
To: [e-mail]
Please see attached the Division of Water Quality's request for more information
related to your recent application. Please note that this message is being forwarded
to you electronically so that you may expedite preparation of your response. Please
do not send your response as a reply to this e-mail or via fax. All response
correspondence is to be mailed via hard copy to the 401 Oversight and Express Permits
Unit, 2321 Crabtree Blvd., Raleigh, NC, 27604 unless otherwise noted.
051168Blount4(Beaufort)OnHoldMoreOnfo.doe Content-Type: application/msword
Content-Encoding: base64

1 of 1 7/14/2005 7:56 AM
0F WATE9 Michael F. Easley, Governor
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DU1 William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources

-
-? Alan W. Klimek, P.E. Director
Division of Water Quality
July 11, 2005
DWQ Project # 05-1168
Beaufort County
CERTIFIED MAIL: RETURN RECEIPT REQUESTED
Mr. Leighton Blount
3525 South Memorial Drive, Suite E
Greenville, NC 27834
Subject Property: Blount 4 - NWP 18
Aurora, Beaufort County, NC
REQUEST FOR MORE INFORMATION
Dear Mr. Blount:
On June 27, 2005, the Division of Water Quality (DWQ) received your application dated June
24, 2005 to impact 0.08 acres of wetlands to construct the proposed installation of two 24"
culverts to facilitate construction of a driveway to provide access to lots 4/3/2. The DWQ has
determined that your application was incomplete and/or provided inaccurate information as
discussed below. The DWQ will require additional information in order to process your
application to impact protected wetlands and/or streams on the subject property. Therefore,
unless we receive the additional information requested below, we will have to move toward
denial of your application as required by 15A NCAC 2H.0506 and will place this project on
hold as incomplete until we receive this additional information. Please provide the following
information so that we may continue to review your project.
Additional Information Requested:
1. Please provide a County Soil Survey and USGS topographic map with your project
boundaries located.
2. Your project is located in the Tar-Pamlico River Basin and within the 20 coastal counties.
According to the Riparian Buffer Rules, a 50' buffer shall begin at the landward limit of
coastal wetlands as defined by the Division of Coastal Management. Your project is
proposing impervious road surfaces in addition to potentially needing a general major
variance for lots 1-7. Please provide a determination from CAMA that supports this area is
not a coastal wetland.
401 Oversigh0'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: http://h2o.enr.state.nc.us/ncwetiands
Nn` hC
oarolina
Naturallif
An Equal Opportunity/Affirmative Action Employer - 50% Recycled/10% Post Consumer Paper
Leighton Blount:
Page 2 of 2
July 11, 2005:
3. Please show all wetland impacts including all fill slopes, dissipaters, and bank stabilization
on the site plan @ a 1"=50' scale. If these wetland impacts are located in coastal wetlands,
please indicate the location of the protected buffers as overlays on the site plan and please
indicate all buffer impacts on the site plan as well.
Please respond within three weeks of the date of this letter by sending this information to me in
writing and Tom Steffens 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
at 919-733-1786 if you have any questions regarding or would like to set up a meeting to discuss
this matter.
Sincerely,
FIV Cyndi Karoly, Supervisor
401 Oversight/Express Review Permits Unit
CBKlijm
cc: Leighton Brown, 3525 South Memorial Drive, Greenville, NC 27834
Tom Steffens, DWQ Washington Regional Office
USACE Washington Regulatory Field Office
Doug Huggett, DCM
File Copy
Central Files
Filename: 051168Blount4(Beaufort)OnHoldMoreInfo

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UN 2 7 2005 >
DENR WATER QUALITY
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Pre-Construction Notification (PCI) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Mules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
xyww.saw.usace.amly.mil/wetlands/Permits.html.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at www.saw.usacc.army.niil/wetlands/index.litmi, or contact one of the field offices
listed on page 3 of this application. The website also lists the responsible project manager for each
county in North Carolina and provides additional information regarding the identification and regulation
of wetlands and waters of the U.S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://h2o.enr.state.nc.us/ncwetiands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for General Certifications is not required, provided
that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet should
contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on page 4 of this application) prior to submittal of the application.
Page 1 of 12
Coastal Area Management Act (CAMA) Coordination - If the project occurs in any of North Carolina's
twenty coastal counties (listed on page 4) the applicant should contact the North Carolina Division of
Coastal Management (DCM). DCM will determine whether or not the project is within a designated
Area of Environmental Concern, in which case DCM will act as the lead permitting agency. In such
cases, DCM will require a CAMA Permit and will coordinate the 404/401 Permits.
The applicant may also choose to coordinate with the United States Fish and Wildlife Service to ensure
that the proposed project will have no impact upon any endangered or threatened species or critical
habitat as regulated by the Endangered Species Act, and the State Historic Preservation Office, North
Carolina Department of Cultural Resources to ensure that the proposed project will have no impact upon
any properties listed or eligible for listing on the National Register of Historic Places. Compliance with
these regulations is required to be eligible for any Department of the Army permit. The addresses for
both agencies are listed on page 3 of this application.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office. Upon receipt of an application, the
USACE will determine if the application is complete as soon as possible, not to exceed 30 days. This
PCN form is designed for the convenience of the applicant to address information needs for all USACE
Nationwide, Regional or General permits, as well as information required for State authorizations,
certifications, and coordination. Fully providing the information requested on this form will result in a
complete application for any of the USACE Nationwide, Regional or General permits. To review the
minimum amount of information that must be provided for a complete PCN for each USACE
Nationwide permit, see Condition 13, 67 Fed. Reg. 2090 (Jan. 15, 2002), available at
littp://www.us,ice.anny mil/inet/functions/cw/cecwo/reg/2002n?yps.pdf. Processing times vary by
permit and begin once the application has been determined to be complete. Please contact the
appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wedands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at littp://h2o.ehnr.state.ne.us/ncwetlands/fees.litmi. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 12
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Caldwell Haywood McDowell
US Army Corps of Engineers Alleghany Catawba Henderson Mecklenburg
151 Patton Avenue Ashe Cherokee Iredell Mitchell
Room 208 Avery Clay Jackson Polk
Asheville, NC 28801-5006 Buncombe Cleveland Lincoln Rowan
Telephone: [phone] Burke Gaston Macon Rutherford
Fax: [phone] Cabanas Graham Madison Stanley
Raleigh Regulatory Field Office Alamance Franklin Nash Suny
US Army Corps Of Engineers Caswell Forsyth Northampton Vance
6508 Falls of the Neuse Road Chatham Granville Orange Wake
Suite 120 Davidson Guilford Person Warren
Raleigh, NC 27615 Davie Halifax Randolph Wilkes
Telephone: [phone] Durham Johnston Rockingham Wilson
Fax: [phone] Edgecombe Lee Stokes Yadkin
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladcn Hamett Pcndcr
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
US Fis
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
Division of Water Quality
Ecosystem Enhancement Program
1652 Mail Service Center
Raleigh, NC 27699-1652
Telephone: [phone]
Fax: [phone]
h and Wildlife Service / National M
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
Pitt
Tyrrell
Washington
Wayne
Swain
Transylvania
Union
Watauga
Yancey
*Croatan National Forest Only
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 276994617
Telephone: [phone]
Fax: [phone]
arine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivcrs Island
Beaufort, NC 28516
Telephone: [phone]
Page 3 of 12
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Pcrquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Allegharry Caldwell Watauga
38551dlewild Road Ashe Mitchell Wilkes
Keraersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
APPLICATION FORM BEGINS ON PAGE 5. PLEASE BO NOT SUBMIT PAGES 1- 4.
Page 4 of 12
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Office Use Only: Form Version March 05
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USACI•J Action ID No. DWQ No.
(If any particular item is not applicable to this Proicct. please enter "Not Annlicable" or "N/A"_)
I. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
© 401 Water Quality Certification ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: N 43 18
3. If this notification is solely a courtesy copy because written approval fbr the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details)'MM
IL Applicant Information D
JUN 2 7 2005
1. Owner/Applicant Information
Name: DENR-I WATER QUALITY
Mailing Address: S)DI
rn
CTT''e -t h u J11 c ti?? Z7 `tZ 3
Telephone Number: 2.r2 - 7 i y- 84, t, ? Fax Number: ?S2 - y? 3 -- o , 66
E-mailAddress: .S2r- n t hu 'l c e pCr/ /,:,k . ?, L
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 ownerlapplicant.)
Name:
Company Affiliation:
Mailing Address:
Telephone Number: Fax Number:
E-mail Address:
Page 5 of 12
IQ. 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: 8 !,- '?'+ L/
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): 65- LVV L5'-`/ 6S R ($--e 2 8
GS F? c-I l 3692-
4. Location
County: (3 ????br? Nearest Town:_ r?-
Subdivision name (include phasellot number):
Directions to site (include road numbers/names, landmarks, etc.):
/'?
.t/1_'! 33 C-I S Ay.-o V-a fake- le
3-r- 44 %_ -/#--n1 i11140 l/ickrmn4 O,A. 4Z j, NLiSR /0 5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
") . G9 86 °W
Decimal Degrees (6 digits minimum): r c ON
c S
6. Property size (acres): 12.9-3
7. Name of nearest receiving body of water: S-?? C"'e -c k
8. River Basin: i
(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/maw.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: R-c: +? • ? l An' /S e ;L -r -v, / 6 't-t )l Ir u e to e ?
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used:
/a Tce u i'? ( ?Z r?-?a Lt s e Z qn Z Crr-?., n I L-3 I t /3 < //-- I e E ;J
11. Explain the purpose of they proposed work: /??•'? ?? y -? /l?c'f 5 S
IV. Prior Project History
V.
VL
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. 0-k,-n 's t c-, 1 " a /TT3
{- k.rx 7Iib?.n.sc?h C•-aSs/'te t?e.S /lc L-% cr r?ti??.?ae,?e?
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.
o rY--r-
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. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should 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.
1. Provide a written descri tion of the proposed impacts:
Jai-c a o s •r J Fi 11 % X 2o A-C c

