20051359 Ver 1_Complete File_20050718

?QF WATF9o Michael F. Easley, Governor
G William G. Ross, Jr., Secretary
50 r North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
September 8, 2005
DWQ Project # 051359
Pender County
Pender Adult Services, Inc.
c/o Mr. Wes Davis
901 S. Walker Street
Burgaw, NC 28425
Subject Property: Pender Adult Services Center l)?
env
?FP 4 7.005
Approval of 401 Water Quality Certification with Additional Conditions
Dear Mr. Davis: :.D sir,;t,: ,,. •icR 6«51;CH
1'.?Tln; 3
You have our approval, in accordance with the attached conditions and those listed below, to place fill
within or otherwise impact 0.0776 additional acres of wetlands for the purpose of expanding the parking
and fitness facilities within the existing Pender Adult Services Center as described within your permit
application received by the N.C. Division of Water Quality (DWQ) on July 26, 2005 and additional
information on August 8, 2005 and August 31, 2005. After reviewing your application, we have decided
that the impacts are covered by General Water Quality Certification Number(s) 3402 (GC3402). This
Certification can also be found on line at: http://h2o.enr.state.ne.us/ncwetiands/certs.htm]. The
Certification(s) allows you to use Nationwide Permit(s) 39 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 State Stormwater Management and NPDES Stormwater
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 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 211 .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 Wetlands 0.0776 (acres) 2 road crossings
North Carolina Division of Water Quality 127 Cardinal Drive Extension Phone [phone] Customer Service 1-817&23-6748
Wilmington Regional Office Wilmington, NC 28405-3845 FAX [phone] Internet: h2o.enr.state.nc.us One
North
An Equal Opportunity/Affirmative Action Employer- 50% Recycled/101,10 Post Consumer Paper CAI olina
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Page Two
Mr. Wes Davis
DWQ Permit # 051359
September 8, 2005
2. Erosion & Sediment Control Practices
Erosion and sediment control practices must be installed, operated, and maintained with all
specifications governing the proper design, installation and operation and maintenance of such
Best Management Practices in order to protect surface waters standards:
3. No Waste, Spoil, Solids, or Fill of Any Kind
No waste, spoil, solids, or fill of any kind, and no excavation 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
stabilized project.
5. Recorded Conservation Covenant/Restriction
A copy of the recorded wetlands conservation covenants, conditions and restrictions shall be sent
to this office (See condition # 16 within GC # 3402).
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/Wetlands Unit, North Carolina Division of Water Quality,
1650 Mail Service Center, Raleigh, NC, 27699-1650.
7. Wetland Restoration
All wetlands restoration work must be completed in accordance with the USACE Restoration
Plan.
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 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.
Page Three
Mr. Wes Davis
DWQ Permit # 051359
September 8, 2005
This letter completes the review of the DWQ Permit #051359 under Section 401 of the Clean Water Act.
If you have any questions, please telephone Ian McMillan in the Central Office in Raleigh at 919-715-
4631 or Joanne Stcenhuis in the DWQ Wilmington Regional Office at [phone].
Since ly,
Alan W. Klimek, P.E.
Enclosures: GC 3402 l
Certificate of Completion
cc: Ian McMillan, DWQ 401 Oversight Unit
Lillette Granade, USACE Wilmington Regulatory Field Office
Ren Holt - Pender County Inspections
Kim Williams - Land Management Group
WiRO
Pennits issued
Subject: Permits issued
From: Joanne Steenhuis <Joanne. S teenhuis@ncmai 1. net>
Date: Fri, 09 Sep 2005 09:56:48 -0400
To: Ian McMillan <[e-mail]>, Laurie J Dennison <[e-mail]>
Pender Adult Services- Pender County (DWQ # 05-1359) was issued 9/8/05
Widgon Creek Hunt Club Carteret County (DWQ # 05-1461) was issued 9/8/05
Paula S. Hand Pender County (DWQ # 051411) GC letter written 9/8/05
Hard Copies in Courier
1 of 1 9/9/2005 9:57 AM
Pender Adult Services
Subject: Pender Adult Services
From: Joanne Steenhuis <[e-mail]>
Date: Fri, 26 Aug 2005 15:39:25 -0400
To: Ian McMillan <[e-mail]>
This project is under an NOV with the Corps and will need to do some restoration
along with the project. They sent a letter addressing the violation. The Corps is
requiring them to place conservation easements on the remaining wetlands and they are
working on that since that is a part of our requirements too. Do I need to place them
on hold until I get this, or can I consider it an incomplete application? Kim
Williams will be e-mailing you that the County is work on this.
1 of 1 8/26/2005 3:40 PM
Pender Adult Services; dwq# 051359
Subject: Pender Adult Services; dwq# 051359
From: "Kim Williams" <[e-mail]>
Date: Fri, 26 Aug 2005 15:45:25 -0400
To: <[e-mail]>, <[e-mail]>
Dear Joanne
Pender Adult Services is in the process of putting together draft deed
restriction language, which will eventually be recorded in order to preserve
all remaining wetlands within the site. The Corps is requiring this
preservation (as well as payment into the EEP) as mitigation for past and
proposed wetland impacts within the site.
We request that you temporarily place the project on hold until the
applicant has completed the draft covenants. This document will be forwarded
to your office as soon as possible.
Thank you for your assistance with this project. Give me a call if you have
any questions.
Sincerely,
Kim Williams
Land Management Group, Inc.
P.O. Box 2522
Wilmington, NC 28402
[phone] phone
[phone] fax
1 of 1 8/26/2005 3:53 PM
r; r

