20051733 Ver 1_Complete File_20050912

~.;~..

Michael F. Easley, Govemor

William G. Ross Jr., Secretary
North Carolina Departinent of Environment and Natural Resources

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

November 10, 2005

DWQ Project # 05-1733
McDowell County

Norman McKalvey
Old Fort Properties, LLC
1 McKenzie Way
Old Fort, NC 28762

1Et":::'lo.--n~,..,~ ~
! r:-.. . . .' I ~
10). Si \~.! . \.1..::::1 ~
lh\ t.
1\11-\' 1 7 .'005'
I 'p) V, !..'

DENH lJ/\Tb? (~\Jr,Llrr
\^:''ETIN in>: f!Ji", ~TnpI..!W"Tr.fl F1AHctj

Subject Property:

Gateway Mountain - Mulberry Drive
McDowell County

Approval of 401 Water Quality Certification with Additional Conditions

Dear Mr. McKalvey:

You have our approval, in accordance with the attached conditions and those listed below, to
place fill within or otherwise impact 60 linear feet of streams for the purpose of roadway
construction at the subject property, as described within your application received by the N.C.
Division of Water Quality (DWQ) on September 20, 2005. After reviewing your application, we
have decided that the impacts are covered by General Water' Quality Certification Number(s)
3402 (GC3402). The Certification(s) allows you to use Nationwide Permit(s) 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 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 or
CAMA Permit.

This approval is for the purpose and design that you described in your application. If you change
your project, you must notify us and you may be required to send us a new application. If the
property is sold, the new owner mu'st be given a copy of this Certification and approval letter and
is thereby responsible for complying with all conditions. If total fills for this project (now or in
the future) exceed one acre of wetland or 150 linear feet of stream, compensatory mitigation may
be required as described in 15A NCAC 2H .0506 (h). This approval requires you to follow the
conditions listed in the attached certification and any additional conditions listed below.

The Additional Conditions of the Certification are:

N?;'ithCarolina
/Va/lifally

401 Wetlands Certification Unit
1650 Mail Service Center, Raleigh, North Carolina 27699-1650
2321 Crabtree Boulevard, Suite 250, Raleigh, North Carolina 27604
Phone: [phone]/ FAX [phone]/lntemet htto:llh20.enr.state.nc.us/nC'vVetlands

An Equal Opportunity/Affirmative Action Employer - 50% Recycledi10% Post Consumer Paper

Old Fort Properties, LLC
Page 2. of 5
November 10, 2005

~.

~

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 Plan Location or Reference
(Units)
Stream 60 (feet) UT

2. Erosion & Sediment Control Practices

Erosion and sediment control practices must be in full compliance with all specifications
governing the proper design, installation and operation and maintenance of such Best
Management Practices in order to protect surface waters standards:

a. The erosion and sediment control measures for the project must be designed,
installed, operated, and maintained in accordance with the most recent version of the
North Carolina Sediment and Erosion Control Planning and Design Manual.
b. The design, installation, operation, and maintenance of the sediment and erosion
control measures must be such that they equal, or exceed, the requirements specified
in the most recent version of the North Carolina Sediment and Erosion Control
Manuql. The devices shall be maintained on all construction sites, borrow sites, and
waste pile (spoil) projects, including contractor-owned or leased borrow pits
associated with the project.
c. For borrow pit sites, the erosion and sediment control measures must be designed,
installed, operated, and maintained in accordance with the most recent version of the
North Carolina Surface Mining Manual.
d. The reclamation measures and implementation must comply with the reclamation in
accordance with the requirements of the Sedimentation Pollution Control Act.

3. No Waste, Spoil, Solids, or Fill of Any Kind

No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or riparian areas
beyond the footprint of the impacts depicted in the Pre-Construction Notification. All
construction activities, including the design, installation, operation, and maintenance of
sediment and erosion control Best Management Practices, shall be performed so that no
violations of state water quality standards, statutes, or rules occur.

4. No Sediment & Erosion Control Measures win Wetlands or Waters

Sediment and erosion control measures shall not be placed in wetlands or waters to the
maximum extent practicable. If placement of sediment and erosion control devices in
wetlands and waters is unavoidable, they shall be removed and the natural grade restored
within six months of the date that the Division of Land Resources has released the
project.

Old Fort Properties, LLC
Page 3 of5
November 10, 2005

5. Certificate of Completion

Upon completion of all work approved within the 401 Water Quality Certification or
applicable Buffer Rules, and any subsequent modifi9ations, the applicant is required to
return the attached certificate of completion to the 40l/Wetlands Unit, North Carolina
~ivision of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650.

6. Diffuse Flow

All constructed stormwater conveyance outlets shall be directed and maintained as
diffuse flow at non-erosive velocities through the protected stream buffers such that it
will not re-concentrate before discharging into a stream.

7. Turbidity Standard

The turbidity standard of 10 NTUs (Nephelometric Turbidity Units) shall not be
exceeded as described in 15 A NCAC 2B. .0200. Appropriate sediment and erosion
control practices must be used to meet this standard.

8. No Impacts Beyond those in Application

No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or riparian
areas beyo.nd 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.

9. Deed Notifications

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

10. Culvert Installation

Culverts required for this project shall be installed in such a manner that the original stream
profiles are not altered. Existing stream dimensions (including the cross section
dimensions, pattern, and longitudinal profile) must be maintained above and below
locations of each culvert. Culverts shall be designed and installed to allow for aquatic life
movement as well as to prevent head cutting of the streams. If any of the existing pipes are
or become perched, the appropriate stream grade shall be re-established or, if the pipes
installed in a perched manner, the pipes shall be removed and re-installed correctly.