Page 7 of 12
2. Individually list wetland impacts. Types of 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 floodine_
Wetland Impact
Site Number
(indicate on map)
T5'Pa of Impact Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.) Located Nvithin
100 year
Floodplain
es/no Distance to
Nearest
Stream
(linear feet) Area of
Impact
(acres)
/ ?! !1 1`v?e5f e? ?t
?If ,
.Z5
Z /C1 I ?rv-? 'e f w C

Total Wetland Impact (acres)
3. List the total acreage (estimated) of all existing wetlands on the property: 9 ke_ -c5
4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, 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. To calculate acreage multi 1 len h X width, then divide b 43 560
Stream Impact
Number
indicate on ma
Stream Name
Type of Impact
Perennial or Intermittent? Average
Stream Width
Before Impact Impact
Length
linear feet Area of
Impact
(acres)

A /A

Total Stream Impact (by length and acreage)
5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, dyed in , floodin , drainage bulkheads etc
Open Water Impact
Site Number
indicate on ma) Name of Waterbody

(if applicable)
Type of Impact Type of Waterbody
(lake, pond, estuary, sound, bay,

ocean, etc. Area of
Impact

(acres)

Total Open Water Impact (acres)
Page 8 of 12
6. List the cumulative impact to all Waters nfthe TI R re.vdt;ncn frnm the nrr„rrt-
Stream Impact (acres): Nip
Wetland Impact acres :
Open Water Impact (acres):
Total Impact to Waters of the U.S. acres
Total Stream Impact (linear feet):
7. Isolated Waters
Do any isolated waters exist on the property? ? Yes ? No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.
S. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Current land use in the vicinity of the pond:
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. 2 1_-_' .'I t G -c 5A t.re-eJ
et?f lei.... ,L
rc-e
_K C, C__' t 11- f? rh r A-- //c t 4-0 <Z /I I- S, t., 4,4 jet, ?
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 January 15, 2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
littl):Hli2o.enr.state.nc.us/ncwetlands/strmgide.llttnl.
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.
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at http://h2o.enr.state.nc.us/wrp/index.him. If use of the NCEEP is proposed, please
check the appropriate box on page five 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.
X.
Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ? No ?
2. 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 ?
3. 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 ?
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.
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify. V Yes ? No ?
2. If "yes", 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*
2
Total
' Zone 1 extends out 30 feet perpcndici
additional 20 feet from the edge of Zone 1.
Multiplier
3 (2 for Catawba)
1.5
the top of the near bank or channel; Zone 2 extends an
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration I Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B .0242 or.0244, or.0260.
Page 11 of 12
XL
X11
Stormwater (required by DWQ)
Describe impervious acreage (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. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. 5.r 01
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.
1- 1 A sI -{
XHI. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No [d
Is this an after-the-fact permit application? Yes ? No ?
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ? No ?
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
httwMi2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description:
XV. 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).

G/2 y /? s-
Applicant/Agent's 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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Pre-(Construction Notification (PCB Application ]Form
QG
j
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
xv\v,%v. saw.usace. army. mil/wetlands/Permits. ht nil.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at wxvw.saw.usace.army.mil/wedandshndex.html, or contact one of the field offices
listed on page 3 of this application. The website also lists the responsible project manager for each
county in North Carolina and provides additional information regarding the identification and regulation
of wetlands and waters of the U. S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
hup:Hl12o.enr.state.tic.us/ncwetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for General Certifications is not required, provided
that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet should
contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on page 4 of this application) prior to submittal of the application.
Page 1 of 12
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Pre-Construction Notification (PCN) Application Form
QG
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
,vvNvw.saw.usace.arnly.mil/wetlands/Pemiits.litml.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at www.saw.usace.army.mi]/wetIandshndex.html, or contact one of the field offices
listed on page 3 of this application. The website also lists the responsible project manager for each
county in North Carolina and provides additional information regarding the identification and regulation
of wetlands and waters of the U. S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://l12o.enr.state.ne.us/newetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for General Certifications is not required, provided
that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet should
contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on page 4 of this application) prior to submittal of the application.
Page 1 of 12
Coastal Area Management Act (CAMA) Coordination - If the project occurs in any of North Carolina's
twenty coastal counties (listed on page 4) the applicant should contact the North Carolina Division of
Coastal Management (DCM). DCM will determine whether or not the project is within a designated
Area of Environmental Concern, in which case DCM will act as the lead permitting agency. In such
cases, DCM will require a CAMA Permit and will coordinate the 404/401 Permits.
The applicant may also choose to coordinate with the United States Fish and Wildlife Service to ensure
that the proposed project will have no impact upon any endangered or threatened species or critical
habitat as regulated by the Endangered Species Act, and the State Historic Preservation Office, North
Carolina Department of Cultural Resources to ensure that the proposed project will have no impact upon
any properties listed or eligible for listing on the National Register of Historic Places. Compliance with
these regulations is required to be eligible for any Department of the Army permit. The addresses for
both agencies are listed on page 3 of this application.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office. Upon receipt of an application, the
USACE will determine if the application is complete as soon as possible, not to exceed 30 days. This
PCN form is designed for the convenience of the applicant to address information needs for all USACE
Nationwide, Regional or General permits, as well as information required for State authorizations,
certifications, and coordination. Fully providing the information requested on this form will result in a
complete application for any of the USACE Nationwide, Regional or General permits. To review the
minimum amount of information that must be provided for a complete PCN for each USACE
Nationwide permit, see Condition 13, 67 Fed. Reg. 2090 (Jan. 15, 2002), available at
littp://w,,vw.usace.amiy.mil/inet/functions/cw/cecwo/rerV2002nwpUdf. Processing times vary by
permit and begin once the application has been determined to be complete. Please contact the
appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at littp://li2o.elinr.state.ne.us/newetIands/fees.litml. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 12
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Caldwell Haywood McDowell
US Army Corps of Engineers Alleghany Catawba Henderson Mecklenburg
151 Patton Avenue Ashe Cherokee Ircdell Mitchell
Room 208 Avery Clay Jackson Polk
Asheville, NC 28801-5006 Buncombe Cleveland Lincoln Rowan
Telephone: [phone] Burke Gaston Macon Rutherford
Fax: [phone] Cabarrus Graham Madison Stanley
Raleigh Regulatory Field Office Alamance Franklin Nash Surry
US Army Corps Of Engineers Caswell Forsyth Northampton Vance
6508 Falls of the Neuse Road Chatham Granville Orange Wake
Suite 120 Davidson Guilford Person Warren
Raleigh, NC 27615 Davie Halifax Randolph Wilkes
Telephone: [phone] Durham Johnston Rockingham Wilson
Fax: [phone] Edgecombe Lee Stokes Yadkin
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pcndcr
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
US Fis
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
Division of Water Quality
Ecosystem Enhancement Program
1652 Mail Service Center
Raleigh, NC 27699-1652
Telephone: [phone]
Fax: [phone]
h and Wildlife Service / National M
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
Pitt
Tyrrell
Washington
Wayne
Swain
Transylvania
Union
Watauga
Yancey
*Croatan National Forest Only
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 276994617
Telephone: [phone]
Fax: [phone]
arine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivers Island
Beaufort, NC 28516
Telephone: [phone]
Page 3 of 12
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638
Telephone: [phone] Bnmswick Currituck New Hanover Pergwmans

