20051889 Ver 1_Complete File_20051011

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._____ .____ --~. - ____ .... -- .:; .: "~'.:~t::~.~~~~::....:...~-~_:.""

Michael F. Easley, Governor

Mr. H. L. Greene
144 Oak Point Drive
Cherryville, NC 28021

~@.@@.\\~@. ~

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William G. Ross Jr., Seetelary
North Carolina Department of Environment and Nnturnl Resources

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

October 28, 2005
DWQ# 05-1889
Cleveland County

Subject: Shoreline Stabilization, Moss Lake
Approval of 401 Water Quality Certification with Additional Conditions
Dear Mr. Greene: .

You have our approval, in accordance with the attached conditions and those listed below, to place fill in
or to otherwise impact approximately 0.007 acre of water for the purpose of stabilizing approximately 99 linear
feet of shoreline on Moss Lake, as described in your application received on October 11, 2005. After
reviewing your application, we have determined that this project is covered by Water Quality General
Certification Number 3495, which can be viewed on our web site at http://h20.enr,state.nc,us/ncwetlands.This
General Certification allows you to use Nationwide Permit 13 once it is issued to you by the U.S. Army Corps
of Engineers (USACOE). Please note that you should get any other federal, state or local permits before
proceeding with your project, including those required by (but not limited to) Sediment and Erosion Control,
Non-Discharge, and Water Supply Watershed regulations.

The above noted Certification will expire when the associated USACOE's 404 permit expires unless
otherwise specified in the General Certifications. This approval is only valid for the purpose and design that
you described in your application. If you change your project, you must notify us in writing, and you may be
required to send us a new application for a new certification. If the property is sold, the new owner must be
given a copy of the Certification and approval letter; and is thereby responsible for complying with all conditions

In addition to the requirements of the certification, you must also comply with the following condition:

1. Upon completion of the project, the applicant/responsible party shall complete and return the enclosed
"Certificate of Completion" form to the Division of Water Quality's 401/Wetlands Unit.

If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You
must act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition (that
conforms to Chapter 1508 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.

N.P.IthCarolina
/Vnlllfnlly

North Carolina Division of Water Quality 610 East Center Ave., Suite 301 Mooresville, NC 28115
Internet h2o.enr.state.nc.us
An Equal Opportunity/Affumative Action Employer- 5O"k Recycledl10% Post Consumer Paper

Phone [phone]
FAX [phone]

Customer Service
1-877-623-6748

. '.~~!':.: :-:: + l..:/ .'~ ::.: ~'~ ~~ ..~.:. :.'.: ,,:: :~. ::.:.:~'~li.:~~:~;' ~ .,:; :.f ... .,~:i:i'~~~~2.~~~.2~:"i'~,::::~;~};~.::.,~ :~.:+~:~.: :l;:~~,:'~~~~;'~~~~~~L~~.~:~:.'::;~ ~~i;:.~.~:l'~! t"~'~' .~~;;. '.:~. ~ ;, :~.: ..~.:::..;':~:.: ',; .

Page 2

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 Barry Love in the Mooresville Regional Office at 704-663-1699 or
Cyndi Karoly in the Central Office in Raleigh at 919-733-9721.

Sincerely,

~1~9M.~~~~
forAlan W. Klimek, P.E.

Attachments

cc: Corps of Engineers Asheville Regulatory Field Office
Wetlands Unit- Ian McMillan
Central Files

Triage Check List

Date: 10/14/05

Project Name: H. L. Greene Boat Dock
DWQ#: 05-1889
County: Cleveland

To: Alan Johnson, Mooresville Regional Office

60-day Processing Time: 10/11/05 -12/09/05

From: Cyndi Karoly Telephone: [phone]

The file attached is being forwardcd to you for your evaluation.
Please call if you nced assistance.