Old Fort Properties, LLC
Page 4 of5
November 10, 2005

Culvert(s) shall not be installed in such a manner that will cause aggradation or ~rosion of
the stream up or down stream of the culvert(s). Existing stream dimensions (including the
cross section dimensions, pattern and longitudinal profile) shall be maintained above and
below locations of each culvert. Therefore, you must provide plans with adequate details
that indicate that the current stability of the stream will be maintained or enhanced. You
must receive written approval from this Office for the above plans before the culvert(s) is
installed. Culvert(s) must be installed according to approved plans.

The establishment of native, woody vegetation and other soft stream bank stabilization
techniques must be used where practicable instead of rip rap or other bank hardening
methods. If rip-rap is necessary, it shall not be placed in the stream bed, unless specifically
approved by the Division of Water Quality.

Installation of culverts in wetlands must ensure continuity of water movement and be
designed to adequately accommodate high water or flood conditions.

11. Compensatory Mitigation (Final Plan Needed)

As 125 linear feet of impact was previously permitted within the Gateway Mountain
Subdivision, mitigation must be provided for the proposed impacts as specified in the
table below. A final compensatory mitigation plan must be approved in writing by this
Office before any of the impacts approved herein are conducted. Additionally, the
compensat.ory mitigation plan must be completely constructed and implemented
according to the plans approved by this Office before any permanent building or road
associated with the project is occupied or opened. The mitigation must be maintained
according to the approved plan and permanently protected by the use of conservation
easements or similar protections. Any repairs or adjustments to the mitigation site must
be made according to the approved plan or must receive written approval from this Office
to make the repairs or adjustments.

Stream

Compensatory Credit Mitigation Re uired
185 (feet)

Upon completion of the project, the Applicant shall complete and return the enclosed "Certificate
of Completion" form to notify NCDWQ when all work included in the 9401 Certification has
been completed. The responsible party shall complete the attached form and return it to the
401/Wetlands Unit of the NC Division of Water Quality upon completion of the project. Please
send photographs upstream and downstream of each culvert site to document correct installation
along with the Certificate of Completion form.

Violations of any condition herein set forth may result in revocation of this Certification and may
result in criminal and/or civil penalties. The authorization to proceed with your proposed
impacts or to conduct impacts to waters as depicted in your application and as authorized by this
Certification, shall expire upon expiration of the 404 or CAMA Permit.

Old Fort Properties, LLC
Page 5 of5
November 10,2005

If you do not accept any of the conditions of this Certification (associated with the approved
wetland or stream impacts), you may ask for an adjudicatory hearing. You must act within 60
days of the date that you receive this letter. To ask for a hearing, send a written petition, which
conforms to Chapter 150B of the North Carolina General Statutes to the Office of Administrative
Hearings, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. This certification and its
conditions are final and binding unless you ask for a hearing.

This letter completes the review of the Division of Water Quality under Section 401 of the Clean
Water Act. If you have any questions, please telephone Cyndi Karoly in the Central Office in
Raleigh at 919-733-9721 or Mr. Kevin Barnett in the DWQ Asheville Regional Office at
[e-mail] or at 828-296-4657.

AWK/khb

Enclosures: Gc. 3402
Certificate 'of Completion

cc: USACE Asheville Regulatory Field Office
DWQ 401 / Central Office
DLR Asheville Regional Office
File Copy
Central Files

Filename: 05-1733.GatewayMountain-MulberryDrive.GC3404.approval

Re: [Fwd: Re: [Fwd: Tardies]]

Subject: Re: [Fwd: Re: [Fwd: Tardies]]
From: Kevin Barnett <[e-mail]>
Date: Thu, 10 Nov 2005 14:56:55 -0500
To: Ian McMillan <[e-mail]>
CC: Larry Frost <[e-mail]>

Hi Ian:

All three were issued today.

Kevin

Ian McMillan wrote:

Kevin, I'm really not trying to bug you and this will be my last message on the subject. But, if you
need my help with these please let me know as I just learned today that we're off tomorrow. -
Thanks, Ian

Subject:
Re: [Fwd: Tardies]
From: Larry Frost <Larry.FrostCa}ncmai1.net>
Date: Thu, 10 Nov 2005 10:51 :39 -0500
To: Ian McMillan <ian.mcmillanCa}ncmai1.net>
To: Ian McMillan <ian.mcmillanCa}ncmail.net>
CC: Kevin Barnett <Kevin.BarnettCa}ncmai1.net>

Ian
I got a hold of Kevin and he informs me that he will update you on these projects this afternoon. He
should be back to the office by 1 :pm.
Larry

Ian McMillan wrote:

Subject:
Tardies
From:
Ian McMillan <ian.mcmillanCa}ncmai1.net>
Date:
Wed, 09 Nov 2005 17:02:45 -0500
To: Kevin Barnett <Kevin.BamettCa}ncmai1.net>

lof2

11/10/2005 2:57 PM

Re: [Fwd: Re: [Fwd: Tardies]]

To: Kevin Barnett <Kevin.Bamett~ncmai1.net>

Kevin, would you be able to update me on these? Thanks, Ian

05-1746, Mountain River ofCullowhee, Jackson Co, NW12 9/15/05 11/13/05

05-1733, Gateway Mountain Mulberry Drive, McDowell Co, NW39 9/12/05 11/10/05

05-1739, Owens Bell Water Quality Improvement, Buncombe Co, NW27 9/14/05 11/12/05

Larry Frost - [e-mail]
North Carolina Dept. of Environmenit-and Natural Resources
Asheville Regional Office
Division of Water Quality - Water Quality Section
2090 U.S. 70 Highway
Swannanoa, NC 28778
Tel: [phone]
Fax: [phone]