Fax: [phone] Camden
Carteret Dare
Grates Onslow
Pamlico Tyrrell
Washington

NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kernersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville NC 28786 Ctay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
APPLICATION FORM BEGINS ON PAGE S. PLEASE BO NOT SUBMIT PAGES 1- 4.
Page 4 of 12
P,ECEIV U
Office Use Only: Foam Vcrsion March 05
USACE Action ID No. DWQ No. <' + U
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
® 401 Water Quality Certification ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: N C'' / g
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 Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coas ppa
Environmental Concern (see the top of page 2 for further details), ch t49
IL Applicant Information JUN 2 7 2005
Owner/Applicant Information DENR - WATER QUALITY
Name: /- e #-14 4c,.-) /3 t o •f WETLANDS AND STORMWATER BRANCH
Mailing Address: ?s 2s" Ste:-k- E'
rr? th ?+1??c nlt- Z') 73 3f
Telephone Number: 2-,T-Z- 7/Y' 514t '8 Fax Number: ?.S2 - y93 - ???
E-mail Address: SRr' r?r r.,?.'?r c e E'41 /4/1:,k , na
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: Fax Number:
E-mail Address:
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: 8 ie 111-f l/
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): 65769 6-Y hSR (I.-R7.S``/?? 28
657 g? 7-5-
c5--/ 3692
4. Location
County: s3 e 2 ?b r Nearest Town: 4? ?? rt
Subdivision name (include phasellot number):
Directions to site (include road numbers/names, landmarks, etc.):
Nu ti 33 n -/ eke /,e
/1,%s kc-n- At.. del Nfi'iSR /Q??/
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing: of a distinct waterbody.)
Decimal Degrees (6 digits minimum): L/ " ON 4. O%
6. Property size (acres): f'Z , 9.3 /) c re t
7. Name of nearest receiving body of water: S? 4- fh Cf'f -c k
8. River Basin: l o ,
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at httpJ/h2o.enr.state.nc.us/adniin/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: R-c I Lh 4-,-.,- t to ?5 ?r t,, 14 ?Li ti it. V e tore
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used:
A p--,- a 1 1 .- r-% C' to e Z a., Z G9-4-...C 1 U. I (
tr 23
/ C-,-/ -.J 'C-4- /? Ce I I'VE ^-2 ' r4 u CG_Ch
11. Explain the purpose of th proposed work: l??•'? ? R<< 5 S
IV.
V.
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. k-ktn kj1r1-t p.?.??-..`,? `st c..& 1 " &, /
re, i?1?X ?I?o+-.n.e•r, C•-oS?Srcc "e.S Air &.1 C? ?zP1,-1 ac
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.
/V o "--r-
VL 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. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should 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.
1. Provide a written desc 'p lion of the proposed i Tpacts:
Arc p b J •t ? t? , /l 94 X 20 A" -
rr ?bSe.? - it no it 1d' /qrc•?
Page 7 of 12
2. Individually list wetland impacts. Types of 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 floodinn_
Wetland Impact

Site Number
(indicate on map)

Type of Impact Type of Wetland

(e.g., forested, marsh,
herbaceous, bog, etc.)
Located within
100 year
Floodplain
es/no)
Distance to
Nearest
Stream
(linear feet
Area of
Impact
(acres)

2 F. II ?arv-r .? f ' . C% t

Total Wetland Impact (acres)
3. List the total acreage (estimated) of all existing wetlands on the property: 0 Ae-r-5
4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, 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. To calculate acreage. multinly length X width then divirlP hu Al SF,n
Stream Impact
Number
indicate on ma)
Stream Name
Type of Impact
Perennial or Average
Stream Width
Before Impact Impact
Length
(finear feet) Area of
Impact
(acres)

A /A

Total Stream Impact (by length and acreage)
5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, dredging, flooding. drainage. bulkheads- etc.
Open Water Impact
Site Number
indicate on ma) Name of Waterbody
(if applicable)
Type of Impact Type of Waterbody
(lake, pond, estuary, sound, bay,
ocean, etc. Area of
Impact
(acres)

