20051628 Ver 1_Complete File_20050825

Office Use Only:

Form Version May 2002

USACE ActionID No. DWQ No. 2 0 0 5 1 6 2 R
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N! A".)

I. Processing

1. Check all of the approval(s) requested for this project:
D Section 404 Pennit D
D Section 10 Permit D
Cir401 Water Quality Certification

2. Nationwide, Regional or General Permit Number(s) Requested: 18

,__ '''. ~i, 1 -.;.... r~ :~
u '1 \" ~ I 1 ~ ".r' j ,~
. -', f" \ .. .: \ ~-....., ;'1 '".... i \ -...-~.
Riparian or 'WatershedJBuffer Rules

Isolated Wetland Permit from DWQ

3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: 0

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

q

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 Concem (see the top of page 2 for further details). Chem mm OW~ W

Applicant Information AUG 2 5 2
. 005

II.

1. Owner/Applicant Information
Name: ,-EdKYYJLl h1
Mailing Address: pO. BDt .;)Sb
S-fqn inn. '~lt,.. 5 .v c ;? '} f{ X 3

DENR. WATER QUAliTY
\'''ETI..N~DS NID STOOMWATER BRANCH

Telephone Number: J5:J. - ;U'/- S 5 '75
E-mail Address:

Fax Number:

2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:

Telephone Number:
E-mail Address:

Fax Number:

Page 5 of 12

III. Project Information

Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17 -inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.

1. Nameofproject: BYtJum .{;,.,...s

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

Iv lict-

3. Property Identification Number (Tax PIN):

4. Location
County: /1) ; bon Nearest Town:
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.):
7/,1"0'1" ,Si-c,,..,-/,,,,d'UI"5, +/'e", 1e1+ o,,-Iu SR /5.~ '1 .
Cro~,,;", RR
/ .

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

S-fzv,-/Oi1S l4YJ

,Me.. 5'k S'o"",f;'
I "",'Ie (In "p~ Cilf~....

6. Property size (acres):~O &Lcr.e.j

7. Nearest body of water (stream/river/soundlocean/lake): Cel" te,.,-f"e.. C~ed<

8. River Basin: NCt.ue...
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enLstate.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: C'lJpk",( . C4:t- cv.e... \,AIeedl..,,). l"Joed /.. ...,.,(
. I I

Page 6 of 12

().~

11. Explain the purpose or the propj?sed work:_lfcU''u fv b'<.-k ,-( /,r~,.-<:,;-I7 fay ,'e(f<'.....ft...~
C J,4,-,-h'''J <1",1 -r: s l, .....,) linel j..Q"~sf YVl1In"9f:.MeA//-

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 ill 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.

414

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//4
, I

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

It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.

Page 7 of 12

1. Provide a written description of the proposed impacts: ;;)(j'
l.v./I kH. IM-~t<J 0" Ai,L.. areAl ,., 'VC;f/.....L{ {,J/cw';'1

l-V;J. ( cI,~-t fc, fA ,
"tel YJ,' fl.
I

pcJ"

2. Individually list wetland impacts below:

Wetland Impact Area of Located within Distance to
Site Number Type of Impact* Impact IOO-year Floodplain** Nearest Stream Type ofWetland***
(indicate on map) (acres) (yes/no) (linear feet)
i H.J -1 f-.',()..J:L.-: -fi 1\ L \l~S i060 .. ~{~dt:A.~ lv~~
.t n,,(,t;~ I

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- Y ear 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 httn:/lwww.fl~ma.gl1v.
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:
Total area of wetland impact proposed: ~ . J

;;. O~ c-

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

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

List each impact separately and idcntify tcmporary impacts. Impacts include, but arc not limited to: culverts and associated rip-rap,
dams (separately list impacls 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 arc available through the USGS at 1-800-358-9616, or online at
wWW.uSl!S.l!OV. Several internct sites also allow direct download and printing of USGS maps (e.g., www.tonozone.com,
www.marJllUcsLcom, elc.).

*

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

N/yt
, I

Page 8 of 12

IX. Environmental Documentation (required by DWQ)

Does the project invol ve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes 0

No

if

If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPAfSEPA)?
Note: If you are not sure whether a NEPNSEPA document is required, call the SEPA
coordinator at (919) 73 3 - 5 ~o review current thresholds for environmental documentation.
Yes 0 No bd'

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

X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)

It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the 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 iden ti fiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.

Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply BufferRequ~ents), or other (please identify )?
Yes 0 No ~ If you answered "yes", provide the following information:

Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.

Zone* Impact Multiplier Required
(square feet) Mitigation
1 3
2 1.5
TOlal

*

Zone I extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additionnl20fcct from the edge of Zone 1.

Page I I of 12

If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within ISA NCAC 2B .0242 or .0260.

A/fA
[

XI. Storrnwater (required by DWQ)

Describe impervious acreage (both eXIstmg and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.

;ilr+

,

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.

/Jltt

XIII. Violations (required by DWQ)

Is this site in violation of ~9. Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes 0 No gr

Is this an after-the-fact permit)wplication?
Yes 0 No [il

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).

./

6 -Ig/~ oi

Applicant r gent's Signature Date
(Agent's signatur is valid only if an au horization letter from the applicant is provided.)

Page 12 of 12

Scale 1:7920

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DATA FORM
ROUTINE WETlAND DETERMINATION
(1987 CO E Wetlands Delineation Manual)

~ , 5:f.- /1':1'( I ~

~ c::t.r_ I

Project/Site: ("7 ~
Applicant/Owner:
Investigator:

Do Normal Circumstances exist on the site?
Is the site significantly disturbed (Atypical Situation)?
Is the area a potential Problem Area?
(If needed, explain on reverse,)

:VEGET A TION

Strltum
S
5
t+-

Indicator
Fit Li
~ ftr c-

9.
10.
lL
12.
13.
14.
7. 15.
8. 18.

Date: 7 - 2 I - 6)
County: W. \,'( ..s d\......
~tate: /'rI c..

Community 10: / it / L
Transect 10:
Plot 10:

Oominant Plant Saacias

Stratum

Indicator

Percent of Dominent Specie. that er. 0&, FACW or FAC ,I j/ D
(excluding FAC.), _ _

Remark.:

h yL~ ~L~~7 ~;J2~

Wetlend Hydrology Indicator.: .
Primery lildlcetors: . ."
lnundltld,
_ SltUrltld In Upp.r 1 2 Inch..
Witt, Merk.
Drift Unes
= Sediment Depoeita
Drlinage Pstteme In Wetlands
Secondary Indicators 12 or more required):
_ Oxidized Root Chenne's in Upper 1 2 Inches
_ Wlter.Stalned, L.ev..
LocI/ Soil Survey Date
- FAC.Nautrel Test
_ Othe, (explain in Remarks)

ffYDROlOGY

I _ Record~ Data (Desclib. in Remarbl:
_ Strelm, Lake, or Tid. Gauge
/ _ ~~ Photo~~8pha

~ No R.corded Data Aveilabl.

Field Ob.ervations:

Depth of Surfac. Wllter:

IIn.)

Depth to Fr.. Weter In PIt:

.7/fc.
;:;>-( b

(in,1

(In.1

Depth to Saturatld Soil:

Ramark.:

/Vi)

~ ~ t~'-rUk

r

I

..:~
at'ons . .
j'ai(tJ~e? h. No
"~l'''''\", .

Te,~r{C.()ncretlon..
S'tructure;\,etc.., ,

..'1 _ Concretions
':I' _ High Organio Content in Surface layor in Sandy Sol's
- Organic Streakl~ln Sandy SOj'.
- Uated 0!:'.t.00.4 Hydrio Soil. Uat
- Uated on National, Hydrio SoHs Uat
_ Other (Explain In Ramarb)

SOILS

Map Unit Name
(Series and Pha..):

v

Taxonomy (Subgroup):

erofile DescriDtio'li
Depth
{inchesl Horilon

~~'~6 jJ"-
J': '~:'~'I;'~",' ,~,I ff

, '6':-' 6 L

;;'''!f.,.;~~~!~I, .. ~
M4trix Color Mottle CoI.a. ",;.~,'P.;1p~e.1 \,
'LMur,seIlM.olstI7_t Munsell Mol t;..'''''....,~6undanca/cont1asI '
I {) y~:rz ,-;~ t ~,.,.
I () ( ~ 6/7'-

<t\:'

~

~~\l~
I,' ,,;..11-
"\

L

~j

f ..\~::)

k\:

ijf...."....."..
" ,
'1':'1

"~ydric Soil Indloators: ~
I
HI.to.ol
_ HI.tle Eplpedon
_ Sultld'~ Odor
.....;.;.. Aqulo Moisture Ragime
Reducing Conditio'"
= G'.Ved or LOw-ChrOm. Colors

~'f~

-,
Reinark.:

;v~~-- hy~

."",! WETLAND DETERMINA nON
'~~~,

Hydfophytic Vegetatlon Pt..ent7
We~and Hyd~l)/ogy Pte.ent?
Hydlio Soj'a Pt..ant?