Kevin Barnett - [e-mail]
North Carolina Dept. oE--Environment and Natural Resources
Asheville Regional Office
Division of Water Quality - Water Quality Section
2090 U.S. 70 Highway
Swannanoa, NC 28778
Tel: [phone]
Fax: [phone]

Kevin Barnett <Kevin.Bamett~ncmail.net>
NC DENR - Asheville Regional Office
Division of Water Quality - Water Quality Section

20f2

11/10/20052:57 PM

Triage Check List

Date: 09/16/05

Project Name: Gateway Mountain - Mulberry Drive
DWQ #:05-1733
County: McDowell

To:

Kevin Barnett, Asheville Regional Office

60-day Processing Time: 9/12/05 to 11/10/05

filE GuPV

From: Cyndi Karoly Telephone: [phone]

The fIle attached is being forwarded to you for your evaluation.
Please call if you need assistance.

D Stream length impacted
D Stream determination
D Wetland determination and distance to blue-line surface waters on USFW topo maps
Minimization! avoidance issues
D Buffer Rules (Neuse, Tar-Pamlico, Catawba, Randleman)
D Pond fill
D Mitigation Ratios
Ditching
D Are the stream and or wetland mitigation sites available and viable?
D Check drawings for accuracy
D Is the application consistent with pre-application meetings?
Cumulative impact concern
D

D

D

Comments: As per our discussion regarding revision ofthe 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!

PAYMF',rr
?__ .. -_I, f
!it.(lF/! fi-"
v I ii-I'
-fL.U

Office Use Only:

I. Processing

1. ~SCk all of the approval(s) requested for this project:
~ Section 404 Permit 0 Riparian or Watershed Buffer Rules
D Section 10 Permit D Isolated Wetland Permit from DWQ
~OJ Water Quality Certification 0 Express 401 Water Quality Certification

2. Nationwide, Regional or General Pel111it Number{s) Requested:

1/(.</ 3Cf

3. If this notification is solely a courtesy copy because written approval for the 40 J Cettification
is not required, check here: 0

4. Ifpaymentinto the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: 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 Management Area of
Environmental Concem {see the top of page 2 for further details}, check here: D

II. . Applicant Information @ &! @ @ U W@ @

SEP 1 2 2005

,.-,e
1','ETLAfi"i)S Ar~~ ~s~~0.~, S~":LITY
-n'''''.ilt;'( bRANCH

1. Owner/Applicant Inform tion
Name:
Mailing Address:

! P1G-f:.E, )"Z-I ~ /JAV
O'~ FDiZ~, 1- 11'..... Z~7~ Z

Telephone Number: f3Z,g-~~8'" ~8~ Fax Number:
E-mail Address:

2. Agent/Consultant Infoffilation (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

ill. 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 ofproject: lY1oJ.-8&tZ/Z..V DtZ.,JE,

2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): ('~fI - DO'" 2..S' - '" /37

4. Location .
County: ;41~O()(~J61.1 . Nearest town: t:JJ.-l) {4;IZ:-r .
Subdivision name (include phase/lot number): (),;H'IE.~JAv IIfn,l.r1"A'~- NJJ~Ej?1ZY .De.
Directions to site (include road numbers/names, landmarks, etc.):
I=~l'" \:l7~ ~ :L-Llo -;Au gA"r~e. ep/~t:t,rz;."'{Zn AWtztH 7.~ .....1l.2.~
-G.. tc1A1.J ~A"r'GLa4y ~~...., ~ 1/1?,IJ. .,/ &. ;)tOJ UiPr'

5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum): "N OW

6. Property size (acres): '-10 /4(,/?;6

7. Name of nearest receiving body of water: SAu.,Y~2..A~H

8. River Basin:-B tz-oAO
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at htto://h20.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: P;,K€:<" ~ '( 10 ~ f ~~,A L 'D;Vt:=1 ~~~ '\..,..-

Page 6 of12

10. Describe the overall project in detail, including the type of equipment to be used:

~~ :/!:i;;;:~,%;=::;"~~~~~,~~-r
~-ee:e-~ tlDS - ~ HoE. -lAi..., PO'-~
11. Explain the purpose of the proposed work:
~ ~,. fZ€,S/~Al_ Va/B..eI?~ru.:rr

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. P.JIZI.u4, ,eJ./1- p~~c; P.Jr';'~'I'l'" ~ ~ ~","rf"'d~L
P"AIloJ~ ~.-k. S,.J8;tt,.,...-t"€.D AaJD ..4PP~al/E,p

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.

VI. Proposed Impacts to Waters ofthe United StateslWaters ofthe State

It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts are proposed to these systems.
Wetland and stream evaluation and delineation fonns 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 ~ts:
~~S PJ)AAJ C",ul-I/l9Z-rs '()~ p'L>AOWA-Y

Page 7 of12

2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized. clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
I r' d b h d fl d'

seoarately 1St Impacts ue to ot structure an 00 mg.
Wetland Impact Type of Wetland Located within Distance to Area of
100-year Nearest Impact
Site Number Type of Impact (e.g., forested, marsh, Floodplain Stream (acres)
(indicate on map) - herbaceous, bog, etc.) (yes/no) (linear feet)
.tJif
.
Total Wetland Impact (acres)

3. List the total acreage (estimated) of all existing wetlands on the property: vA-

4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
must be included. To calculate acrea e, multi lien h X width, then divide b 43,560.
Stream Impact Average Impact Area of
Number Stream Name Type of Impact Stream Width Length Impact
indieate on ma Before act linear feet acres
, ,
D
0'

Total Stream Impact (by length and acreage)

60

~I

5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill . d d' fl d' dra b lkh

, excavation, re lemg, 00 mg, inage, u eads, etc.
Open Water Impact Name ofWaterbody Type ofWaterbody Area of
Site Number Type of Impact (lake, pond, estuary, sound, bay, Impact
(indicate on maD) (if applicable) ocean, etc.) . (acres)
./J
p,T
Total Open Water Impact (acres)

Page 8 of12

I

6.