9 North Carolina Wildlife Resources Commission 0
Richard B. Hamilton, Executive Director
MEMORANDUM ?Q V :V
0 ?? V
To: Cyndi Karoly $ '`QQ5
NC DENR/DWQ AUG 1
? DES NA STURt Q ? E GRW?GN
From: Steven H. Everhart, PhD, CWB 5 A Diu
Southeastern Permit Coordinator
Date: August 9, 2005
RE: Pender Adult Services - 401/404 Application, Pender Adult Center Expansion, Pender Co., DWQ
#20051359
Biologists with the North Carolina Wildlife Resources Commission (NCWRC) have reviewed the subject
application for impacts to wildlife and fishery resources. A site visit was conducted on August 2, 2005.
Our comments are provided in accordance with provisions of the Fish and Wildlife Coordination Act (48
Stat. 401, as amended; 16 U.S.C. 661 et. seq.), and Sections 401 and 404 of the Clean Water Act (as
amended).
The project is located off US Hwy 117 Business in Burgaw. The nearest stream is an un-named tributary
of Burgaw Creek in the Cape Fear River Basin. Adjacent land use is commercial.
The applicant proposes to expand the fitness and parking facilities of the Adult Services Center. The
project would impact 0.0776 acre of 404 wetlands by filling. Having already obtained approval for 0.3
acre wetland impacts for construction in 1998 under NWP 26, the cumulative impact is to 0.3776 acre.
The applicant proposes to mitigate this impact through the buy-in of 0.5 acre of non-riparian wetland
through the NCWRP.
The Wildlife Resources Commission does not object to this project as proposed. Thank you for the
opportunity to review and comment on this application. If you have any questions or require additional
information regarding these comments, please call me at [phone].
Mailing Address: Division of Inland Fisheries • 1721 Mail Service Center • Raleigh, NC 27699-1721
Telephone: [phone] • Fax: [phone]
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August 3, 2005
TO: Ronnie Smith
U.S. Army Corps of Engineers
P.O. Box 1890
Wilmington, NC 28402
RE: Pender Adult Services, Inc.
Pender County, NC
1
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111; 11

Dear Ronnie:
Thank you for meeting me at the Pender Adult Services site today. As we noted
during the visit, a small amount of wetlands (approximately 4500 sf) has been filled to
build a walking path and prayer garden behind their existing facility. These impacts
occurred without first obtaining a 404 or 401 permit. In order to rectify this violation, the
applicant agrees to remove any excess fill not located within the proposed impact areas
(see attached figure), as requested in the PCN form submitted on July 12, 2005. These
restored areas will then be planted with a wetland seed mixture to provide temporary
stabilization. Restoration will occur prior to any wetland fill activities.
Please let me know if you need any additional information. Thank you for your
assistance with this project.
Sincerely, `
Vt4L
Kim Williams
Wetland Scientist
Encl.
C: Mr. Wes Davis, Pender Adult Services, Inc.
Mr. Hunter Coffey, Michael Ross Kersting Architecture
Ms. Noelle Lutheran, DWQ
Ms. Cyndi Karoly, DWQ
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SCALE 1"= 100'
PENDER COUNTYADULT SERVICES CENTER
Pender County, NC
Site plan showing
proposed wetland impacts.
July 2005
Site plan design by Michael Ross Kersting Architecture.
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Pender County, NC
E , ••= J Proposed wetland impact #2.
July2005; Revised August2005
Site plan design by Alic Gael Ross Kersting Arc ,ifectura.
I PENDER COUNTY ADULT SERVICES CENTER I
Triage Check List
7/22/05
Date: Project Name: Pender Adult Services Center
DWQ#: 05-1359
County: Pender
To: Noelle Lutheran, Wilmington Regional Office
60-Day processing time: 7/20/05 to 9/18/05
From: Cyndi Karoly Telephone: [phone]
The file attached is being forwarded to your for your evaluation.
Please call if you need assistance.
? Stream length impacted
? Stream determination
Wetland determination and distance to blue-line surface waters on USFW topo maps
? Minimization/avoidance issues
? Buffer Rules (Neuse, Tar-Pamlico, Catawba, Randleman)
? Pond fill
Mitigation Ratios
? Ditching
? Are the stream and or wetland mitigation sites available and viable?
? Check drawings for accuracy
Is the application consistent with pre-application meetings?
? Cumulative impact concern
1-1
Comments: As per our discussion regarding revision of the triage and delegation processes,
please review the attached file. Note that you are the first reviewer, so this file will need to be
reviewed for administrative as well as technical details. If you elect to place this project on hold,
please ask the applicant to provide your requested information to both the Central Office in
Raleigh as well as the Asheville Regional Office. As we discussed, this is an experimental, interim
procedure as we slowly transition to electronic applications. Please apprise me of any
complications you encounter, whether related to workload, processing times, or lack of a "second
reviewer" as the triage process in Central had previously provided. Also, if you think of ways to
improve this process, especially so that we can plan for the electronic applications, let me know.
Thanks!
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TO: Ms. Noelle Lutheran JUL 2 0 2005
Division of Water Quality DENk • WATER QUALITY
127 Cardinal Drive Extension ?'==M o3?:,p gtc; ?z
Wilmington, NC 28405
RE: 401 Water Quality Certification Application for Pender Adult Services, Inc.
Burgaw; Pender County, NC
Dear Noelle:
Enclosed is a 401 Water Quality Certification application for your review. This application is submitted
on behalf of Pender Adults Services, Inc. for a site located off of Business 117 in Burgaw, NC. The applicant
plans to expand the existing Adult Services center. Although they have attempted to minimize wetland impacts,
two crossings are needed to access uplands. Proposed wetland impacts will be 0.0776 acre. Please note that the
applicant received a Nationwide 26 in 1998 to fill 0.3 acre of wetlands for the construction of the existing
facilities. To mitigate for these cumulative impacts, the applicant proposes to buy into the EEP for the
restoration of 0.5 acre of non-riparian wetlands.
The Pre-Construction Notification form, associated maps, and site plan are enclosed for your review. In
addition, the $200 application fee has been submitted to Cyndi Karoly. Thank you for your assistance with this
project.
Sincerely, &A,
?m Williams
Wetland Scientist
Encl.
C: Mr. Phil Norris; Norris, Kuske, & Tunstall
Mr. Wes Davis; Pender Adult Services, Inc.
Ms. Lillette Granade, ACOE
Ms. Cyndi Karoly; DWQ