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

Commcnts: As per our discussion regarding revision of the triage and delegation processes,
please review the attached file. Note that you are the first reviewer, so this file will need to be
reviewed for administrative as well as technical details. If you elect to place this project on hold,
please ask the applicant to provide your requested information to both the Central Office in
Raleigh as well as the Asheville Regional Office. As we discussed, this is an experimental, interim
procedure as we slowly transition to electronic applications. Please apprise me of any
complications you encounter, whether related to workload, processing times, or lack of a "second
reviewer" as the triage process in Central had previously provided. Also, if you think of ways to
improve this process, especially so that we can plan for the electronic applications, let me know.
Thanks!

Office Use Only:

Foml Version March 05

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

I. Processing

1. Check all of the approval(s) requested for this project:
D Section 404 Pennit D Riparian or Watershed Buffer Rules
D Section 10 Pennit D Isolated Wetland Penn it from DWQ
1Sa 401 Water Quality Certification D Express 401 Water Quality Certification
./

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

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

II.

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 VlII,
and check here: D

5. If your project is located in any of North Carolina's t\I~~~Th{li~fi\\ed on page
4), and the project is within a North Carolina Divisi ~'E(fa'sml rvYanage~nt Area of
Environmental Concern (see the top of page 2 for furthe taB~\c\ect }LOO3 0

Applicant Information DENR. WATER QUALITY 'CH
\'.BtJJIDS mo STORlINA1ER BRAt.

1. Owner/Applicant Infonnation
Name: \\, L GRtb~
Mailing Address: 'L\ L\ 0 ~ \(' ?D'~' C :t::J,~
C' \-T;:Q G"l ~ \) ILL f ~ ~ _'"'\ R (l ,-- \
. I

Telephone Number: --j \) ~ L\.<(., L'\ .3 -)"" Fax Number:
E-mail Address: \~t~'K_~ L G(~.J=.t::Nt (:J 8 ~l,L~O uTTT' 1\\cI
--

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 infonned that
the project has been placed on hold until decipherable maps are provided.

1. Name of project: ~o ~ \' ~ e.-\l... r 0(< \-\. L C, n. E i:l\JC::"

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

3. Property Identification Number (Ta.x PIN):

D.. _ \ ~ ~ - \ - Uri

4. Location
County: c::: \.-c \.l C: l- tyl'l:.b Nearest Town: S \-\E-US 'I
Subdivision name (include phase/lot number): CRuS$, CREEk L~\ I t.\ l
Directions to site (include road numbers/names, landmarks, etc.):
S-c."i=. ~\, \) ~~;::.. '" l"Y\J\-'?

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

6. Property size (acres):

~~q:>RD,!-

':).
~ ! J..... T\)
.J .

7. Name of nearest receiving body of water: '('{\ Os,,, LCl,.'("G

8. River Basin: "RRo ~
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at httn:/lh20.cnu;tate,llc.us/admin/mans/.)

9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: ~\\"1-0 or0 \-~Ir<.-e. ~(<Or-J\~ NO
, ~ Vt N C,t \ ~ \\tG:c\ {;.II 'fH...:J.... ~N~ 1 ~ r. R I~ ~ ~~ ~
Y"<\ \ N' ~'''2--r- ~ 1::'l'D (, \ 11 N V\ L- E-f20.s. ('0 ,,\ .

Page 6 of 12

10. Describe the overall project in detail, including the type of equipment to be used:
"5 ~~O,~t. L\ C;. 1 , Bu. ILl
(<-\)r-- '-t' t: '" ':'N:D, N(i ClA ( \ NIL"":>

11. Explain the purpose of the proposed work: ~c t \ t:> ~,\u d e

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 pennits issued for prior segments of the same T.!.P. project, along with
constructio~ schedules.
\\. '\ \\
\ "\

V. Future Project Plans

Are any future pennit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
")0

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

It is the applicant's (or agent's) responsibility to detennine, 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 impacts:
~i\~.Q \' ~~J\~ ('\\ I ~ \\\\ \:;1:- B..\l..-~ \(
~ 'y E<.~?

~)n I. (\\? ii.; ~\ t::Y ?tZ~b
t=:.. Q \) ~ (<D G'-"\ B 'I

Page 7 of 12

2. Individually list wetland impacts. Types of impacts include, but are not
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc.
se arately list im acts due to both structure and flooding.