!f~"'J
y..~

I. th/e Semp/'ng Point With/,n ..Wetland?

Remarks: ..

-

!/;!'
'."

C;;\\~
.'.tJ.'. .~.'..'

~~.;..... _/

.(

~

Approved.by

.....

~

'-5
...s'

1'1
.t>~
'.1-

(Clre/e)
Yes @)

3/92

....

1...,

...'

'....

ProjecU$.ite: G.
Applic;antJOwner:
4"'.' .
Iny~p~~()H

Do No~al Circumstances exist on the. site?
Is the site significantly disturbed. (Atypical Situation)?
Is the area a potentia' Problem Area?
(If ,needed, explain on revers~.).

DATA FORM
ROUTINE WETlAND DETERMINATION
(1987 COE Wetlands Delineatiofl'.Manu<!!)
~ (53,

Date: 7-:- 21 ~ Qr
,CountY: _w " { .s ~ =- .
State: _ /V' C

Community.lD: I Wa:{
Transect 10:
Plot 10:

VEGETATION

~~

. Stratum 'ndicator
1+
H
s
tl-
ft

08'--
DeL
..0 8. L
LJlfL
OeL-

Dominant Plant Soeeies
9.
10.
11.
12.
13.
14.
15.
18.

~atum Indicalor

7;.
8.

:. ,
. Percent of Dominent Specie, that.re OBl. FACW or FAC
lex 'no FAC-}.

Remarks:

=

HYDROLOGY

- R8cord~ D8t4i tDe.cno. in <Remarb}: :
w.tf.nd Hydrology IndiCItOIl:
- Streem. Lake. or Tid. Geuge Primary indicator.:
. _ A.riel Photographs ~/idlted
vi. Other. s.rUtated.ln IJpper 1 2 Inches
-- No R'~ed Data AV8l1eb1. _ Wat.r Meritt
- Drift Unes
_ Secliment D.potlts
Fi,'d 'Obeervatione: - DrtlRlge Pattetll8 In Wed.nds
S,cOndaty Indicators (2 or more requiredl:
Depth of SUrfac. Water: (In.), - OxIdiztd Root Cbtnne's In Upper 12 'ncfMs
l:1 _ W.ter-Sr.ined,l.e.v..
\ Depth to Free Wat.r In Pit: (In.) _ Locol Soil Survey D.ta
., _ FAC-Noutral Test
Depth to S.tur.ted Soil: 3 (in.) - Other IExplaln In Romarb)
Rem.rit8: g '-I ~b~ry .~
.

./

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, '