Office Use Only: Form Version May 2002
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. 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
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 39; GC 3402
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here:
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details) u, WM 6?'/
1-9
II. Applicant Information D
JUL 2 0 2005
1. Owner/Applicant Information
Di:r;?t. a+AYcti tsua? iI v
Name: Pender Adult Services, Inc.
Mailing Address: c/o Mr. Wes Davis
901 S. Walker Street
Burzaw, NC 28425
Telephone Number: [phone] Fax Number: [phone]
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: Ms. Kim Williams
Company Affiliation: Land Management Group, Inc.
Mailing Address: P.O. Box 2522
Wilmington, NC 28402
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: kwilliams( 1mgroup.net
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: Pender Adult Services Center
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): 3228 79 5723 0000
4. Location
County: Pender Nearest Town: Burgaw
Subdivision name (include phase/lot number): NA
Directions to site (include road numbers, landmarks, etc.): From Wilmington, take US 40 W
toward Ralei__h. Take Highway 117 N toward Burgaw. Turn left onto 117 Business. Site will
be on the left (see vicinity map).
5. Site coordinates, if available (UTM or Lat/Long): 34.5419°N 77.9114°W
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): 7.146 acres
7. Nearest body of water (stream/river/sound/ocean/lake): UT of Burgaw Creek
8. River Basin: Cape Fear River Basin
(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: Adjacent land use is commercial. The property currently
contains the Pender Adult Services Center.
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used: This project
will consist of expanding the existiniz Pender Adult Services Center. The applicant will
initially complete gradin. Planned roads and stormwater conveyances will be constructed.
11. Explain the purpose of the proposed work: To expand the fitness facilities and Parkin, within
the existing Adult Services center.
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.
The 404 wetland line was delineated by Land Management Group, Inc. LMG is submitting the
wetland survey with this permit application for Corps approval. Please note that the applicant
received a Nationwide 26 in 1998 to fill 0.3 acre of wetlands for the construction of the Adult
Services Building (attached) This work was completed
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.
No additional permit requests are anticipated for this site.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Provide a written description of the proposed impacts:
The applicant proposes to impact 0.0776 acre of 404 wetlands. Since 0.3 acre of impacts have
already occurred cumulative impacts will be 0.3776 acre.
Page 7 of 12
2. Individually list wetland impacts below:
Wetland Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
acres) Located within
100-year Floodplain**
(es/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
1 Fill/culvert 0.07 No -300 Forested wetland
2 Fill/culvert 0.0076 No -300 Forested wetland

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://wcvNv.fema.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property: 2.2 acres
Total area of wetland impact proposed: 0.0776 acre
3. Individually list all intermittent and perennial stream impacts below: N/A
Stream Impact
Site Number
(indicate on ma)
Type of Impact* Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
( leases ecify)

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.uses.eov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
vvww.mapquest.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below: N/A
Open Water Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Name of Waterbody

(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. Pond Creation NA
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.):
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.
The applicant has taken areat care in the site design in order to avoid 404 wetlands. Wetlands
will be crossed at the narrowest points. Furthermore, no wetland impacts are needed for building
footprints or parking.
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.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
Page 9 of 12
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
littp://h2o.enr.state.nc.us/ncwetiands/strm,Qide.html.
Provide a brief description of the proposed mitigation plan. The description should provide
as much infonnation 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.
The applicant proposes to buy into the EEP for the restoration of 0.5 acre of non-riparian
wetlands. Please note that a small amount of wetlands were filled to build a walking path
without first obtaining a 404 or 401 permit. The applicant has positioned the proposed
driveway crossing to occur in the same location and plans to remove any excess fill not
located within the designated impact areas.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at http://h2o.enr.state.nc.us/wm/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):_
Amount of Non-riparian wetland mitigation requested (acres)
Amount of Coastal wetland mitigation requested (acres):
0.5 acre
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ? No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ) N/A
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Meuse), 15A NCAC 213 .0259 (Tar-Pamlico), 15A NCAC 213 .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ® If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian- buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet) Multiplier Required
Mitigation
1 3
2 1.5
Total
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Gone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Page 11 of 12
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Existing building and parking totals approximately 2 acres of impervious cover within the site.
Additional proposed impervious cover will consist of two parking areas (the proposed fitness
facility will be located where an existing parking area is) consisting of 0.7 acre. Therefore, total
final impervious cover for the entire site would be approximately 37% of the entire site. The
applicant will install silt fencing around the construction area to reduce erosion into wetland
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
This facility already ties into the local sewer system.
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
N/A
- /AZ/o5-
`Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
? ` 117 p\ _ 't?Y,\n.Ma M:f ? ? y 6 C _r ?•
• It - w ?`I i I i
j' SITE
1Y J
51
SITE
SCALE 1" = 2.4 Miles
Ma Source: DeLorme: North Carolina Atlas and Gazetteer., 2001 . 84.
Pander Adult Services Land Management Group, Inc.
Pender County, NC Environmental Consultants
Wilmington, N.C. Site Location
40-04-492 July 2005
4 i ¦ s I ?
i?? t i i p r 1; ti r
d + Ch
6% 6
3c ` s a ti r a 0?.? } (r
lob
SITE
All
,
t : i {, rt
Ch f adio 'ever' 4i
irf?T ht .= of r= P: f ? ?viy?3tion :?-' R3j i
kMapSource: Burgaw N.C., 1997, USGS 7.5' Topographic quadrangle. SCALE 1 1000'
rAdult Services Land Management Group, Inc.
der County, NC Environmental Consultants USGS
Wilmington, N.C. Topographic Quadrangle
40-04-492 July 2005
SCALE 1" = 1000'
Ponder Adult Services Land Management Group, Inc.
Ponder County, NC Environmental Consultants
Wilmington, N.C.
40-04-492 July 2005
SCS Soil Survey for
Ponder County
LOCATION MAP
-------------
. \ 1 '01 to
scut )
-? tir J.e? ?` vrt 7
CNS?^'a M Nµ
i ?Z? Fe+ Ml.A a \\-_ g,,, W l ry. e+r
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L. PlNYxr; '3. I `_
LV r s
Existing hq `agxH "O ??
Paling °LV
• ea weanda vaaifl -
--- Existing --y
Parsing --i C vw r\C
_ -? pNCES i '
"STING SEN'FdILUNGEN
c °
°
,c P.
_ _ I r•a °
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_..... (I V \. ?1 I\ s iV& e . a arsing
,"No wd+ Pw t ? t T 1 ...1 A 1-1
? !I_IIII'' ? ,? o
404 WVjrdS
1
A 0-H-9
6Na??M ?o-o= l? ? (ia OaMk"da) -
Wetland Impact p1: I \ 404 Wetlands J +
0.07ac _.-
/ \ I Proposed- 5 i
Parsing b
Parking
\ 404 WOVE Ws i
I \ I
I Proposed
1Na?k,ng Trails
\ Wet/ Impact #2:
Lns?wc woN M,s.x ea wsnends I zv'e a+\ „his LM1,,;sx. -' 076 ac
u!.n.a FFC :N?3M?'?.<iui N.Y CoN?Ma
. C. t vif ? V 't
/ roi:a tN
(NS'r•? we' PCB'A
I
Cns woN M!N
CUN?N0.
0 SO 100 200
SCALE 1"= 100'
Site plan design by Michael Ross Kersting Architecture.
PENDER COUNTYADULT SERVICES CENTER
Ponder County, NC
Site plan showing
proposed wetland impacts.
July 2005
1 1
404 Wetlands