7. Isolated Waters
Do any isolated waters exist on the property? 0 Yes 0 No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.

8. Pond Creation .
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): 0 uplands 0 stream 0 wetlands
Describe the method of construction (e.g., da.m.(epbankment, excavation, installation of
draw-down valve or spillway, etc.): 1.//1"
Proposed use or pmpose of pond (e.g., livestoCk watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Current land use in the vicinity of the pond:
Size of watershed draining to pond: Expected pond surface area:

VII. Impact Justification (Avoidance and Minimization)

Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts. A1eA~~~ 1A.J~p6

~ ~:;--:;~~~1';:t:':-:::'~:;'~~~~:;t,LD

17~es to. VYr" ~~_ ~ /~7iZ€AM ~AL.lI\1€.,L~
,

VIII. Mitigation

DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.

Page 9 of12

USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on January 15,2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.

If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
htto:/ /h2o.enr.state.nc. us/ncwetlands/strmgide.html.

1. Provide a brief description of the proposed mitigation plan. 'The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.

~

2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at htto://h20.enr.state.nc.us/wm/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:

Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):

J1-

.. .

Page 10 of12

.,

IX. Environmental Documentation (required by DWQ)

1. Does the project involve an expenditure of public (federa~ta~local) funds or the use of
public (federal/state) land? Yes 0 No l2t'"

2. If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPAJSEPA)?
Note: If you are not sure whether a NEP AJSEP A document is required, call the SEP A
coordinator at [phone] to review current thresholds for environmental documentation.
Yes D No 0

3. If yes, has the document review been fmalized by the State Clearinghouse? If so, please
attach a copy ofthe NEPA or SEPA final approvalletter. Yes 0 . No 0

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

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

1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify vA )? Yes 0 No 0

2. If "yes", identify the square feet and acreage of impact to each zone of the riparian buffers.
If buffer mitigation is required calculate the required amount of mitigation by applying the
buffi I

er multipliers.
Zone. Impact Multiplier Required
(SQuare feet) Mitigation
1 3 (2 for Catawba)
2 1.5
Total

* Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
. additional 20 feet from the edge of Zone 1.

3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration / Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all ~p~ropriate information as identified
within 15A NCAC 2B .0242 or .0244, or .0260. ~1.B:.

Page 11 ofl2

XI. Stormwater (required by DWQ)

Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss
stonnwater controls proposed in order to protect surface waters and wetlands downstream from
the property. If percent impervious surface exceeds 200h, please provide calculations
demonstrating total proposed impervious level. ~Aou.JAYt;. ~JU.{ uJA71!:/Z. IS IZt.JAJ
JIV""1D f34~/AJ~ 4)JZ J...EiH::L ~PP~-4Dt!:lZ.4!5 J()O 'D11Z6G-""r DlsoIAD/.~ ~
~'1DlZ-wt ~ ~ ~71ZFAJt,I';

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.
~E.P-rlc.-

XIII. Violations (required by DWQ)

Is this site in violation of ~Q..Wetland Rules (15A NCAC 2H .05(0) or any Buffer Rules?
Yes 0 No ~

Is this an after-the- fact pennit application? Yes 0

No~

XIV. Cumulative Impacts (required by DWQ)

Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes 0 No 0
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
htto://h20.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description:

xv. Other Circumstances (Optional):

It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).

~~ 7'-~ - ~~
Applicant/Agent's Signature Date
(Agent's signature is valid only ifan aut orization letter from the applicant is provided.)