I d T f'" tl d Located within
Wet an Impact ype 0 '" e an 100
-year
Site Number Type ofImpact (e,g., forested, marsh, FI d I .
b ) 00 p am
(indicate on map) herbaceous, og, etc. ()
es 0
J-2.S

limited to
For dams,

'\

~~t:>~ ruN C

Distance to
Nearest
Stream
(linear feet)
J

Area of
Impact
(acres)

Total Wetland Impact (acres)

3. List the total acreage (estimated) of all existing wetlands on the property: 3 (i- r~ ,

4. Individually list all intennittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but arc not limited to placement of fill ?rarlvcrt>, dam
construction, flooding, relocation, stabilization activities (c.g., cement walls rip-raP:'crib
walls, gabions, etc.), excavation, ditching/straightening, etc. If stream relocatio~H)peSed,
plans and profiles showing the linear footprint for both the original and relocated streams
b . I d d T I I I . I I I X 'd I I d"d b 4" 560

III ust e mc u e . o ca cu ate acreage, IllU tlply engt 1 WI t 1, t 1en IVI e >y .),
Stream Impact Perennial or Average Impact Area of
Number Stream Name Type of Impact Intermittent? Stream Width Length Impact
(indicate on maD) Before ImDact (linear feet) (acres)
\0,'1 c:R O~$, tRr.-c\~ ~ \ \) T.? f,\ ~ Ilnl ctc,' ~/4-
v
Total Stream Impact (by length and acreage)

5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
fill. excavation, dredging. flooding, drainage, bulkheads, etc.

Open Water Impact Name of Water body Type of Waterbody Area of
Site Number (if applicable) Type of Impact (lake, pond, estuary, sound, bay, Impact
(indicate on map) ocean, etc.) (acres)
\ --\-"l iY\ C)~s, Lh-k'':::: 0JONt L~\<~
Total Open Water Impact (acres)

Page 8 of 12

6. List the cumulative im act to all Waters of the U.S. resultin
Stream Impact (acres):
Wetland Impact (acres):
Open Water Impact (acres):
TotalIm act to Waters of the U.S. (acres)
Total Stream Impact (linear feet):

7. Isolated Waters , .
Do any isolated waters exist on the property? D Yes ESJ 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 G\) \f\-
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): D uplands D stream D wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local storm water requirement, etc.):
Current land use in the vicinity ofthe 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 ofthe project. The applicant may attach drawings of altemative, 100ver-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
\\.;-t:.<:t.-:c- ~~u.L'-D <t)N t-\..\ ~~ ?D~ (I'" ~c \ ifl'PucT
S '-I, ~ \~ ~~p ~ ~0\"< i==' L, \ oJ? '\0 ,y, I N I 11\ 17 t .
t5:-.l 0'<;' (1)~

VIII. Mitigation

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

Page 9 of 12

USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Penn its, 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 detennining 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
h11n://112o.enr.state. nc.lIs/nc\\'ct lands/strm uide.html.

I. Provide a brief description of the proposed mitigation plan. The description should provide
as much infonnation as possible, including, but not limited to: site location (attach directions
and/or map, if o ffsite), affected stream and river basin, type and amount (acreagellinear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, ctc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
1
~Ct ~T\~Ch21) ~o~i..\ OF ~Nr; (Nt-C1Z S \1~ycQWII.v~

2. Mitigation may also bc made by payment into the North Carolina Ecosystem Enhanccmcnt
Program (NCEEP). Please note it is the applicant's rcsponsibility to contact the NCEEP at
[phone] to detennine 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
web site at I1ttn://h2o,enr.St<1te,nc,lIs/wrn/indc:,-:,htm. Ifuse of the NCEEP is proposed, please
check the appropriate box on page five and provide the following infonnation:

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

Page 10 of 12

IX. Environmental Documentation (required by DWQ)

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

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

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

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.