10'-0"
Overhang
(no wetland impacts)

Wetland Impact #1:
0.07 ac
i
i
i
v?
0 30 60 120
SCALE 1"= 20'
Site plan design by Alichael Ross Kersting
PENDER COUNTYADULT SERVICES CENTER
Ponder County, NC
Proposed wetland impact #9.
July 2005
0 30 60 120
Pender County, NC
Jy4,`E _ 20' I Proposed wetland impact #2.
Site plan design by k7ichael Ross Kersting Archi:'ecture. July 2005
PENDER COUNTY ADULT SERVICES CENTER I
Typical Cross-Section of Road
0+10'
44'-wide impact
24'-wide road
0+5'
3.1 slope
culvert /Proposed Grade
?
0+0'
0+0' 0+10' 0+20'
Existing Grade
0+30' 0+40' 0+50'
Proposed Grade
Culvert
Existing Grade
NOT TO SCALE
NOTE: Final culvert specifications to be deterrnined by project engineer.
Pender Adult Services, Inc. Laud 11laitaaemeut Group, Iuc.
S. Walker Street, Burgaw Environmental Consultants
Pender County, NC Wilmington, NC
Penn it Application July 2005
Horizontal: 1" =10'
Vertical: 1" = 5'
Typical Road
Cross-Sections
r. .
U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. County here e
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property owner SGh? ox, C-(,+j 7-&,1 4&1Lwce5 40' wcc, ?,vr S Apt 6eo tP"nno,
Vp
Size and Location of project (water body, road name/number, town, etc.) e0
Applicable Law: ? Section 404 (Clean Water Act, 33 U.S.C. 1344).
(check all that apply) Section 10 (River and Harbor Act of 1899).
Authorization: ho, Regional General Permit Number.
a6 Nationwide Permit Number.
Your work is authorized by this Regional General (RGP) or Nationwide Permit (NWP) provided it is ticcomplished
in strict accordance with the attached conditions and your submitted plans. If your activity is subject to Section
404 (if Section 404 block above is checked), before beginning work you must also receive a Section 401 water
quality certification from the N.C. Division of Environmental Management, telephone [phone]. For any
activity within the twenty coastal counties, before beginning work you must contact the N.C. Division of Coastal
Management, telephone [phone].
Please read and carefully comply with the attached conditions of the RGP or NWP. Any violation of the conditions
of the RGP or the NWP referenced above may subject the permittee to a stop work order, a restoration order, and/or
appropriate legal action.
This Department of the Army RGP or NWP verification does not relieve the ermittee of the res onsibili to obtain
any other required Federal, State, or loca approvals/permits. The permittee may need to contact appropriate State
and local agencies before beginning work.
If there are any questions regarding this authorization or any of the conditions of the General Permit or Nationwide
Permit, please contact the Corps Regulatory Official specified below.
Date 3-1 `-f ?
Corps Regulatory Official Telephone No.
Expiration Date of Verification 0-r -
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT PLANS, ETC., MUST
BE ATTACHED TO THE YELLOW (FILE) COPY OF THIS FORM, IF REQUIRED OR AVAILABLE.
CESAW Form 591
Telephone No.
0 ,3 64- :L 4r-1 114,j?
11 P r c ,,.r? _ 1
GENERAL CONDITIONS
1. Navigation. No activity may cause more than a minimal adverse effect on navigation.
2. Proper Maintenance. Any structure or fill authorized shall be properly maintained, including maintenance to ensure public
safety. - -' 2.1 •_-_ ,
3. Erosion and Siltation Controls. Appropriate erosion and siltation controls must be used and maintained in effective
operating condition during construction, and all exposed soil and other fills must be permanently stabilized at the earliest
practicable date.
4. Aquatic Life Movements. No activity may substantially disrupt the movement of those species of aquatic life indigenous
to the waterbody; including those species which normally migrate through the area, unless the activity's primary purpose is to
impound water.
5. Equipment. Heavy equipment working in wetlands must be placed on mats or other measures must be taken to minimize
soil disturbance..:
6. Regional and Case-by-case Conditions. The activity must comply with any regional conditions which may have been
added by the Division Engineer and any case specific conditions added by the Corps.
7. Wild and Scenic Rivers- No activity may occur in a component of the National Wild and Scenic River System; or in a
river officially designated by Congress as a "study river" for possible inclusion in the system, while the river is in an official
study status. Information on Wild' and Scenic'Rivers may be obtained from the National Park Service and the U.S. Forest
Service.
8. Tribal Rights. No activity or its operation may impair reserved tribal: rights, including, but not limited to, reserved water
rights and treaty fishing and hunting rights. -
9. Water Quality Certification. In certain states, an individual state water quality certification must be obtained or waived.
10. Coastal Zone Management. In certain states, an individual state coastal zone management consistency concurrence
must be obtained or waived. -
11. Endangered Species. No activity is authorized under any NWP which is likely to jeopardize the continued existence of
a threatened or endangered species or a species proposed for such designation, as identified under the Federal Endangered
Species Act, or which is likely to destroy or adversely modify the critical habitat of such species. Non-Federal permittees shall
notify the District Engineer if any listed species or critical habitat might be affected or is.in the vicinity of the project and shall
not begin work on the activity until notified by the District Engineer that the requirements of the Endangered Species Act have
been satisfied and that the activity is authorized. Information on the location of threatened and endangered species can be
obtained from the U.S. Fish and Wildlife Service and National Marine Fisheries Service.
12. Historic Properties. No activity which may affect Historic Properties listed, or eligible for listing, in the National Register
of Historic Places is authorized, until the District Engineer has complied with the provisions of 33 CFR 325, Appendix C. The
prospective permittee must notify the District Engineer if the authorized activity may affect any historic properties listed,
determined to be eligible, or which the prospective permittee has reason to believe may be eligible for listing on the National
Register of Historic Places, and shall not begin the activity until notified by the District Engineer that the requirements of the
National Historic Preservation Act have been satisfied and that the activity is authorized. Information on the location and
existence of historic resources can be obtained from the State Historic Preservation Office and the National Register of Historic
Places (see 33 CFR 330.4(g)).
13. Water Supply Intakes. No discharge of dredged or fill material may occur in the proximity of a public water supply intake
except where the discharge is repair of the public water supply intake structures or adjacent bank stabilization.
14. Shellfish Production. No discharge of dredged or fill material may occur in areas of concentrated shellfish production,
unless the discharge is directly related to a shellfish harvest activity authorized by nationwide permit.
15. Suitable Material. No discharge of dredged or fill material may consist of unsuitable material (e.g., trash, debris, car
bodies, etc.) and material discharged-must be free from-toxic-pollutants in-toxic amounts.------"7-----
16. Mitigation. Discharges of dredged or fill material into waters of the United States must be minimized or avoided to the
maximum extent practicable at the project site (i.e., on-site), unless the District Engineer has approved a compensation
mitigation plan for the specific regulated activity.__...
17. Spawning Areas. Discharges in spawning areas during spawning. seasons must be. avoided to.-the-maximum extent
practicable.
18. Obstructions of High Flows. To the maximum extent practicable, discharges. must not permanently restrict or impede
the passage of normal or expected high flows or cause the relocation of the water (unless the primary purpose of the fill is to
impound waters).
19. Adverse Impacts from Impoundments. If the discharge creates an impoundment of water, adverse impacts on the
aquatic system caused by the accelerated passage of water and/or the restriction of its flow shall be minimized to the maximum
extent practicable.
20. Waterfowl Breeding Areas. Discharges into breeding areas for migratory waterfowl must be avoided to the maximum
extent practicable.
21. Removal of Temporary Fills. Any temporary fills must be removed in their entirety and the affected areas returned to
their preexisting elevation.
1
Permit Number: Ma{O.1 wJe ND• o-11. II
Name of Permittee: ?? (??"? SCNIv?c ?,T,2en ?Ru.Cts
Date of Issuance: 3- a-qg
Upon completion of the activity authorized by this permit and any mitigation
required by the permit, sign this certification and return it to the following
address:
District Engineer
Wilmington District
U.S. Army Corps of Engineers
Attention: CESAW-RG
Post office Box 1890
Wilmington, North Carolina 28402-1890
Please note that your permitted activity is subject to a compliance inspection
by a U.S. Army Corps of Engineers representative. If you fail to comply with
this permit you are subject to permit suspension, modification, or revocation.
I hereby certify that the work authorized by the above referenced permit has
been completed in accordance with the terms and conditions of the said permit,
and required mitigation was completed in accordance with the permit
conditions.
Signature of Permittee Date
FAX NO. :9102599144 Jul. 09 2005 04:46PM P2
11:45 9104520060 LANDMANAGEMENT wAuk eria`