Page 12 of12

/~ .----
,,,,, /~ ""--'
~..;......"'-- ~ 0 ' ~,

~~ s
~~ )
~~ I
\

~~~

c
= .2
- ..
-u
UG)
en

/

E E
80
. U
" .
-"
c: >.N :! li
ora ~~.::! ><;c
-CD>COO:!OS
S.~.!!!NClO'" [E
O:t:NOGONca>.t
::oa;z~:;;~;
~.!1~-c:~ggi!
~lU::~~~~@
~(/)Cll'Cg~~~
Cl 50ClOClO...5
S ..
Uifti
.cE
.. .
:1:w

z~~

~

s:'
~-
~
~
~~
~:t
d~
~~
~
'-!1

11

.~ >-~.E x
ca"'ccoJ!!
::>=:1:N"'O
~o.!!1ulD~
"" .~Z~O
~~ "'t:m~
:tOn 0"''''
sa::eu.cOcO
~ "'51;j1;j

w
C
o
(.)
w
~
C)

_/' ~

- ..._~.."'~.

o
e
>-.
os ..
E E
Co;>
- os_
~E~
....-
,,- ..
.. t: g
E '0;
e~ c
"'00
eN..
".c U
~~E
8,:E ~
..,,0
E- U
-.E'O
" :l ..
lie..
~S=
.,,:E~
.!! >- 0
os .. ..
UlI'"
.... os
..- 0
os _
.!lOll
Co- ..
..oe
E >--
.. U
.!It.!!
~~!

1

"ii
w
..
u
c
..
e>
..
E

~
\
I
"
)
J
f
;

)
,
1
~
.~
I
\
\
\
)
\
J
.
"
f
\

..

"
,
I
(
(
,)

.",
F/i/......
I?t j 'ii'! DVl
'[ C [;l~r:- D

Office Use Only:

.

Form Version March 05

2 0 051 733

USACE Action ID No. DWQ No.
(If any particular itcm is not applicable to this project, please enter "Not Applicable" or "NIN'.)

I, Processing

1. ~7k a~l ofthe appr~val(s) requested for this proj~c.t: .
~ SectIOn 404 Pem1lt 0 Rlpanan or Watershed Buffer Rules
D Section 10 Permit 0 Isolated Wetland Permit from DWQ
~Ol Water Quality Certification 0 Express 401 Water Quality Certification

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

p(~J 3t:f

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

4. Ifpayment"into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: 0

5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is w.ithin a North Carolina Division of Coastal ~J~~.mefr~af~f~ m1
Environmental Concern (see the top of page 2 for further details), checktlfierf? t:J -->. . ~

SEP 1 2 2005

Applicant Information

II.

if

DENR . iV;,-j ER CU;\UTY

1. ~~::~/ Applicant Info~~:"'A-~ /l1G. /~ALtI&y ItJuJ ~dp':~ ST~,~~ B~JJCH
Mailing Address: I /'Yl(,-j':.u JZ.Ill.. /JAV I
(!)l-O rdZ--r1 ~ .11'___ Z'/!,il, 'Z

Telephone Number: e.z.g-~t.g... ~87~ Fax Number:
E-mail Address:

2. Agent/Consultant lnfonnation (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 ofl2

ID. 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: lYIoJ-8EiUZ-V DIZ..,J€,

2. TJ.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): /,(, II - DO - 2.-s" - Ij /37

4. Location
County: fi1~O()I~J~'.1 . Nearest Town: t:JJ-[) ~IZ..-r
Subdivision name (include phase/lot number): ~1H'~~J,4v II1~JJl.r1'A'L.J- A4J/Aqqz.'f .Pi2.
Directions to site (include road numbers/names, landmarks, etc.):
~l'" \:li~ c;F;; :L-L/o -,;:,/:6 gA,,'rZ,AVe en/ant=bn..-r"{Zn AP?~ 7.S'"~,l.e.~
-.;. tf1A/~ 4h'('€'1B4y II/h i~.1'" ';'1/17,4...,j ~ .,.,1'-1 u:Pr'

5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum): "N OW

6. Property size (acres): L/o A-t,tu:~

7. Name of nearest receiving body of water: SAlk,! t32.A~H

8. River Basin:_B ~AD
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at htto://h20.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: ~~E:c;. ~ '"( "7'C eB f ~~,A L ~t:;/ ~rlw~ ,-r-

Page 6 ofl2

10. Describe the overall project in detail, including the type of equipment to be used:

~~ :!;;'i2~~~~~=::,~~~~/~;r-

~-ee:e-~ ~oe-~ Hoc. -1At,.,P...,.e;u:.1c5
11. Explain the purpose of the proposed worlc
A~ ~.I'-- US'~AL Va/~~fEA.Y'(

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. D .JtZJA..J4 LJI' L_ p~~~ PJZ' j)";UJ~ ~~~ rf'/?1JL.
j7t.-AIloJ$ ~ .5,.J8M,-r-r€D A~C) ftpp(ZLJJ~p

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.

VI. Proposed Impacts to Waters ofthe United StatesIWaters ofthe State

It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts are proposed to these systems.
Wetland and stream evaluation and delineation forms should be included as appropriate.
Photographs may be included at the applicant's discretion. If this proposed impact is strictly for
wetland or stream mitigation, list and describe the impact in Section VIII below. If additional
space is needed for listing or description, please attach a separate sheet

1. Provide a written description of the proposed ~acts:
~~S PpAAJ 6ul-I/~-rs he.. ~ot.JA-Y

Page 7 of12

2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
I r' d b h d f1 d'

separate Iv 1st impacts ueto ot structure an 00 mg.
Wetland Impact Type of Wetland Located within Distance to Area of
100-year Nearest Impact
Site Number Type of Impact (e.g., forested, marsh, Floodplain Stream (aCres)
(indicate on map) herbaceous, bog, etc.) (ves/no) (linear feet)
.vA-
.
Total Wetland Impact (acres)

3. List the total acreage (estimated) of all existing wetlands on the property: vII-

4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
must be included. To calculate acrea e, multi lien h X width, then divide b 43,560.
Stream Impact Average Impact Area of
Number Stream Name Type of Impact Stream Width Length Impact
indieate on ma Before act linear feet acres
, ,
t:)
0'

Total Stream Impact (by length and acreage)

~o

,(

5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill . dr d' fl di dra" b Ikh ds

, excavation, e 19me, 00 n~, ma~e, u ea , etc.
Open Water Impact Name ofWaterbody Type of Water body Area of
Site Number Type of Impact (lake, pond, estuary, sound, bay, Impact
(indicate on map) (if applicable) ocean, etc.) (acres)
Ll
IV"
Total Open Water Impact (acres) .

Page 8 of12

't

I

6.

7. Isolated Waters
Do any isolated waters exist on the property? DYes D No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.

8. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): 0 uplands 0 stream 0 wetlands