I. Will the project impact protected riparian buffers identified within ] 5A 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 )? Yes D No rszJ
1\
\
\
2. If "yes", identify the square feet and acreage of impact to each zone of the riparian buffers.
1f buffer mitigation is required calculate the required amount of mitigation by applying the
buffi I . r

er mu tJpl1ers.
Zonc* Impact !\1ultiplier Required
(square feet) Mitigation
I 3 (2 for Catawba)
2 1.5
Total

Zone I c).1ends out 30 fcct perpendicular from the top of the near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone I.

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 appropriate infonnation as identified
within 15A NCAC 2B .0242 or .0244, or .0260.

Page 11 of12

XI. Stormwatcr (rcquircd 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. ,_
(\ )"n Nc:

XII. Scwagc Disposal (rcquircd 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.

t\.) ('){'J ~

XIII. Violations (required by DWQ)

Is this site in violation of DWQ Wetland Rules (l5A NCAC 2H .0500) or any Buffer Rules?
YesD No~
\

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

NoW
/ \

XIV. Cumulativc Impacts (rcquircd by DWQ)

Will this project (based on past and reasonably anticipated future impacts) result in ~itional
development, which could impact nearby downstream water quality? Yes D No l2U
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with
the most recent North Carolina Division of Water Quality policy posted on our website at
http://h2o.t.:nr.stote.nc.lls!ncwetland~. Ifno, please provide a short narrative description:

XV. Othcr Circumstanccs (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
\vork 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).
I
l'\QN ~ 1 /

IL--
~~ i(~I'{)\

Applicant/~gcnt's Signature batc/
(Agent's'signaturpis val id only if an authorization letter from the applicant is provided.)

Page 12 of 12

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Office Use Only:

Form Version March 05

USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please cntcr "Not Applicablc" or "N/A",)

I. Processing

1. Check all ofthe approval(s) requested for this project:
D Section 404 Permit D Riparian or Watershed Buffer Rules
D Section 10 Permit D Isolated Wetland Permit from DWQ
15a 40] Water Quality Certification D Express 40] Water Quality Certification
./

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

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 Ecosystem Enhancement Program (NCEEP) is proposed
for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VIII,
and check here: D

II.

5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further det~l~c(gn~~~ 1M

Applicant Information m ~
Or: T 1 1 Z005

1. Owner/Applicant Infonnation
Name: \-\, L G R ;;i;.~
Mailing Address: \ L\ L\ 0 C>I Y ?D t ~, C
C'\-\-;.(t Q'-\ d t Ll f N ~
I

:Q,~
...-:'1 ,R (l ,-- \

nFNR - WATER QUALITY
WE1lANDS AND STORMWATER BfWW

Telephone Number: l Q '1 4~ L ~ J -, l Fax Number:
E-mail Address: \\t~'K\...\ L GR t:oi::Nc ,(cl 8 ~tA.s.-o uTil-' 1\leT
---

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 infonnation to be submitted on sheets no larger than 11 by I7-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 wiII be infonned that
the project has been placed on hold until decipherable maps are provided.

1. Name of project: 13--,0 ~.,.- :t::v c-,(. F oQ. ~. L C, fZ E r t.:Je:-

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

3. Property Identification Number (Tax PIN):

D.. _ ,.:-- ~ - \ - '+1
\ \ ~

4. Location
County: c:: L-C '-.l c L-CYN.:b Nearest Town: S \-\cGS 'i
Subdivision name (include phase/lot number): CRus'$, (\~tEk [J:), I L\ I
Directions to site (include road numbers/names, landmarks, etc.):
S'C.J't ~\\ \) r~::;. '" '<"Y\p.-?

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):

~~f>R D-!-

:s i J.-- T'J
.J '

7. Name of nearest receiving body of water: '('(\ Os,,, L~Y.......c

8. River Basin: -g,~O ~
(Note - this must be one of North Carolina's seventeen designated major river b~sins. The
River Basin map is available at httD://h2o.enr,st2tc.nc.us/crdmin/11l211s/.)