AGENT AUTHORIZATION FORM
TO WHOM IT MAY CONCERN:
Ilwe, the undersigned, hereby authorize Land Management Group, Inc, to act as our agent in the
preparation and representation of infarmation related to the 404/401 permit application for the
Bier Adult Service Cen er located in Burgaw, NC. All questions in regards to this application
should be dimcted to Land Management Group, Inc.
Sincerely,
q;
L 4t"'
ne.r/Applicant
7/e Date
u? dab"iage jie)iI ?6,tac i., t ic.
&vhojijjaejt1a1'6ltdtillaldi,
JasI611&e Paz 2522
0)(it minylon, ?6aicl na 28402
crc)Ie'V JXtanc/a C??ce A?X;
3805 9l"tr'q/f uille iZiexrre J'rrrfe 15
'91FI iiny1cu, 1VC28403
July 12, 2005
TO: Ms. Noelle Lutheran
Division of Water Quality
127 Cardinal Drive Extension
Wihnington, NC 28405
J/Xcne: 910-452-0001
91,'7x: 910-452-0060
rcrcrc.l ?t? tor?a.?ael
JUL 2 u 2005
DENR - WATER QUALITY
RE: 401 Water Quality Certification Application for Pender Adult Services, 1t e MOSAND STORMWATF.R ERM CN
Burgaw; Pender County, NC
Dear Noelle:
Enclosed is a 401 Water Quality Certification application for your review. This application is submitted
on behalf of Pender Adults Services, Inc. for a site located off of Business 117 in Burgaw, NC. The applicant
plans to expand the existing Adult Services center. Although they have attempted to minimize wetland impacts,
two crossings are needed to access uplands. Proposed wetland impacts will be 0.0776 acre. Please note that the
applicant received a Nationwide 26 in 1998 to fill 0.3 acre of wetlands for the construction of the existing
facilities. To mitigate for these cumulative impacts, the applicant proposes to buy into the EEP for the
restoration of 0.5 acre of non-riparian wetlands.
The Pre-Construction Notification form, associated maps, and site plan are enclosed for your review. In
addition, the $200 application fee has been submitted to Cyndi Karoly. Thank you for your assistance with this
project.
Sincerely',
'm Williams
Wetland Scientist
Encl.
C: Mr. Phil Norris; Norris, Kuske, & Tunstall
Mr. Wes Davis; Pender Adult Services, Inc.
Ms. Lillette Granade, ACOE
Ms. Cyndi Karoly; DWQ

Office Use Only: Form Version May 2002
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
1. Processing
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
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 39; GC 3402
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here:
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coa ((? t of
Environmental Concern (see the top of page 2 for further details), c dl?tz
D
II. Applicant Information JUL 2 0 2005
DENR - WATER QUALITY
1. Owner/Applicant Information 1'IETW 0SANOSTOfi},", ATEAE;r„x{
Name: Pender Adult Services, Inc.
Mailing Address: c/o Mr. Wes Davis
901 S. Walker Street
Buraaw, NC 28425
Telephone Number: [phone] Fax Number: [phone]
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: Ms. Kim Williams
Company Affiliation: Land Management Group, Inc.
Mailing Address: P.O. Box 2522
Wilmin,Qton, NC 28402
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: kwilliamsnlmgroup.net
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: Pender Adult Services Center
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): 3228 79 5723 0000
4. Location
County: Pender Nearest Town: Burgaw
Subdivision name (include phase/lot number): NA
Directions to site (include road numbers, landmarks, etc.): From Wilmington, take US 40 W
toward Raleigh. Take Highway 117 N toward Burgaw. Turn left onto 117 Business. Site will
be on the left (see vicinity map).
5. Site coordinates, if available (UTM or Lat/Long): 34.5419°N 77.9114°W
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): 7.146 acres
7. Nearest body of water (stream/river/sound/ocean/lake): UT of Burgaw Creek
8. River Basin: Cape Fear River Basin
(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.ne.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: Adjacent land use is commercial. The property currently
contains the Pender Adult Services Center.
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used: This project
will consist of expandiniz the existiniz Pender Adult Services Center. The applicant will
initially complete iZradin Planned roads and stormwater conveyances will be constructed.
11. Explain the purpose of the proposed work: To expand the fitness facilities and parking within
the existing Adult Services center.
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.
The 404 wetland line was delineated by Land Management Group, Inc. LMG is submitting the
wetland survey with this permit application for Corps approval. Please note that the applicant
received a Nationwide 26 in 1998 to fill 0.3 acre of wetlands for the construction of the Adult
Services Building (attached) This work was completed.
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.
No additional pen-nit requests are anticipated for this site.
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and snap all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Provide a written description of the proposed impacts:
The applicant proposes to impact 0.0776 acre of 404 wetlands. Since 0.3 acre of impacts have
already occurred cumulative impacts will be 0.3776 acre.
Page 7 of 12
2. Individually list wetland impacts below:
Wetland Impact
Site Number
(indicate on ma)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(es/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland*
1 Fill/culvert 0.07 No -300 Forested wetland
2 Fill/culvert 0.0076 No -300 Forested wetland

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http://NvNvw.femt.gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property: 2.2 acres
Total area of wetland impact proposed: 0.0776 acre
3. Individually list all intermittent and perennial stream impacts below: N/A
Stream Impact
Site Number
(indicate on ma)
Type of Impact* Length of
Impact
(linear feet)
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
( leasespecify)

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usps. Several intemet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
wvww.maRqucst.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below: N/A
Open Water Impact
Site Number
indicate on ma)
Type of Impact* Area of
Impact
(acres) Name Waterbody
)
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.)