Total Open Water Impact (acres)
Page 8 of 12
6. List the cumulative impact to all Waters of the U.9- resnltinsr frnm the nmient-
Stream Impact (acres): !VIA
Wetland Impact acres : A
Open Water Impact (acres):
Total Impact to Waters of the U.S. (acres) M
Total Stream Impact (linear feet): _ AZ I'
7. Isolated Waters
Do any isolated waters exist on the property? ? Yes ? No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.
8. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Current land use in the vicinity of the pond:
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.-& 2 '_-, -mot t R < Sti APe J
rlc?r
# C' t I v -ems-•-S t-%) I I - 1Z, It'- I *C1 4-1- 19- t..3
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 January 15, 2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
littp://li2o.enr.state.nc.tis/ncwetlands/strmgide.litml.
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.
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at littp://h2o.enr.state.nc.us/wrp/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five 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.
X.
Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ? No ?
2. 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 ?
3. 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 ?
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.
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify )? Yes ? No ?
2. If "yes", 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.
3
type of mitigation is proposed (i.e.,
Enhancement, or Payment into the
appropriate information as identified
Zone* ( Impa Wit) Multiplier R ared
ware 1 3 (2 for Catawba)
2 1.5
Total
' Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what
Donation of Property, Riparian Buffer Restoration
Riparian Buffer Restoration Fund). Please attach all
within 15A NCAC 2B.0242 or.0244, or.0260.
Page 11 of 12
XL
XII.
Stormiyater (required by DWQ)
Describe impervious acreage (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. If percent impervious surface exceeds 20%, please provide calculations
f?, L
demonstrating total proposed impervious level. I--% Sr
'z a'/,
Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater enerated from the proposed project, or available capacity of the subject facility.
'.S YID ?'`G ? +T S? -r tM,
XDL Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 211.0500) or any Buffer Rules?
Yes El No [O
Is this an after-the-fact permit application? Yes ? No ?
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ? No ?
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
httl)-02o.enr.state.ne.us/ncwetlands. If no, please provide a short narrative description:
XV. 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).
'-? Fri i
6/2 y /,c, S-
Applicant/Agent's 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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DENR - WA[ER QUALITY
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Pre-Construction Notification (PCI) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
w"vw. saNv.usace. army. mil/wetlands/Permits. html.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at www.saw.usace.army.mil/wetlands/indcx.html, or contact one of the field offices
listed on page 3 of this application. The website also lists the responsible project manager for each
county in North Carolina and provides additional information regarding the identification and regulation
of wetlands and waters of the U.S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
ihttp://h2o.enr.state.nc.us/ncwetiands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for General Certifications is not required, provided
that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet should
contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on page 4 of this application) prior to submittal of the application.
Page 1 of 12
Coastal Area Management Act (CAMA) Coordination - If the project occurs in any of North Carolina's
twenty coastal counties (listed on page 4) the applicant should contact the North Carolina Division of
Coastal Management (DCM). DCM will determine whether or not the project is within a designated
Area of Environmental Concern, in which case DCM will act as the lead permitting agency. In such
cases, DCM will require a CAMA Permit and will coordinate the 404/401 Permits.
The applicant may also choose to coordinate with the United States Fish and Wildlife Service to ensure
that the proposed project will have no impact upon any endangered or threatened species or critical
habitat as regulated by the Endangered Species Act, and the State Historic Preservation Office, North
Carolina Department of Cultural Resources to ensure that the proposed project will have no impact upon
any properties listed or eligible for listing on the National Register of Historic Places. Compliance with
these regulations is required to be eligible for any Department of the Army permit. The addresses for
both agencies are listed on page 3 of this application.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office. Upon receipt of an application, the
USACE will determine if the application is complete as soon as possible, not to exceed 30 days. This
PCN form is designed for the convenience of the applicant to address information needs for all USACE
Nationwide, Regional or General permits, as well as information required for State authorizations,
certifications, and coordination. Fully providing the information requested on this form will result in a
complete application for any of the USACE Nationwide, Regional or General permits. To review the
minimum amount of information that must be provided for a complete PCN for each USACE
Nationwide permit, see Condition 13, 67 Fed. Reg. 2090 (Jan. 15, 2002), available at
http://www.usace.army.miI/inet/functions/cw/ceewo/re 2002nwps pdf. Processing times vary by
permit and begin once the application has been determined to be complete. Please contact the
appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at littp:Hii2o.chnr.state.nc.us/ncwetlands/fees.litmi. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 12
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Caldwell Haywood McDowell
US Army Corps of Engineers Allcghany Catawba Henderson Mecklenburg
151 Patton Avenue Ashe Cherokee Ir edell Mitchell
Room 208 Avery Clay Jackson Polk
Asheville, NC 28801-5006 Buncombe Cleveland Lincoln Rowan
Telephone: [phone] Burke Gaston Macon Rutherford
Fax: [phone] Cabarms Graham Madison Stanley
Raleigh Regulatory Field Office Alamance Franklin Nash Surry
US Army Corps Of Engineers Caswell Forsyth Northampton Vance
6508 Falls of the Ncuse Road Chatham Granville Orange Wake
Suite 120 Davidson Guilford Person Warren
Raleigh, NC 27615 Davie Halifax Randolph Wilkes
Telephone: [phone] Durham Johnston Rockingham Wilson
Fax: [phone] Edgecombe Lee Stokes Yadkin
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
North Carolina State Agencies
Division of Watcr Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
US Fis
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
Division of Water Quality
Ecosystem Enhancement Program
1652 Mail Service Center
Raleigh, NC 27699-1652
Telephone: [phone]
Fax: [phone]
h and Wildlife Service / National M
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
Pitt
Tyrrell
Washington
Wayne
Swain
Transylvania
Union
Watauga
Yancey
*Croatan National Forest Only
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 276994617
Telephone: [phone]
Fax: [phone]
arine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivers Island
Beaufort, NC 23516
Telephone: [phone]
Page 3 of 12
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Pcrquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Crates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Allcghany Caldwell Watauga.
3855 Idlewild Road Ashe Mitchell Wilkes
Kcrnersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
APPLICATION FORM BEGINS ON PAGE 5. PLEASE DO NOT SUBMIT PAGES 1- 4.
Page 4 of 12
rj,iv N
Office Use Only: Form Version March 05
USACE Action ID No. DWQ No.' `-
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
L Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
® 401 Water Quality Certification ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: N w I V
3. If this notification is solely a courtesy copy because written approval fbr the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area -of
Environmental Concern (see the top of page 2 for further details), check t
IL Applicant Information 2 7 2005
1. Owner/Applicant Information cENR-WATERauAUTti'
Name: /_e-1344o.? istot?r?-I- y TLpNoSANDSTOREIIYdkTERB?tvi?Y
Mailing Address: 3s 2 S a .- ?1, M o c;./ o,-. S •1t E
Gr?c???.,,flJc . lilt. 27 t'`i3%
Telephone Number: zrz - IiV- F4 c ? Fax Number: ?S2 - Y93 0? ?
E-mail Address: .Skr' 3r -c e h -'I r c e z 4-Cr/I, /,:nk , n c.L
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: Fax Number:
E-mail Address:
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: /3 tv '?'+ 7
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): 65- L V7 (-.S- 8 ) / C ..'r8 7:S- y ?S?T 2-
-5- F7 LI-V 3622
4. Location
County: 13 t -L,-A. r?- Nearest Town: 14 4??'0 ??
Subdivision name (include phase/lot number):
Directions to site (include road numbers/names, landmarks, etc.):
.Nus 33 4 .Mu_'5C.-2S Ay.-m/?-' -{4ke- /POP
--_3tC 44i-S 4&--n I ;#,1 10 r/ickc'c- {PAI IV al -S
/eve/
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossinn of a distinct waterbody.)
Decimal Degrees (6 digits minimum): -1 12' °N 4. 47 86 °w
6. Property size (acres): 1Z.93 n c s
7. Name of nearest receiving body of water: 5-1 -A C'',e -c k
8. River Basin: % , ro"
(Note -- this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://112o.enr.state.nc.us/admin/mans/.)
9. Describe the existing conditions on the site and get
at the time of this application: R-e s ; I u, 4-,
land use in the vicinity of the project
1a t5 4C:L tr -v-_ / 1t 9-01 le u e of -e
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used:
p?-« s x'11 13,p- f".c% lu V. Z 4., Z
'Z Y " Ctrl v { P/aee x.-21 ?•c -o F'--C?e( - ---
11. Explain the purpose of th proposed work: 1??.'y ?e Y 4e Ae f 5 S
/zi-14S `/ / 2 / 7
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules. N OJ- to L--trl-t P?•-??`? , s t c 1 ?. /? 4 2,
{t: M,-x 7-/,0
C?aSS r''c
L.3 t, r
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.
A/ c, ry-r-
VL 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. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should 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.
1. Provide a written desc ' tion of the propos
A'Opo J•r C !L F, Y/
iTpacts*
X 20 Ate <-
0 jease i 1-17( no x /S- /9rct-
CJ
Page 7 of 12
2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
sevarately list impacts due to both structure and flooding.
Wetland Impact
Site Number
(indicate on map)
Type of Impact Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.) Located within
100 year
Floodplain
cslno Distance to
Nearest
Stream
linear feet Area of
Impact
(acres)

2 F.'ll ? ? -? f ' • C%

Total Wetland Impact (acres)
3. List the total acreage (estimated) of all existing wetlands on the property: 0 Ac.-5
4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, 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. To calculate acreage. multiply length X width- then divide by 43 560
Stream Impact
Number
(indicate on ma)
Stream Name
Type of Impact Perennial or
Intermittent? Average -
Stream Width
Before Im act -- -Impact - -
Length
linear feet Area of
Impact
(acres)

Total Stream Impact (by length and acreage)
5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, dredging, floodin , drainage, bulkheads, etc.
Open Water Impact
Site Number
(indicate on ma) Name of Waterbody

(? applicable)
Type of Impact Type of Waterbody
(lake, pond, estuary, sound, bay,

ocean, etc.) Area of
Impact

acres

Total Open Water Impact (acres)
Page 8 of 12
6. List the cumulative impact to all Waters of the U.S. resulting from the nroiect-
Stream Impact (acres): IVIA
Wetland Impact acres : A
Open Water Impact (acres): Al -A
Total Impact to Waters of the U.S. (acres) M 1,A
Total Stream Impact linear feet):
7. Isolated Waters
Do any isolated waters exist on the property? ? Yes ? No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.
Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Current land use in the vicinity of the pond:
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. 2 A, +.e,)
et??