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;~,

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f
~~~;'.' ;

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SOILS

Map Unit Neme
{Series end Phase):

Drainage Class: p ])
Field Observation;
. Confirm MaPP<<lTl'Jltl Y.. N9

..'}

. TaxonQllW (SubgroUPI:

, ,
, . Profile DoscriDtion,
, Depth !
,{inches) Horizon

o - if 4- ~ O''r7 7"b
~ ~ /0 , 8 I ~ 2~ rl',SI'Z-
1 0 - 21) IS Lj Sf '-I/i

Matrix .COIOr
lMunsell. MoIst) .

Mot,tle Colors
../MInsell Moist!

MO~t .
. AbtindlltlCe/l1lntr~,

T extu", Concretions.
Structure.. em.

'1/ .~~ Il~
. ~ S '7;(J y~, ..::t ~ rt"~
, t (,

S'L
CL-
CL

--

1,,/'. .

Hydric SoiIlndlcatora:
I
_ H1stosol
H1~o Eplpedon
- Sl,lffldfc Odor
= Aquio Mol",,, Regime
. Redueing Conditio....
Z GI~ or Lo.chromeColors

. Concretions
= ligh Organic Content In Surface Leyof'ln Sendy Soils
~ o.v.wo S~:Jn Send>( SOtl.
-.: 1,Iated on LoeaI !lYdricSoifa U<<
_!Mid on NetioNI H,tdrio Soil. U~
_ 01IMr ~n In.RIIlIIIrbI

Remarks:

hyk s ~

'-',;.
i

WETlAN,D DETEftMlN!\npN .

No (CIn;Ie).. .., (Cltdt'
::: I,.., "_no ... WI"". . w.i...... ~ ..

Hydrophytic Vegetation Pteeentl
. W.tland Hydrology Pre..nt7
Hydrio Soil. Pr...ntl

Rern.rb:

m; .1
.W~

V'

~.
f~
,

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".)

2 0 0 5 1 6 2 8

I. Processing

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

2. Nationwide, Regional or General Permit Number(s) Requested: 18

Riparian or Watershed Buffer Rules
Isolated Wetland Permit from DWQ

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

4. If payment into the North Carolina 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: D

5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal t;f~~t Area of
Environmental Concern (see the top of page 2 for further details), checL\rlS~ DWm @

Applicant Information AUG 2 5 2005

II.

1. Owner/Applicant Information
Name: ,.EJby.YJU h1
Mailing Address: PO. Bot ;; So
S-fqn'fnns'~l'''''5 Me. :? 17ffK3

\imZ~R. WATER QUALITY
AND STORMwATER BRANCH

Telephone Number: d5:J. - ~ g Ct- 5575
E-mail Address:

Fax Number:

2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:

Telephone Number:
E-mail Address:

Fax Number:

Page 5 of 12

III. Project Information

Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17 -inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.

1. Name of project: BYt'Jum ~"""'5
2. T.I.P. Project Number or State Project Number (NCDOT Only):

IV) 14
(

3. Property Identification Number (Tax PIN):

4. Location
County: IV; bon Nearest Town:
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.):
-/l,y,,'1" ,Sk'Y1fc}.,~ll.4'5 I +I.e., ~&I- 0'1+0 Sf! 15.3'1 ,
Cro,<;S Ii,.; K R
/ '

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

S~-IOhS~L1Y.5

,Me.. .5'k J"o",,+J,
I ,..,,"le. 0"" /.1# c;lf~....

6. Property size (acres):--.3'O <i.C~j

7. Nearest body of water (streamlriver/sound/ocean/lake): Co '1 te'l-fl1e<. Cir.ee..k

8. River Basin: A!Ct-ue..
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.ellr.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: C'lipl~,( I c""i- Dv.e'" t,./c"lIli."d. 1".)0 cd /" ",)
r I ,

Page 6 of 12

() ; >t.<.

b,.c..k ,-f r> r...-.:,;1'1 fay 1~e(ft'",,~\;i~
j/ I T

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 ill 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.

li/lq.

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//4
, /

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

It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.

Page 7 of 12

1. Provide a written description of the proposed impacts: :;)0'
l.</./I h<. 1^c.~t<J 0" 1-.'7" t/r-eAOlJ I~ wc;f/~'tA (;,J/cw';'1

l,v ;) ( cI,;.-t f (,ft. ,
"IA '" I' ..Ji,
I

P cift-

2. Individually list wetland impacts below:

Wetland Impact Area of Located within Distance to
Site Number Type of Impact* Impact 1 DO-year Floodplain** Nearest Stream Type ofWetland***