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc.
5. Pond Creation NA
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.):
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.
The applicant has taken areat care in the site design in order to avoid 404 wetlands. Wetlands
will be crossed at the narrowest points. Furthermore, no wetland impacts are needed for building
footprints or parking.
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.
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
Page 9 of 12
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.ne.us/ncwetlands/strm,Qide.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.
The applicant proposes to buy into the EEP for the restoration of 0.5 acre of non-riparian
wetlands. Please note that a small amount of wetlands were filled to build a walking path
without first obtaining a 404 or 401 permit. The applicant has positioned the proposed
driveway crossing to occur in the same location and plans to remove any excess fill not
located within the designated impact areas.
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at http:/lh2o.enr.state.nc.us/wm/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres): 0.5 acre
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federaUstate) funds or the use of public
(federal/state) land?
Yes ? No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ) N/A
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 213 .0233
(Meuse), 15A NCAC 213 .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ? No ® If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian- buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet) Multiplier Required
Mitigation
1 3
2 1.5
Total
* Zone I extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Page 11 of 12
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Existin,g building and parking totals approximately 2 acres of impervious cover within the site.
Additional proposed impervious cover will consist of two parking areas (the proposed fitness
facility will be located where an existing parking area is) consisting of 0.7 acre. Therefore, total
final impervious cover for the entire site would be approximately 37% of the entire site. The
applicant will install silt fencing around the construction area to reduce erosion into wetland
areas.
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
This facility already ties into the local sewer system.
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No
Is this an after-the-fact permit application?
Yes ? No
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
N/A
--1/17- /a 5-
`Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
.< - , ?? Tit 117\ - _ ?I •` ivhe M<? ' L C c; k
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SITE
SCALE 1" = 2.4 Miles
Ma Source: DeLorme: North Carolina Atlas and Gazetteer., 2001 . 84.
Pender Adult Services Land Management Group, Inc.
Pender County, NC Environmental Consultants
Wilmington, N.C. Site Location
40-04-492 July 2005
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rAdult Services Land Management Group, Inc.
der County, NC Environmental Consultants USGS
Wilmington, N.C. Topographic Quadrangle
40-04-492 July 2005
SCALE 1" = 1000'
PenderAduIt Services Land Management Group, Inc.
Pender County, NC Environmental Consultants
Wilmington, N.C.
40-04-492 July 2005
SCS Soil Survey for
Pender County
LOCATION MAP
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0 50 100 200
SCALE 1 •'= 100'
July 2005
Site plan design by Michael Ross Kersting Architecture.
PENDER COUNTYADULT SERVICES CENTER
Pender County, NC
• Site plan showing
proposed wetland impacts.