-?_ ?t1vY•-•?-S ?.?.fy1? !? /h?s?1/c2 .-?-r, c//?.?,• ?Q,? ?'jec,..?
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 January 15, 2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
littp://h2o.enr.state.nc.us/ncwetlands/strmf;ide.lhtml.
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.
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at littp://li2o.enr.statc.nc.us/wrp/indox.fitm. If use of the NCEEP is proposed, please
check the appropriate box on page five 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)
1. Does the project involve an expenditure of public (federal/stateAocal) funds or the use of
public (federal/state) land? Yes ? No ?
2. 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 ?
3. If yes, has the document review been finalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SEPA final approval letter. Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify V Yes ? No ?
2. If "yes", 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.
#
Zane Impact
(square feet)
Multiplier Required
Miti
gation. 3 (2 for Catawba)
2 1.5
Total
V "Lone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration / Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B .0242 or.0244, or.0260.
Page 11 of 12
XL Stormwater (required by DWQ)
Describe impervious acreage (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. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. f -,T Sr fA ??.
XII. SeNvage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater enerated from the proposed project, or available capacity of the subject facility.
XM. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 211.0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application? Yes ? No ?
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ? No ?
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
http:02o.enr.state.nc.us/newetlands. If no, please provide a short narrative description:
XV. 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).
6/2
Applicant/Agent's 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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Pre-Construction Notification (PCN) Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
?vNv-\v.saiv.usace.arnly.mil/xvetlands/Perniits.litmi.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at www.saw.usace.army.mil/wetlands/index.html, or contact one of the field offices
listed on page 3 of this application. The website also lists the responsible project manager for each
county in North Carolina and provides additional information regarding the identification and regulation
of wetlands and waters of the U. S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wedands Unit website at
http://h2o.enr.state.nc.us/ncwetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for General Certifications is not required, provided
that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet should
contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on page 4 of this application) prior to submittal of the application.
Page 1 of 12
Coastal Area Management Act (CAMA) Coordination - If the project occurs in any of North Carolina's
twenty coastal counties (listed on page 4) the applicant should contact the North Carolina Division of
Coastal Management (DCM). DCM will determine whether or not the project is within a designated
Area of Environmental Concern, in which case DCM will act as the lead permitting agency. In such
cases, DCM will require a CAMA Permit and will coordinate the 404/401 Permits.
The applicant may also choose to coordinate with the United States Fish and Wildlife Service to ensure
that the proposed project will have no impact upon any endangered or threatened species or critical
habitat as regulated by the Endangered Species Act, and the State Historic Preservation Office, North
Carolina Department of Cultural Resources to ensure that the proposed project will have no impact upon
any properties listed or eligible for listing on the National Register of Historic Places. Compliance with
these regulations is required to be eligible for any Department of the Army permit. The addresses for
both agencies are listed on page 3 of this application.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office. Upon receipt of an application, the
USACE will determine if the application is complete as soon as possible, not to exceed 30 days. This
PCN form is designed for the convenience of the applicant to address information needs for all USACE
Nationwide, Regional or General permits, as well as information required for State authorizations,
certifications, and coordination. Fully providing the information requested on this form will result in a
complete application for any of the USACE Nationwide, Regional or General permits. To review the
minimum amount of information that must be provided for a complete PCN for each USACE
Nationwide permit, see Condition 13, 67 Fed. Reg. 2090 (Jan. 15, 2002), available at
http://www.usace.army.niil/inet/functions/cw/ceewo/re > 2002nwps.pdf. Processing times vary by
permit and begin once the application has been determined to be complete. Please contact the
appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief, if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at littp:Hli2o.elinr.stite.iie.us/newetlajids/fees.litm]. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 12
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Caldwell Haywood McDowell
US Army Corps of Engineers Alleghany Catawba Henderson Mecklenburg
151 Patton Avenue Ashe Cherokee Iredell Mitchell
Room 208 Avery Clay Jackson Polk
Asheville, NC 28801-5006 Buncombe Cleveland Lincoln Rowan
Telephone: [phone] Burke Gaston Macon Rutherford
Fax: [phone] Cabarrus Graham Madison Stanley
Raleigh Regulatory Field Office Alamance Franklin Nash Surry
US Army Corps Of Engineers Caswell Forsyth Northampton Vance
6508 Falls of the Neuse Road Chatham Granville Orange Wake
Suite 120 Davidson Guilford Person Warren
Raleigh, NC 27615 Davie Halifax Randolph Wilkes
Telephone: [phone] Durham Johnston Rockingham Wilson
Fax: [phone] Edgecombe Lee Stokes Yadkin
Washington Regulatory Field Office Beaufort Currituck Jones
US Army Corps Of Engineers Bertie Dare Lenoir
Post Office Box 1000 Camden Gates Martin
Washington, NC 27889-1000 Carteret* Green Pamlico
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Pender
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
US Fis
US Fish and Wildlife Service
Raleigh Field Office
Post Office Box 33726
Raleigh, NC 27636-3726
Telephone: [phone]
Division of Water Quality
Ecosystem Enhancement Program
1652 Mail Service Center
Raleigh, NC 27699-1652
Telephone: [phone]
Fax: [phone]
h and Wildlife Service / National M
US Fish and Wildlife Service
Asheville Field Office
160 Zillicoa Street
Asheville, NC 28801
Telephone: [phone]
Pitt
Tyrrell
Washington
Wayne
Swain
Transylvania
Union
Watauga
Yancey
*Croatan National Forest Only
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 276994617
Telephone: [phone]
Fax: [phone]
arine Fisheries Service
National Marine Fisheries Service
Habitat Conservation Division
Pivcrs Island
Beaufort, NC 28516
Telephone: [phone]
Page 3 of 12
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasgaotank
1638 Mail Service Center Bcrtie Craven Hyde Pendcr
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Pcrquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties,
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kernersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
APPLICATION FORM BEGINS ON PAGE 5. PLEASE BO NOT SUBMIT PAGES 1- 4.
Page 4 of 12
i I I
11C1,?
Office Use Only: Form Vcrsion March 05
0 11
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
L Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
© 401 Water Quality Certification ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: N ?*-' If
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 Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check [ROW hheer7e: ?
II. Applicant Information D O
D
Q
1. Owner/Applicant Information
Name:
JUN 2 7 2005
Mailing Address: ?s 2 s r It, t?? P </ °> a s c ?RA? H
Gr V -t h v s'll Nit-
Telephone $ 3 `/
Telephone Number: Z5--7- 7 i Y- ,A & IF Fax Number: ?S2 - yY 3 -- e ?
E-mail Address: Sar 3rKr?,?•.'??< a z4- rA/,:,k,nc.
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: Fax Number:
E-mail Address:
Page 5 of 12
IM 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: /? io 1?1-1+ r/
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): LS-?9 d-`/ &59 28
GS F7 LV-/ 3692
4. Location
County: c •??er,? Nearest Town:
Subdivision name (include phase/lot number):
Directions to site (include road numbers/names, landmarks, etc.):
3t`?I '/tips 46_nI ;P1 10 NIC/Cany Vii. v\J "CSR /Q?y '_
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum):L12' °N '7 , b? 86
6. Property size (acres): 12.93 0?.•-? <
7. Name of nearest receiving body of water: S--' -1h Cff -c k
8. River Basin: % ?- I?
(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: ?-? s 4-•-:. 1 le, f5 rr c*. f /H ?? d? u e /?? e
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used:
n" a Lu Q c? an Z Crr-w c 1 v? l /3 c /?:. (c l %?
RICL-Ce I I' G.
-k /1 c? 5 S
11. Explain the purpose of they proposed work: L-3' -!j
IV.
V.
VL
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. 4-kn ?- 1 " 1, /9!? 3
1c? /1/17-4b o6,P.4ep) C-b55r cc t?c.S At-cr /'Lp.-,4
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.
A/c, rY-e,
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. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should 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.
1. Provide a written descXt ion of the proposed impacts:
i-cpa s M ? FiY( - 96 tprX 20 .4
A r jelly 1 /-JI( I x /S- A.-
Page 7 of 12
2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
se aratel list impacts due to both structure and floodin .
Wetland Impact
Site Number
(indicate on map)
Type of Impact Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.) Located within
100 year
FloodpLvn
es/no Distance to
Nearest
Stream
(linear feet Area of
Impact
(acres)
/ ?( -FvreS?-ed rt I ,
Z F? II ?r,-? .? f ? . r