(indicate on map) (acres) (yes/no) (linear feet)
i HI-1 t:.'''/lA:~"", . -Pi I \ L \1 ... C) /060/ r;{<'Sfu~ W~~
.f K ~( r;;~ ,

'" List each impacl 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 noodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at httn://www.fema.gov.
"'*'" List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (detennination of isolation to be made by USACE only).

List the total acreage (estimated) of all existing wetlands on the property:
Total area of wetland impact proposed: .:::. . J

,). 0 <'; c..

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

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

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 nows. USGS maps are available through the USGS at 1-800-358-9616, or online at
wWW.USl!S.IIOV. Several internet sites also allow direct download and printing of USGS maps (e.g., www.tonozonc.com,
www.manQucst.cOI11. etc.).

*

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

N/rt
, I

Page 8 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 D

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 NEP AlSEP A document is required, call the SEP A
coordinator at (9 1 9) 733-5~o review current thresholds for environmental documentation.
Yes D No ~

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

X. Proposed Inlpacts on Riparian and Watershed Buffers (requ~red by DWQ)

It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.

Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), l5A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requ~ents), or other (please identify )?
Yes D No lJ!j If you answered "yes", provide the following information:

Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.

Zone* Impact Multiplier Required
(square feet) Mitigation
I 3
2 1.5
TOlal

Zone I extends out 30 feet perpendicular from near bank of channel; Zone 2 eXlends an
addi lional 20 feet from the edge of Zone \.

Page I I of 12

If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or .0260.

/JIA
(

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.

N/H

.

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.

/JIlt

XIII. Violations (required by DWQ)

Is this site in violation of ~.9. Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes 0 No G?"

Is this an after-the-fact per~t J:l?Plication?
Yes 0 No l1V

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).

/'
O-It"o~

Applicant t gent's Signature Date
(Agent's signatur is valid only if an au horization letter from the applicant is provided.)

Page 120fl2

rh~ . lip Is forFSA prof/raM purpos.s only.

o TrElct Boundary
Clu_E1_nc195.shp

N

+

Farm: 6012
Tract 8309

o

.

400

800

1200

1600 Feet

Sollie 1:7920

Printed: Apr If. 200!i
I

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SOILS

Map Unit Nom.
(Serie. .nd Phase):

. Taxononw (Subgroup):

. Profife Descriotlon:
. Depth ! Matrix Color
.finches) H.orizon (MuMe'fMoistt I

0- if A- /Or-x'll?
'1 ~ 10 , () I ~ 2 ~ r7.S/2
J 0-2D g LJ .)r ~/;.

Hydric Soil'ndicatora:
I
_ Histo.oI
Hie1ic Epfpedon
- Suffidlc Odor
_ Aqulc MoI.wre Regime
. Reduclng Conditio".
:z. G'eyed or Low-ChromeCofora

Remarks:

hy~ 5 o-d..

WETlAN.D DETEfWI~npN .

Hydrophytfc VegetatfonPteeent1
. Wedand Hydrology Pre.ent1
Hydric Soil. Pr...nt1

Remark.:

w~

~

\,
:~.,i
. i'
~

I.
f;
i:'

Pi)

DrellUlge Clat:
Fiold Obserwtfons
. Confinn Mapped Type?

v.. ~.

Mo~e Colors
(Munsell Moist!

Mo~. . T.xture, ConcretiOlll, .
Abtindance~ntrest. ~truC1Ure.' etc.'

S'L
C'L-

7'/ .l;-~ Il~
. 7-(7'~. Y4, ~ ~ rl.'~
I I II

CL

U'. .

_ Concretions
- High Organic Content 'n Surf<<t layer In Sandy Soh
-.;. Organ/o S~1n SandY SoiIt
. Usted on local ~ .soa. List
- Uated 01) NadoNI Hydric Soil. tIrt
_Other~nln.~J

No (CIrcle'. CClrete'
No
No I. tN. Sempfing PoInt Within _ W'IIand? ~. No

h'J

.\
v.
/

~.