404 Wetlands
77
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Overhang
(no wetland impacts)

Wetland Impact #1:
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0 30 c0 120
SC;,L= 1'=20'
Site plan design by.Vichael Ross Kersting
PENDER COUNTYADULT SERVICES CENTER
Ponder County, NC
Proposed wetland impact #1.
July 2005
f -a -_- _
0 30 6C '20
Pender County, NC
r, E , .•_ Proposed wetland impact #2.
Sate plan design by hlic hael Ross Kersting Archaecture. July 2005
PENDER COUNTY ADULT SERVICES CENTER
Typical Cross-Section of Road
0+10'
44'-wide impact
24'-wide road
0+5'
3. 1 slope Proposed Grade
Proposed culvert
0+0'
0+0' 0+10' 0+20'
Existing Grade
0+30' 0+40' 0+50'
Proposed Grade
Culvert
Existin.- Grade
NOT TO SCALE
NOTE: Final culvert specifications to be deterinined by project engineer.
Horizontal: 1" =10'
Vertical: 1" = 5'
Pender Adult Services, Inc. Land Management Group, hic.
S. Walker Street, Burgaw Environmental Consultants Typical Road
Pender County, NC Wilmington, NC Cross-Sections
PcrinitApplication July 2005
,.. .
U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. County Ptfk e
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property owner SGKr OIL Q 0 2P,, !-,?,rLw4e5 C'(0: w", -D,-vr 56 t?.+e4
>a1
Size and Location of project (water body, road name/number, town, etc.) c55
Applicable Law: Section 404 (Clean Water Act, 33 U.S.C. 1344).
(check all that apply) Section 10 (River and Harbor Act of 1899).
Authorization: Regional General Permit Number.
A0, a? Nationwide Permit Number.
Your work is authorized by this Regional General (RGP) or Nationwide Permit (NWP) provided it is accomplished
in strict accordance with the attached conditions and your submitted plans. If your activity is subject to Section
404 (if Section 404 block above is checked), before beginning work you must also receive a Section 401 water
quality certification from the N.C. Division of Environmental Management, telephone [phone]. For any
activity within the twenty coastal counties, before beginning work you must contact the N.C. Division of Coastal
Management, telephone [phone].
Please read and carefully comply with the attached conditions of the RGP or NWP. Any violation of the conditions
of the RGP or the NWP referenced above may subject the permittee to a stop work order, a restoration order, and/or
appropriate legal action.
This Department of the Army RGP or NWP verification does not relieve the ermittee of the res onsibili to obtain
any other required Federal, State, or loca approvals/permits. The permittee may need to contact appropriate State
and local agencies before begmnmg work.
If there are any questions regarding this authorization or any of the conditions of the General Permit or Nationwide
Permit, please contact the Corps Regulatory Official specified below.
Date 3-,2`9?
Corps Regulatory Official Telephone No. li ?251 44((
Expiration Date of Verification R-t -
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT PLANS, ETC., MUST
BE ATTACHED TO THE YELLOW (FILE) COPY OF THIS FORM, IF REQUIRED OR AVAILABLE.
CESAW Form 591
Telephone No.
0, 3 Ar ei4 Cn-,?an 10 If uee,4b :b 4-?,cJ I , ?k.?` ?f tie ca, s-hc,c '.0.,
bT 1?0 iX?rt ?b.., ?P r aC (;? r2P 6A.A,:!!7Z
.
.-
GENERAL CONDITIONS
1. Navigation. No activity may cause more than a minimal adverse effect on navigation.
2. Proper Maintenance. Any structure or fill authorized shall be properly maintained, including maintenance to ensure public
safety.. _- .. _ _-
3. Erosion and Siltation Controls. Appropriate erosion and siltation controls must be used and maintained in effective
operating condition during construction, -and all exposed soil and other fills must be permanently stabilized at the earliest
practicable date.
4. Aquatic Life Movements. No activity may substantially disrupt the movement of those species of aquatic life indigenous
to the waterbody; including those species which normally migrate through the area, unless the activity's primary purpose is to
impound water.
5. Equipment. Heavy equipment working in wetlands must be placed on mats or other measures must betaken to minimize
soil disturbance..
6. Regional and Case-by-case Conditions. The activity must comply with any regional conditions which may have been
added by the Division Engineer and any case specific conditions added by the Corps.
7. Wild and Scenic Rivers_ No activity may occur in a component of the National Wild and Scenic River System; or in a
river officially designated by Congress as a "study river" for possible inclusion in the system, while the river is in an official
study status. Information on Wild, and Scenic'Rivers may be obtained from the National Park Service and the U.S. Forest
Service. ,
8. Tribal Rights. No activity or its operation may impair reserved tribal rights, including, but not limited to, reserved water
rights and treaty fishing and hunting rights.
9. Water Quality Certification. In certain states, an individual state water quality certification must be obtained or waived.
10. Coastal Zone Management. In certain states, an individual state coastal zone management consistency concurrence
must be obtained or waived. -
11. Endangered Species. No activity is authorized under any NWP which is likely to jeopardize the continued existence of