Total Wetland Impact (acres)
3. List the total acreage (estimated) of all existing wetlands on the property: 9 A/_'-5
4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, 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. To calculate acreage, multit)ly length X width. then divide by 43.560.
Stream Impact
Number
indicate on ma)
Stream Name
Type of Impact Perennial or
Intermittent? Average
Stream Width
Before Impact Impact
Length
linear feet Area of
Impact
(acres)

A 11A

Total Stream Impact (by length and acreage)
5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, dredging, flooding, drainage, bulkheads, etc.
Open Water Impact
Site Number
(indicate on ma) Name of Waterbody

(if applicable)
Type of Impact Type of Watcrbody
(lake, pond, estuary, sound, bay,
ocean, etc. Area of
Impact
(acres)

Total Open Water Impact (acres)
Page 8 of 12
6. List the cumulative impact to all Waters nfthe TT 4 rrc,ittino frnm the nrninrt-
Stream Impact (acres):
Wetland Impact acres :
Open Water Impact acres):
Total Impact to Waters of the U. S. acres
Total Stream Impact (linear feet):
7. Isolated Waters
Do any isolated waters exist on the property? ? Yes ? No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.
8. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Current land use in the vicinity of the pond:
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.-t 2 '_., 0 t /3 -c Sl, Lr??
?L
cat!`.-e-?S ??11- !? ohs !/<L 40 SY S5 E-3
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 January 15, 2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
http://li2o.enr.state.nc.iis/ncwetlands/stnngide.litml.
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.
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at hup://h2o.enr.state.nc.us/wrp/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five 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)
1. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes ? No ?
2. 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 ?
3. If yes, has the document review been finalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SEPA final approval letter. Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify V Yes ? No ?
2. If "yes", identify the square feet and acreage of impact to each zone of the riparian buffers.
If buffer mitigation is required calculate the required amount of mitigation by applying the
buffer multipliers.
Zone* Impact
(square feet Multiplier Required
Miti
gation 3 (2 for Catawba)
2 1.5
Total
- cone i cmenas out w feet pctpenaicutar Irom the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration / Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B .0242 or.0244, or.0260.
Page 11 of 12
XL Stormwater (required by DWQ)
Describe impervious acreage (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. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level._!--, Q er s ?? /'c s f f? ??
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater enerated from the proposed project, or available capacity of the subject facility.
S Y-0 A;-/- 2=4
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 211.0500) or any Buffer Rules?
Yes? No[-
Is this an after-the-fact permit application? Yes ? No ?
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ? No ?
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
littp:Hli2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description:
XV. 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).

6/2 y /z, s-
Applicant/Agent's 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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JUN 2 7 2005
DENR -WATER QUALITY p
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Pre-Construction Notification (PCB Application Form
For Section 404 and/or Section 10 Nationwide, Regional and General Permits, Section 401
General Water Quality Certifications, and Riparian Buffer and Watershed Buffer Rules
This form is to be used for projects qualifying for any of the U.S. Army Corps of Engineers' (USACE)
Nationwide, Regional or General Permits as required by Section 404 of the Clean Water Act and/or
Section 10 of the Rivers and Harbors Act, and for the North Carolina Division of Water Quality's
(DWQ) associated General 401 Water Quality Certifications. This form is also to be used for any
project requiring approval under any Riparian Buffer Rules implemented by the N.C. Division of Water
Quality. This form should not be used if you are requesting an Individual 404 Permit or Individual 401
Water Quality Certification. The USACE Individual Permit application form is available online at
wNvw saw.usace.army.mil/wetlands/Permit s.lhtml.
The USACE is the lead regulatory agency. To review the requirements for the use of Nationwide,
Regional or General permits, and to determine which permit applies to your project, please go to the
USACE website at xvww.saw.usace.army.mil/wetlands/index.html, or contact one of the field offices
listed on page 3 of this application. The website also lists the responsible project manager for each
county in North Carolina and provides additional information regarding the identification and regulation
of wetlands and waters of the U.S.
The DWQ issues a corresponding Certification (General or Individual), and cannot tell the applicant
which 401 Certification will apply until the 404 Permit type has been determined by the USACE.
Applicants are encouraged to visit DWQ's 401/Wetlands Unit website at
http://112o.enr.state.nc.us/newetlands to read about current requirements for the 401 Water Quality
Certification Program and to determine whether or not Riparian Buffer Rules are applicable. The
applicant is also advised to read the full text of the General Certification (GC) matching the specific 404
Permit requested. In some cases, written approval for General Certifications is not required, provided
that the applicant adheres to all conditions of the GC. Applicants lacking access to the internet should
contact DWQ's Central Office in Raleigh at [phone].
Trout Waters Coordination - Special coordination with the North Carolina Wildlife Resources
Commission (NCWRC) is required for projects occurring in any of North Carolina's twenty-five
counties that contain trout waters. In such cases, the applicant should contact the appropriate NCWRC
regional coordinator (listed by county on page 4 of this application) prior to submittal of the application.
Page 1 of 12
Coastal Area Management Act (CAMA) Coordination - If the project occurs in any of North Carolina's
twenty coastal counties (listed on page 4) the applicant should contact the North Carolina Division of
Coastal Management (DCM). DCM will determine whether or not the project is within a designated
Area of Environmental Concern, in which case DCM will act as the lead permitting agency. In such
cases, DCM will require a CAMA Permit and will coordinate the 404/401 Permits.
The applicant may also choose to coordinate with the United States Fish and Wildlife Service to ensure
that the proposed project will have no impact upon any endangered or threatened species or critical
habitat as regulated by the Endangered Species Act, and the State Historic Preservation Office, North
Carolina Department of Cultural Resources to ensure that the proposed project will have no impact upon
any properties listed or eligible for listing on the National Register of Historic Places. Compliance with
these regulations is required to be eligible for any Department of the Army permit. The addresses for
both agencies are listed on page 3 of this application.
USACE Permits - Submit one copy of this form, along with supporting narratives, maps, data forms,
photos, etc. to the applicable USACE Regulatory Field Office. Upon receipt of an application, the
USACE will determine if the application is complete as soon as possible, not to exceed 30 days. This
PCN form is designed for the convenience of the applicant to address information needs for all USACE
Nationwide, Regional or General permits, as well as information required for State authorizations,
certifications, and coordination. Fully providing the information requested on this form will result in a
complete application for any of the USACE Nationwide, Regional or General permits. To review the
minimum amount of information that must be provided for a complete PCN for each USACE
Nationwide permit, see Condition 13, 67 Fed. Reg. 2090 (Jan. 15, 2002), available at
littp:/hvww.usace.army.niii/inet/functions/cw/cecwo/rea/2002nwps pdf. Processing times vary by
permit and begin once the application has been determined to be complete. Please contact the
appropriate regulatory field office for specific answers to permit processing periods.
401 Water Quality Certification or Buffer Rules - All information is required unless otherwise stated
as optional. Incomplete applications will be returned. Submit seven collated copies of all USACE
Permit materials to the Division of Water Quality, 401/Wetlands Unit, 1650 Mail Service Center,
Raleigh, NC, 27699-1650. If written approval is required or specifically requested for a 401
Certification, then a non-refundable application fee is required. In brief; if project impacts include less
than one acre of cumulative wetland/water impacts and less than 150 feet cumulative impacts to
streams, then a fee of $200 is required. If either of these thresholds is exceeded, then a fee of $475 is
required. A check made out to the North Carolina Division of Water Quality, with the specific name of
the project or applicant identified, should be stapled to the front of the application package. For more
information, see the DWQ website at http:02o.ehnr.state.nc.us/newetlands/fees.html. The fee must be
attached with the application unless the applicant is a federal agency in which case the check may be
issued from a separate office. In such cases, the project must be identifiable on the U.S. Treasury check
so that it can be credited to the appropriate project. If written approval is sought solely for Buffer Rules,
the application fee does not apply, and the applicant should clearly state (in a cover letter) that only
Buffer Rule approval is sought in writing. Wetlands or waters of the U.S. may not be impacted prior to
issuance or waiver of a Section 401 Water Quality Certification. Upon receipt of a complete application
for a 401 Certification, the Division of Water Quality has 60 days to prepare a written response to the
applicant. This may include a 401 Certification, an on-hold letter pending receipt of additional
requested information, or denial.
Page 2 of 12
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Caldwell Haywood McDowell Sivain
US Army Corps of Engineers Alleghany Catawba Henderson Mecklenburg Transylvania
151 Patton Avenue Ashe Cherokee Irrdell Mitchell Union
Room 208 Avery Clay Jackson Polk Watauga
Asheville, NC 28801-5006 Buncombe Cleveland Lincoln Rowan Yancey
Telephone: [phone] Burke Gaston Macon Rutherford
Fax: [phone] Cabarrus Graham Madison Stanley
Raleigh Regulatory Field Office Alamance Franklin Nash Surry
US Army Corps Of Engineers Caswell Forsyth Northampton Vance
6508 Falls of the Neuse Road Chatham Granville Orange Wake
Suite 120 Davidson Guilford Person Warren
Raleigh, NC 27615 Davie Halifax Randolph Wilkes
Telephone: [phone] Durham Johnston Rockingham Wilson
Fax: [phone] Edgecombe Lee Stokes Yadkin
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers Bertic Dare Lenoir Tyrrell
Post Office Box 1000 Camden Gates Martin Washington
Washington, NC 27889-1000 Carteret* Green Pamlico Wayne
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans *Croatan National Forest Only
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Ponder
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
North Carolina State Agencies
Division of Water Quality
401 Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
Telephone: [phone]
Fax: [phone]
Division of Water Quality
Ecosystem Enhancement Program
1652 Mail Service Center
Raleigh, NC 27699-1652
Telephone: [phone]
Fax: [phone]
State Historic Preservation Office
Department Of Cultural Resources
4617 Mail Service Center
Raleigh, NC 276994617
Telephone: [phone]
Fax: [phone]
US Fish and Wildlife Service / National Marine Fisheries Service
US Fish and Wildlife Service US Fish and Wildlife Service National Marine Fisheries Service
Raleigh Field Office Asheville Field Office Habitat Conservation Division
Post Office Box 33726 160 Zillicoa Street Pivers Island
Raleigh, NC 27636-3726 Asheville, NC 28801 Beaufort, NC 28516
Telephone: [phone] Telephone: [phone] Telephone: [phone]
Page 3 of 12
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638
Telephone: [phone] Brunswick Currituck New Hanover Perquimans