"
,.

. ProjeciJ~ite: C:,~.
Appn~nt/Owner:
.. . 4.... .
In'(~Q~~~t-:

Do No~al Circumstances exist on th~ site ~
'S the site significantly disturbed.(Afyplca' Situation)]
Is the area a potential Problem Area?
{'{!leaded, explain on revers~.J.

DATA FORM
ROUTINE WETlAND DETERM'NA nON
0987 COE Wetlands De'ineatioll',ManuaJI
. 1< 153'1

Date: 7~ 2/ - Q s
,County: _W (' {.s ~ ~
State: tv C .

No. Community./o: _I L.J a;f
Transect 10:
Plot 10:

VEGETATION

t~

. Stratum 'ndiclJtor
1+
i+
s
H
If

, ....Q8 L-
Ou
-DeL
..tJ iJ L
.DeL

Dominant Plant Species

Stratum ID51iC8tor

1:.
8.

9.

10.

11.
12.
13.

14.

15.

18.

."Perc~t of Dominant Speciet! that.,. OBI.. FACW or FAC
(ex no FAC-).

Remarb:

=

HYDROLOGY

- R.COrd~D.. tOe,crib. in "Remaib): Wedillnd Hvdrofogy Indic.to,.:
- S~am. Leke, or Tldt GICI9. Prirriaty Indicatorr.
. _ Aerial Photographs ~,idlttd
~ Other. . setiU.ted:/nUpper 12'nchfl
. No Rt'C;rded DaUI Available _ Wat., Marks
. -- . .. , Drift Unes
-
. _ Sediment Dtposits
..
ReId' Ob.ervltiont: - Drtlnage PattetNI In Wed.nds
SeCOndary IndiCltOll (2 or mort requ'rod):
Depth of Surface Water: (In.)- Oxidlztd Root Channel. In Upper 121nche.
11 = W.te....Stelned.le.vt. .
\ Depth to Free Water In Pit: (in.) _ LOCal Soli Survey Data
., FAC-NlVtrtl rest
3 -
Depth to S.tureted SoU: (in.) - Other lExp/tln in Remark.)
. r
Rem.rke: ~ ~ ~utr0rv
.
.

./

SOILS

Map Unit Name
(Sarie. .nd Pha.e): ~

Yea No

Taxonomy (Subgroup):

Profi'e DescriDtioni
Depth
Linches) Hkn

:i'f'rfi.~1
lr...:~~~.;~(1 {)

( .'6;:-' 6 ~

.....

fA

s
c .
~ ,k~
'~ .

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1'j:'

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, \...,j~:
wi"

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,

....

ij

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\

~ir:.

'Aydric SOi"ndicators: ~
I

!~

Histoso'
_ HI.tic Eplpedon
- Sulfidic Odor 1~
_ Aquio Moisture Regime
Reducing Conditio"
= G'lIyed or LOw-ChrOma CoIol1l

-'1

Concretion.
- High Organio Contant In Surface Layor in Sandy Soi'.
_ Organio Streakl~ln Sandy Soi'.
_ Uated on Loc.I Hydrio Soil. Uat
_ Uated on NatiorMll Hydrio SoH. Uat
_ Other (Exp/81n in R.-natb)

Remarks:

jJ~~- flY ~

."';: WETLAND DETERMINA nON

.,

Hydtophytio Vagetation Present? ~r' (CIrcle)
We~and Hydrl)/ogy Pre.ent? Ves ... Ye.@
Hydric Sol'. Present? V.. 0 ,. th/. Semp/lng Point Wlth/,n a Wetland?
Remarka: .. '~~
'~~:'J '
; ',~j
'B;\~'"
~ ~
Approved by . ;J/14Z

it1, .

(,

'....

lO/

DATA FORM '
ROUTINE WETLAND DETERMINATION
(1987 COE Wetlands Delineation Manual)

~ '. s:~ 1{"1'f I ~

~. Q.,,--- '

Project/Site: (., ~
Applicant/Owner:
Investigator:

00 No~al Circumstances exist on the site?
Is the site significantly disturbed (Atypical Situation)?
Is the area a potential Problem Area?
(If needed, explain on reverse.)

;VEGET A TION

7.
8.

Stratum
S
s
l-I--

Indicator
. Fir ( '1
~ I'tr C-

Percent of Dominent Speciee that are OBL, FACW or FAC
(exCluding FAC.),

Remarkl:

Date: '7 - 2 I - (])
County: W ( '( ..s d\.....
~tate: H c...

Community .10: / it j? L
Transect ID:
Plot 10:

Dominant Plant SDIICillS
9.
10.
11.
12.
13.
14.
15.
18.

8tretum

Indicetor

IUD
~~~'1

h y L",-,~~ Ive~V..~t~7'

fiYDROlOGY

I _ Racorded Data (Delciibe In Remerltl):
_ Stre~, Uke, or TIde GlUge
_ Aeriel PhotogrepM

~ Re;rd:-~ata AV~leb'e

Field Obaarvations:

Depth of Surfaca Wat.r:

Depth to F.... Water In PIt:

D.pth to Saturated Soi':

(In.)
7J~ (In.)

;7( b (In.)

... ..
Wetland Hydrology Indicators:
Primary lildlcators: "
_ Inundated,
_ Saturated in Upper 1 2 'nches
Water Marks.
_ Drift Unal
_ Sediment Depoeiu
Dr.nag. Pattern. in Wetland.
Secondlry Indicators (2 or more required):
_ Oxidized Root Channel. in Upper 12 Inche.
Wat,,.StlIlned, L.av..
_ Local Soi' Survey Data
FAC-Neutral Test
_ Other (Exp/lIin In Remarks)

Remerlt.:

No

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