Describe the method of construction (e.g., da~ejl1bankment, excavation, installation of
draw-down valve or spillway, etc.): l.Jrt
Proposed use or purpose of pond (e.g., livestoCk watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Current land use in the vicinity of the pond:
Size of watershed draining to pond: Expected pond surface area:

VII. Impact Justification (Avoidance and Minimization)

Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
infonnation related to site constraints such as topography; building ordinances, accessibility, and
financial viability of the project The applicant may attach drawings ofaltemative, 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. A1eJ1/.<U~~ IA.U:../AJP6

L1 'fj(;~~~~~~~l~~:':-::~~:;;:;'~~:A~A D

17.oe; .. vrr' ~€:V ~EEI!-I ~ 7iZEAM t::.+IAIoo..J,vE.L'S
,

VIII. Mitigation

DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.

Page 9 of12

~

USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on January 15,2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.

If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
htto://h20.enr.state.nc. us/ncwetlands/strmgide.html.

1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if off site), affected stream and river basin, type and amount (acreageninear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.

~

2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at htto:/ /h20.enr.state.nc. us/wro/index.htm. If use of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:

Amount. of stream mitigation requested (linear feet): ~
Amount of buffer mitigation requested (square feet):
Amount of Riparian wetland mitigation requested (acres):
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):

Page 10 of12

.;

IX. Environmental Documentation (required by DWQ)

1. Does the project involve an expenditure of public (federa~ta~local) funds or the use of
public (federal/state) land? Yes 0 No ~

2. If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPAlSEPA)?
Note: If you are not sure whether a NEP AlSEP A document is required, call the SEP A
coordinator at [phone] to review current thresholds for environmental documentation.
Yes 0 No 0

3. If yes, has the document review been fmalized by the State Clearinghouse? If so, please
attach a copy ofthe NEPA or SEPA final approval letter. Yes 0 No 0

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

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

1. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify p/f )? Yes 0 No 0

2. If "yes", identify the square feet and acreage of impact to each zone of the riparian buffers.
If buffer mitigation is required calculate the required amount of mitigation by applying the
buffi I' r

er mu tIP lers.
Zone* Impact Multiplier Required
(SQuare feet) MitilUition
1 3 (2 for Catawba)
2 1.5
Total

* Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.

3. If buffer mitigation is required, please discuss what type of mitigation is proposed (Le.,
Donation of Property, Riparian Buffer Restoration / Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all ap!lropriate information as identified
within 15A NCAC 2B .0242 or .0244, or .0260. .t.-M

Page 11 of12

. ,

XI. Stormwater (required by DWQ)

Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss
stonnwater controls proposed in order to protect surface waters and wetlands downstream from
the property. If percent impervious surface exceeds 20%, please provide calculations
demonstrating total proposed impervious level. ~AOu.JA'ft;. ~JU{ ,LIA~ /5 ZuAl
IAJ"70 T34<o.J~ t!)IZ ~ ~?J7..1E.4DFJZ.~ IlJo '[;>,fZLU.,,-r DI!iOIAI26r~ ",:::.
~'1DfZ.wt ~ 7D '6T1ZFA"'JS

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.
--5e.?-rr c-

XIII. Violations (required by DWQ)

Is this site in violation of ~Q..Wetland Rules (15A NCAC 2H .05(0) or any Buffer Rules?
Yes 0 No ~

Is this an after-the- fact permit application? Yes D

NO~

XIV. Cumulative Impacts (required by DWQ)

Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes D No 0
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
htto://h20.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description:

xv. Other Circumstances (Optional):

It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).

...L-'..--

,,/

f-I..-e~
Date
tion letter from the applicant is provided)

Applicant/Agent's Signature
(Agent's signature is valid only if an auth

Page 12 ofl2

'--"~~~~~---.~
~~)'
~~ I
\

J...~
.- ~

c
...0
!:;
-u
u.
en

/

E E
80
. u
" '
- "
C >.N. .:! C;
'iij :!l!:e~ )(5;;
"'C):>ClOOCGO:l
5.!:!.S!Neo:;; ~~
O:t:NOCONca>-
~ocz""""~~
Ql .,.Cjl.s~
~Jllfi~~:~iG
~"'~.f'9"'I'@
_CI)Ql oeo 0
ca C"CON -
C) 0 (5 eo eo .. .5
S.:.:
Ui"fti
J:l E
~w

s:'
~-
~
~
s='~
~~
~~
::ts
d~
~~
~
'-!S

11

./

Iii
Q
o
o
w
~
C)

/-

..~.>

z~~

~

.~ ~~ s x
c5~Cl)ool!!
5iE(J)N~~
::E~'~~~13I
fs;O>tf8f8
0> q l6 af """
ma..~ a,a.,
<!l cn5~~

o
c
i:'ai
E E
",;:l
-..-
~e~
....-
;~ g
E .jjj
ES c
"'00
eN ;;
wz: u
:;=5
:g,::E ~
..,,0
E- U
-.:'0
" :l ..
~"..
-8s!
-a::E~
.!! >0.0
.. .. ..
u~...
Ill....
..- 0
.. ..
.!ICl~
"'... ..
.. 0 c
E >o-
W U
.!It.!!
.=';
.......

-,

1

r

..
w
...
...
c
..
ea
..
e

~
I
\
)
f
/
)
1
~
1
)
)
..
<
(
\
J
(
'I
.l

\n Ii Cl\IT
: L I'.
',0: J\/[D

..

USACE Action ID No. DWQ No.
(lrany particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)

Form Version March 05

2 0 0 5 1 7 3 3

Office Use Only:

I. Processing

1. ~S9k all of the approval(s) requested for this project:
~ Section 404 Pemlit 0 Riparian or Watershed Buffer Rules
o Section 10 Permit D Isolated Wetland Permit from DWQ