Fax [phone] Camden Dare Onslow Tyrrell
Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kcruersville, NC 27284-9180 Avery Sto =
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynewft NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDowell Yancey
APPLICATION FORM BEGINS ON PAGE 5. PLEASE DO NOT SUBMIT PAGES 1- 4.
Page 4 of 12
LIVE0
Office Use Only: Fonn Vcrsion March 05
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. Processing
1. Check all of the approval(s) requested for this project:
® Section 404 Permit ? Riparian or Watershed Buffer Rules
? Section 10 Permit ? Isolated Wetland Permit from DWQ
® 401 Water Quality Certification ? Express 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: IQ w / 8
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 Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: ?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ? nn
II. Applicant Information R ( P 0d =1 U
1. Owner/Applicant Information JUN 2 7 2005
Name: /_ a si i A 4,-.^ /3l o? n? Mmp - WATI:P r)l 1A, 17-11
Mailing Address: ?s2s- s--ON ti atgST(LW.WA1-ERbRANC+
Cr?Yh`+??IIC Nit- Z-) 83y
Telephone Number: 'es-7- Fax Number: ?S2 - `/93 -- o o gab
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: Fax Number:
E-mail Address:
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: 8 (2'f 7
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): 6rLV7 6-Y NS$ ? J (., _!re y?SS 28
6S ?? CS'`/ 369 2
4. Location
County: f3c?,??'?r,t Nearest Town:
Subdivision name (include phase/lot number):
Directions to site (include road numbers/names, landmarks, etc.):
Y-!X 33 W.-VU-n. C-IS lai..b"A' -f4ke_ IeAt , fly)
P-A, RJ ?QS R /Q,:, Y
5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum): ON -:724, 4796 OW
6. Property size (acres): 12 Z. 9 3 /? c t
7. Name of nearest receiving body of water: 5-1 ?4k k
8. River Basin: r T' (Note -- this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://li2o.enr.state.ne.us/admin/maps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
{ ?? {? /y ?e ?? e /v? e
at the time of this application: R-? s t c ?• 1 Ants
r If
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used:
A r,, t s i'I 1 R? rtib I.is e Z Q.n Z Crr-w •c 1 u i ( /1< 2At? P/01 CeI ?'1.s N1aLJ(-C yr CC-C4
IV.
V.
VL
11. Explain the purpose of th proposed work:
1--,4s C/ / 2 / 2-
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. /Vg-kbn kjQ-t st s- t " k 1273
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.
A/ c, sti ff
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. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should 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.
1. Provide a written descri tion of the proposed iiypacts:
A-0 p M ?r it A" Z
A0 pbse r %( / x 1d- Arct
Page 7 of 12
2. Individually list wetland impacts. Types of 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.
Wetland Impact
Site Number
(indicate on map)
Type of Impact Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.) Located within
100 year
Floodplain
cs/no Distance to
Nearest
Stream
(linear feet Area of
Impact
(acres)

Total Wetland Impact (acres)
3. List the total acreage (estimated) of all existing wetlands on the property: 0 Az,--,5
4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, 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. To calculate acreage, multiply length X width, then divide by 43.560.
Stream Impact
Number
(indicate on ma)
Stream Name
Type of Impact Perennial or
Intermittent? Average
Stream Width
Before Impact Impact
Length
linear feet Area of
Impact
(acres)

A/ A

Total Stream Impact (by length and acreage)
5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, dredging, flooding, drainage, bulkheads, etc.
Open Water Impact
Site Number
indicate on ma) Name of Watcrbody
(if applicable)
Type of Impact Type of Waterbody
(lake, pond, estuary, sound, bay,
ocean, etc. Area of
Impact
(acres)

Total Open Water Impact (acres)
Page 8of12
6. List the cumulative impact to all Waters of the U. S. resulting from he project:
Stream Impact (acres): &Z A
Wetland Impact acres : A
Open Water Impact acres): A/ Y-A
Total Impact to Waters of the U. S. (acres) MIA
Total Stream Impact (linear feet):
7. Isolated Waters
Do any isolated waters exist on the property? ? Yes ? No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.
8. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Current land use in the vicinity of the pond:
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. _& 2 •'t ( /3 -r-
S?? Lr??
Z ?.L ?? A eatr"-f ?
ycV R,-K .A 1 A --" /-V' c:' cccse /L.!, ?- V
# c+t! •e.---S x)11- /L rhff/-1 1/c1 40 c11 V u'Q41-- OCI,-CO
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 January 15, 2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
littp://h2o.enr.state.nc.us/ncwe.tl,inds/stnngide html.
Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at http://h2o.enr.state.nc.us/wrp/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five 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
XL
IX.
X.
Stormwater (required by DWQ)
Describe impervious acreage (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. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. ? r_ ???5 ?? ` sr- -- -04- &-N
Environmental Documentation (required by DWQ)
1. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federaUstate) land? Yes ? No ?
2. 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, can the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
3. 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 ?
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.
1. Will the project impact protected riparian buffers identified within 15A NCAC 213 .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify )? Yes ? No ?
2. If `yes', 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.
* Impact Required
Zone (square feet Multiplier Mitt lion
l 3 (2 for Catawba)
2 1.5
Total
' Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration / Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all appropriate information as identified
within 15A NCAC 2B .0242 or.0244, or.0260.
Page 11 of 12
XL Stormwater (required by DWQ)
Describe impervious acreage (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. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. Sr A
XIL Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater ggenerated from the proposed project, or available capacity of the subject facility.
:5 ? K <, ., s1 -r.,
XM. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 211.0500) or any Buffer Rules?
Yes ? No [
Is this an after-the-fact permit application? Yes ? No ?
XIV. Cumulative Impacts (required by DWQ)
Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes ? No ?
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
http://h2o.enr.st,ite.nc.us/ncwetlands. If no, please provide a short narrative description:
XV. 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).