a threatened or endangered species or a species proposed for such designation, as identified under the Federal Endangered
Species Act, or which is likely to destroy or adversely modify the critical habitat of such species. Non-Federal permittees shall
notify the District Engineer if any listed species or critical habitat might be affected or is.in the vicinity of the project and shall
not begin work on the activity until notified by the District Engineer that the requirements of the Endangered Species Act have
been satisfied and that the activity is authorized. Information on the location of threatened and endangered species can be
obtained from the U.S. Fish and Wildlife Service and National Marine Fisheries Service.
12. Historic Properties. No activity which may affect Historic Properties listed, or eligible for listing, in the National Register
of Historic Places is authorized, until the District Engineer has complied with the provisions of 33 CFR 325, Appendix C. The
prospective permittee must notify the District Engineer if the authorized activity may affect any historic properties listed,
determined to be eligible, or which the prospective permittee has reason to believe may be eligible for listing on the National
Register of Historic Places, and shall not begin the activity until notified by the District Engineer that the requirements of the
National Historic Preservation Act have been satisfied and that the activity is authorized. Information on the location and
existence of historic resources can be obtained from the State Historic Preservation Office and the National Register of Historic
Places (see 33 CFR 330.4(g)).
13. Water Supply Intakes. No discharge of dredged or fill material may occur in the proximity of a public water supply intake
except where the discharge is repair of the public water supply intake structures or adjacent bank stabilization.
14. Shellfish Production. No discharge of dredged or fill material may occur in areas of concentrated shellfish production,
unless the discharge is directly related to a shellfish harvest activity authorized by nationwide permit.
15. Suitable Material. No discharge of dredged or fill material may consist of unsuitable material (e.g., trash, debris, car
bodies, etc.) and material discharged•must be free front-tonic pollutants in-tonic amounts.-.- -
16. Mitigation. Discharges of dredged or fill material into waters of the United States must be minimized or avoided to the
maximum extent practicable at the project site (i.e., on-site), unless the District Engineer has approved a compensation
mitigation plan for the specific regulated q iyity.___..
17. Spawning Areas. Discharges in spawning areas during spawning. seasons must be. avoided to. the_maximum extent
practicable.
18. Obstructions of High Flows. To the maximum extent practicable, discharges must not permanently restrict or impede
the passage of normal or expected high flows or cause the relocation of the water (unless the primary purpose of the fill is to
impound waters).
19. Adverse Impacts from Impoundments. If the discharge creates an impoundment of water, adverse impacts on the
aquatic system caused by the accelerated passage of water and/or the restriction of its flow shall be minimized to the maximum
extent practicable.
20. Waterfowl Breeding Areas. Discharges into breeding areas for migratory waterfowl must be avoided to the maximum
extent practicable.
21. Removal of Temporary Fills. Any temporary fills must be removed in their entirety and the affected areas returned to
their preexisting elevation.
J
1
Permit Number: mad 'a,i wJe ' GLz, +.4 YvD, 36
2en ?ea?•Ces
Name of Permittee: TeJ1 6(?1 5e?1 1
Date of Issuance: 3- c2--! n
Upon completion of the activity authorized by this permit and any mitigation
required by the permit, sign this certification and return it to the following
address:
District Engineer
Wilmington District
U.S. Army Corps of Engineers
Attention: CESAW-RG
Post Office Box 1890
Wilmington, North Carolina 28402-1890
Please note that your permitted activity is subject to a compliance inspection
by a U.S. Army Corps of Engineers representative. If you fail to comply with
this permit you are subject to permit suspension, modification, or revocation.
I hereby certify that the work authorized by the above referenced permit has
been completed in accordance with the terms and conditions of the said permit,
and required mitigation was completed in accordance with the permit
conditions.
Signature of Permittee
Date
FM
07/08/2005
FAX NO. :9102599144 Jul. 08 2005 04:46PM P2
11:45 9104520060 LANAMANAGEMENT wAuk t71fV)Z
AGENT AUTHORIZATION FORM
TO WHOM IT MAY CONCERN:
I/we, the undersigned, hereby authorize Land Mamagement Group, Inc. to act as our agent in the
preparation and representation of infarmation related to the 404/401 permit applicatioij for the
RMder Adult Services Censer located in Aurgaw, NC. All questions in regards to this application
should be directed to Land Management Group, Inc.
Sincerely,
ne.r/Applicant
7/vo
Date
LAND MANAGEMENT GROUP, INC.
ENVIRONMENTAL CONSULTANTS
North Carolina Division of Water Quality
Date Type Reference
07/07/2005 Bill Permit Fee
Original Amt.
200.00
7/7/2005
Balance Due Discount
200.00
Check Amount
yb-d4-42
Coastal Federal Bank 401 Water Quality Certification Application 6U' ,. w SSQf11 oR ?1
Payment
200.00
200.00
200.00