~Ol Water Quality Certification 0 Express 401 Water Quality Certification

2. Nationwide, Regional or General Pen11it Number(s) Requested:

pw3Q

3. If this notification is solely a courtesy copy because written approval for the 40 I Certification
is not required, check here: D

4. If payment"into the North Carolina Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: D

.

5. If your project i.s lo~ated. in. any of North Ca~olina'.s ~~enty coastal counties (li~.::dn~!\W\?h-\
4), ~nd the project IS w.lthm a North Carolma DIVISion of. C,o. astal\tt~Il"!1~\l\"Y~~\P\
EnVironmental Concern (see the top of page 2 for further details), cheCt~~\.U-11..:!J

Applicant Information StY 1 Z 20GS

. . ENR - WATER Q;J!\L\!Y '''~.
1. Owner/Applicant Jnfof!11~tlOn AA I ~;EJ&iDSN~O SIGi\:.W'i.',.\E:.f\ r;RA",~H
Name: . ~/Z,;1R~ ~~ALv&y -LaJJ ~~J:::"@p. l-LC~
Mailing Address: I fY/t.,.j':.u lZ'lE. tJAV I
OW FdZ--r, ~ 1/"", ZtAi(,Z

II.

Telephone Number: ez.,8-~t,8- ~ez.i> Fax Number:
E-mail Address:

2. Agent/Consultant Info1111ation (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 ofl2

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 fmal version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.

1. Name ofproject: lY1oJ-8urz...v DfZ."J6

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

3. Property Identification Number (Tax. PIN): (,~ II - D() - 2.-S' - II /37

4. Location
County: rJ1~OtJt~J,e;, -' Nearest Town: /'.:)J-.{) ~/Z:"
Subdivision name (include phase/lot number): dfll""'"~~JAv "In.J.rrAIL.J- A4JLJII!l.E;?IZ'I.Pl2.
Directions to site (include road numbers/names, landmarks, etc.):
~l-r \$7'J ~ :L-L/o #:JU ~~~ep/~t:M,..,-.(ZD AP?('2LH 7.~~,l..€.~
-r;. Ji1A'~ 4,AT"Gla4y ~...., ~Jf'1?~...I i:. I')Io..l u:;Pr'

5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that
separately lists the coordinates for each crossing of a distinct waterbody.)
Decimal Degrees (6 digits minimum): "N OW

6. Property size (acres): L/o Af,tu:!'$

7. Name of nearest receiving body of water: SA/L,'1 BlZ.A~""

8. River Basin:-B tz.oAO
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h20.enr.state.nc.us/admin/mavs/.)

9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time ofthis application: ~Z~<'-r1!!.,"" -to ea;fDt:'~,AL 'i);II~LJrlw~'-r

Page 6 of12

10. Describe the overall project in detail, including the type of equipment to be used:

~~ ::!:i;~~:;:;"~~,t:::::'~~~t/~';-'-

'J;b'2!Ee-~ H~e -~ Hcc. -IAI,..,P'-~
11. Explain the purpose of the proposed work:
~ ~,. fZ€.,S'~AL 1)EJ/B.#~fUJ"(

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. p .J/ZlI1u4, LJ./ j _ p~~~ PI ~,'GUJD ....... ~ rl"d.1JL
P"A~~ ~.A S,JTjM,"f"-r€D A-AJCJ flPPfUJhp

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.

VI. Proposed Impacts to Waters of the United StateslWaters of the State

It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. Each impact must be
listed separately in the tables below (e.g., culvert installation should be listed separately from
riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts,
permanent and temporary, must. be listed, and must be labeled and clearly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial)
should be shown on a delineation map, whether or not impacts are proposed to these systems.
Wetland and stream evaluation and delineation forms should be included as appropriate.
Photographs may be included at the applicant's discretion. If this proposed impact is strictly for
wetland or stream mitigation, list and describe the impact in Section vm below. If additional
space is needed for listing or description, please attach a separate sheet.

1. Provide a written description of the proposed ~acts:
CAz.o~S PQA~ uul.I/ez...-r5 "de, .P'A;40WA-Y

Page 7 of12

2. Individually list wetland impacts. Types of impacts include, but are not limited to
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams,
I r' d b h d fl d'

separatelv 1st Impacts ueto ot structure an 00 mg.
Wetland Impact Type ofWet1and Located within Distance to Area of
100-year Nearest Impact
Site Number Type of Impact (e.g., forested, marsh, Floodplain Stream (acres)
(indicate on map) herbaceous, bog, etc.) (ves/no) (linear feet)
.f) J}
.
Total Wetland Impact (acres)

3. List the total acreage (estimated) of all existing wetlands on the property: LJIJ.

4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam
construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, gab ions, etc.), excavation, ditching/straightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
must be included. To calculate acrea e, multi lien h X width, then divide b 43,560.
Stream Impact Average Impact Area of
Number Stream Name Type of Impact Stream Width Length Impact
indicate on ma Before act linear feet acres
, I
D
0'

Total Stream Impact (by length and acreage)

60

~l

5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill . d d' fl d' dra' b lkh ds

, excavation, re 19m9, 00 mg, mage, u ea , etc.
Open Water Impact Name ofWaterbody Type ofWaterbody Area of
Site Number Type of Impact (lake, pond, estuary, sound, bay, Impact
(indicate on map) (if applicable) ocean, etc.) (acres)
LJ.
IV"
Total Open Water Impact (acres)

Page 8 of12

,

6.

7. Isolated Waters
Do any isolated waters exist on the property? DYes D No
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
the size of the proposed impact (acres or linear feet). Please note that this section only
applies to waters that have specifically been determined to be isolated by the USACE.

8. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): 0 uplands 0 stream 0 wetlands
Describe the method of construction (e.g., dam(ejllbankment, excavation. installation of
draw-down valve or spillway, etc.): I/R
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Current land use in the vicinity of the pond:
Size of watershed draining to pond:. Expected pond surface area:

VII. Impact Justification (Avoidance and Minimization)

Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts. 'lJ1eA~JZS;..c" 1A.J~p6

~ ~:;-J~~~:;1~~:'~:~~::-:;;::'~~:A~LD

V.oE.S .. vrr- e:A..:sT'E:::v_ ~ 1'51iz.€A1Vf. t::.+I;h.JA1eL~
,

VIII. Mitigation

DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.

Page 9 of12

USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on January 15,2002, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.

If mitigation. is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCEEP concurrence shall be placed on hold as incomplete.
An applicant may also choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in North Carolina, available at
http://h20.enr.state.nc. us/ncwetlands/strmgide.html.

1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreageninear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.

~

2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement
Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at
[phone] to determine availability, and written approval from the NCEEP indicating
that they are will to accept payment for the mitigation must be attached to this form. For
additional information regarding the application process for the NCEEP, check the NCEEP
website at htto:/1h20.enr.state.nc.us/wm/index.htm. Ifuse of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:

Arllount 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):

Jf
.

Page 10 ofl2

IX. Environmental Documentation (required by DWQ)

1. Does the project involve an expenditure of public (federa~local) funds or the use of
public (federal/state) land? Yes 0 No t..:::J

2. If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEP A/SEP A document is required, call the SEP A
coordinator at [phone] to review current thresholds for environmental documentation.
Yes D No D

3. If yes, has the document review been fmalized by the State Clearinghouse? If so, please
attach a copy of the NEPA or SEPA final approval letter. Yes 0 No 0

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

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

1. Will the project impact protected riparian buffers identified within l5A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), l5A NCAC 02B .0243 (Catawba) l5A NCAC
2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please
identify,ij/f )? Yes 0 No 0

2. If "yes", identify the square feet and acreage of impact to each zone of the riparian buffers.
If buffer mitigation is required calculate the required amount of mitigation by applying the
buffi

er multipliers.
Zone* Impact Multiplier Required.
(square feet) Miti~ation
1 3 (2 for Catawba)
2 1.5
Total

* Zone 1 extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an
additiona120 feet from the edge of Zone 1.

3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration / Enhancement, or Payment into the
Riparian Buffer Restoration Fund). Please attach all aPt'ropriate information as identified
within l5A NCAC 2B .0242 or .0244, or .0260. ~1A.

Page 11 of12

. "

XI. Stormwater (required by DWQ)

Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss
stormwater controls proposed in order to protect surface waters and wetlands downstream from
the property. If percent impervious surface exceeds 200ft" please provide calculations
demonstrating total proposed impervious level. !Z.t;AO/-AJA'ft;. ~ 1I.J{ u.1A~ IS Ii!t.JAJ
1Jt.Y'1D T3.4<OJ~ t!:)/Z ~ ~;:>P~-4DErZ.~ Alo 1Arz.6G,i' D/'5t::,HAo/.~ ~
~'7D1Z-wt ~ 71> '6T1ZFA"'JS

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.
~E.P-rIt:-

XIII. Violations (required by DWQ)

Is this site in violation of ~Q...Wetland Rules (l5A NCAC 2H .05(0) or any Buffer Rules?
Yes D No Gd'" .

Is this an after-the-fact permit application? Yes D

NO~

XIV. Cumulative Impacts (required by DWQ)

Will this project (based on past and reasonably anticipated future impacts) result in additional
development, which could impact nearby downstream water quality? Yes 0 No 0
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
htto://h2o.em.state.nc.us/ncwetlands. If no, please provide a short narrative description:

XV. Other Circumstances (Optional):

It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).

~ ...... ::=::=:::::z::: p - ~ - - ~.(:
ApPlica~Agentls Signafure . Date
(Agent's signature is valid only ifan authorization letter from the applicant is provided.)

Page 12 of12

";I,.;....,,.,.'"'--/~,~..~~ ~ ~-

~~ ~
~ ~ ).
~~ l
\

~
~.......

C
"",0
!:;;
- u
UCD
tI)

/

E E
80
~ ~
>.N ! .5
.5 CUCD' .c:!
co ~""~)(",,,
c(1)>CQo~o5
:::s.!:L!!!NG)a>~E
0== N"", co N ca >.
:iiiOcz""""~~
>'Ul~ ~q.!!..
as.!! CJ~N=~';i
:t co:iii o It)CQ i',g
GJU) LL." ~
iii ~"Og~ .s
" 00 G) G) .. .E
s~
USe;
.cE
~w

z~~

;:

s:
~-

c:!.
~
s:
~~
~~
>-Q
c:!.c:!.
~~
~
\..!1

11

.~ ~fg~ x
g~~re~;
0= G) ,.... v
:;O'-U<o'"
>-< ~ z :b ~
~o~"t!coco
.scL~~~~
~ 0>5~~

,~

Iii
c
o
o
w
~
C)

1)
'"
i:ai
EE
a,;:
-"'-
~E~
....-
;~ g
gN-
...~oC
00
eN;;
".c U
:;~E
~:E ~
..",0
E- U
-.50
"':I ..
~ '" ..
.g8!
';::E~
.!! >. 0
......
u~."
....'"
..- 0
'" -
.!!o ~
a,- ..
..0",
E >--
G>U
.!!~.!!
.c,,'"
I-co!

"""'

r

\
)
~
\
{
"

\
)
I

)
1
\
f
(
\
I
\
1
)
\
)
(
<
(

"

'\
1
f
,
1
. ,