612 y /,n, s-
Applicant/Agent's 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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T.E. GUILFORD TRACT
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42' SS Who Reviewed:
DWQ# Date
plan Detail Incomplete
? Please provide a location map f r the project. I ,t = ?U 1
?c
Please show all stream impacts including all fill slopes, dissipaters, and bank stabilization on the site plan. S (1
Please show all wetland impacts including fill slopes.on the site plan. _
Please indicate all buffer impacts on the site plan. i _? Q`r CSC. k S Ca ?DVL
? Please indicate proposed lot layout as overlays on the site plan.
Please indicate the location of the protected buffers as overlays on the site plan`l
? Please locate all isolated or non-isolated wetlands, streams and other waters of the State as overlays on the site plan.
? Please provide cross section details showing the provisions for aquatic life passage.
? Please locate any planned sewer lines on the site plan.
? Please provide the location of any proposed stormwater.management practices as required by GC
? Please provide detail for the stormwater management practices as required by GC
? Please specify the percent of project imperviousness area based on the estimated built-out conditions.
? Please indicate all stormwater outfalls on the site plan.
? Please indicate the diffuse flow provision measures on the site plan. \•.
? Please indicate whether or not the proposed impacts already been conducted. "
Avoidance and/or Minimization Not Provided

? The labeled as on the plans does not appear to be necessary. Please eliminate the or provide a0di.tiohal
information as to why it is necessary for this project.
? This Office believes that the labeled on the plans as can be moved or reconfigured to avoid the impacts to the
. . Please revise the plans to avoid the impacts.
? This Office believes that the - labeled on the plans as can be moved or reconfigured to minimize the impacts to the
Please revise the plans to minimi?e the impacts.
? The stormwater discharges at the location on the plans labeled will not provide diffuse flow through the buffer because
Please revise the plans and provide calculations to show that diffuse flow will be achieved through the entire buffer. If it
is not possible to achieve diffuse flow through the entire buffer then it may be necessary to provide stormwater management
practices that remove nutrients before the stormwater can be discharged through the buffer.
Other
? The application fee was insufficient because over 150 feet of stream and/or over 1 acre of wetland impacts were requested. Please
provide $ . This additional fee must be received before your application can be reviewed.
? Please complete Section(s) on the application.
? Please provide a signed copy of the application.
? Please provide copies of the application, copies of the site plans and other supporting information.
Mitigation
? of compensatory mitigation is required for this project. -Please provide a compensatory mitigation plan. The
plan must conform to the requirements in 15 A NCAC 211.0500 and must be appropriate to the type of impacts proposed.
? Please indicate which 404 Permit the USACE would use to authorize this project.
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FLB, LLC
DBA SIGN-A- 01q
rth CaroIin DMsion Of Water Quality
6000.Operating Etipenses:6220 • Miscellaneous

Q???oe
JUN 2 7 2005
DENR - WAFER QUALITY
VlE W@S AND STMAVATER ERANCH
6/24/2005
2929
200.00
Operating Account 200.00
REVISIONS
N0. DATE BY
PAMLICD RIVER I I ~
I I
I I I 1004 N
I I SITE N
, ~ti
i ~e- I ~ I ~ ~ ~
Z ~I • o~~ i I ~ I / s / p , p 00
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~ ROBERT GRIFFIN D,B, 986, P, 356 ~ NC 306 pp,pp n1 I ~ ILJLJI i I I
I /
I 1 I 1912 V W /
PLAT CABINET 4, SLIDE 4-8 5 I ,~•~•-~.,r• Z N
MAGNETIC 1944 I ~ I Z o
j ( AURORA NC 33 F-
z
NPS N14.45'00'E 1002,19' I 1923 1002 ~ to EIP Q
322,27' IPS 679,92' 3 679,92' M 15'-0" ~ VI I~(
M~ h I ~ ~ ~ NAIL IN DAK TREE TY M P A
p W 12 POLYPIPE ~ I ~
I N ~
~ ~ 4 ("1 • I x
LEGEND = ~ n O 404 WETLANDS h m
EIP = EXISi1NG IRON PIPE N EIP ~
IPS =IRON PIPE SET NPS ~ I ~ I ~ 200' ~
NPS = NO POINT SET ~ R/W =RIGHT-OF-WAY I
W `..Y I
1 ~ Pi (
M~ ~ y ~ fA I
~ ~ 404 WETLANDS NP 3 a I N
ti6 r I
~ Y o ~ 12,93 ACRES A `,~~~~nunrp~""~ i
I 3 ~ ~ r REJECTS OR CRUSH N RUN ~ I ~ ~ , ~ • •.,~'d y
3 ~ a
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I N C~: Q. ~ :y W : ~ ~
~ ~ ~ 12" PO 12" POLI'PIPE ui y- a I ; `mod' ~
` ~ MARSH 1_ v b / ••Q
404 WETLANDS 1a 404 WETLANDS w Y a ~ I iii P .
O U7 H n oM 2~`
SDUTH CREEK
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a~
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I o~ - EIP
GUILF~RD STREET (UNDEVELOPED 30' PRIVATE R1W) I 0
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NOTES a I 0
1. PROPERTY CONSISTS OF LOTS 1, 2, 3 & 4 OF THE MAX F. THOMPSON JR. EPSON JR. 31 13 W Z Z
SLOPED o CROWN SLI6NTLY PROPERTY AS SHOWN ON PLAT CABINET E, SLIDES 4-8 & 4-9 OF THE OF THE ~ I ~ ~
70 DRAIN BEAUFORT COUNTY REGISTRY. 2. 404 WETLANDS ARE PLOTTED FROM RECORDED SUBDINSION MAP AND AND
II SEE SIGNED BY THE CORPS OF ENGINEERS ON 9/1/93. (404 WETLANDS I I 817E PLAN ARE SUBJECT TO CHANGE) ANDS V U
II 3. APPROXIMATELY 0.16 ACRES ALONG SHORELINE OF SOUTH CREEK HAS ERODED. 4 _ C HAS ERODED.
4. PROPERTY IS LOCATED IN A FLOOD ZONE AE WITH A BASE FLOOD ELEVATION ID ELEVATION
OF 7.0' AS SHOWN Of FlRM MAP 3720658800 J DATED 5/15/03. SLOPED " 6'-0" TYPICAL 5. EXISTING IRON PIPES LOCATED AT ALL FRONT LOT CORNERS. 3. LL
8:1 MAX 12 POLYPIPE
TOP VFW rr _ r u m SCALE: 1 - 80 -0
REJECTS OR CRUSN'N RUN
0 i - BO 0 I 8o iso zoo PROPERTY SURVEY INFORMATION FROM:
I I
BJERKE5ET LAND SURVEYING ALE -FEET ~8q J9 ALM I
sLOPEO GRAPHIC SCALE -FEET 8:1 MAX 12" POLYPIPE A DR VE
SIDE VIFW WINTERVILLE, NORTH CAROLINA 28380
DEED 80OK 1134 PAGE 464
OF THE BEAUFORT COUNTY REGISTER
DATED MAY 3, 2A05
SATE 08/02/05
NOT TO SCALF r ~
_ ~
I J g SCALE AS NOTED
- n DRAWN BY JBC r
J
S7 OF