9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: L~\-\~')~~ ON \-~'.<.'E ~Rar-J\~ t00
" \\'-"'~C,t ,~ \\tG,t\l"'\I'()~' ~~~lNr. "R. I\) ~~~ ~
"\'(\ \ ~, ~ \"2-r- ~ DQ \\ \ 1) N IA L- E=-Ro.s' {'n ,,\ '

Page 6 of 12

10. Describe the overall project in detail, including the type of equipment to be used:
"S'\--\u,'tc L.\ 2 I, BV\\L\\
~'Ur-- q I e t..\ ':'N~' NC,. ciA- I \ Nlc.> <'.O,,-t=:

11. Explain the purpose of the proposed work: ~ t \ t:> ~o J ;:

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
constructi03 schedules.
\\.. "11 \\
\ '

V. Future Project Plans

Are any future pennit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
I'--JO

VI. Ilroposed Impacts to Waters of the United StatesJ\Vaters of the State

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

I. Provide a written description of the proposed impacts:
Cr\~.o.. \ ~t.\~ m IN \\\\ \?:- B;.CJ...-~ k
~ 'y R~?

~')n '. (\\ '? tl,; C:T e'( ?~,-n-b
~Ro~ 1<O~ B."'!

Page 7 of 12

Wetland Impact
Site Number
(indicate on map)

2. Individually list wetland impacts. Types of impacts include, but are not
mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc.
se aratel list im acts due to both structure and flooding.
Located within
lOG-year
Floodplain
('es 0)
t~

limited to
For dams,

Type of Impact

Type of Wetland
(e.g., forested, marsh,
herbaceous, bog, etc.)

Distance to
Nearest
Stream
(linear fect)
J

Area of
Impact
(acres)

'\

1:.~t)~ t'O~ e

Total Wetland Impact (acres)

3. List the total acreage (estimated) of all existing wetlands on the property: ~ (." \"t \

4. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary
impacts. Stream impacts include, but arc not limited to placement of fill Qr-arlV~' dam
construction, flooding, relocation, stabilization activities (e.g., cement watls rip-rap, . ib
walls, gabions, etc.), excavation, ditching/straightening, etc. If stream relocatio~fQPo ed,
plans and profiles showing the linear footprint for both the original and relocated streams
b . I d d T I I I . I I I 'd I I d"d b 4'"

must e mc u e . o ca cu ate acreage, mu tIPly engt 1 X WI t 1, t len IVI e y .:>,560.
Stream Impact Perennial or Average Impact Area of
Number Stream Name Type of Impact Intermittent? Stream Width Lcngth Impact
(indicate on map) Before Imoact (linear feet) ( aeres)
\ -\ "'\ c.R O~~ ~or"t\( ~ \ \) kll'A~ \ I n J c,q' 41lf
t!
Total Stream Impact (by length and acreage)

5. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.). Open water impacts include, but are not limited to
filL excavation, dredging, flooding, drainage, bulkheads, etc.

~ ~ ~
Open Water Impact Name of Waterbody Type of Water body Area of
Site Number (if applicable) Type of Impact (lake, pond, estuary, sound, bay, Imp:lct
(indic:lte on map) ocean, ctc.) (acres)
\--\-, XY\ \)~~ LM<,::: \JON\:::, L~\< ;:-
Total Open Water Impact (acres)

Page 8 of 12

6. List the cumulative im act to all Waters of the U.S. resulting from the ro' ect:
Stream Impact (acres):
Wetland Impact (acres):
Open Water 1m act (acres):
Total Impact to Waters of the U.S. (acres)
Total Stream Impact (linear feet):

7. Isolated Waters , .
Do any isolated waters exist on the property? D Yes ESI 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 Q\) \A-
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): D uplands D stream D wetlands
Describe the method of construction (e.g., dam/embankment, excavation, instalIation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local storm water 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)

SpecificalIy 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 altemative, 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 folIowed during construction to reduce impacts.
\\~t.(~ ~~u. L-U ~N L-\..\ ~~ ?D-S. ((llJC Iff) ~q<=-r
'8. '-I, ~ \~ <tZ~ ~ \;+-7)1<;:' L \.J~ \0 (1'1 \ N ( (f)l, 7.c;
i5:..l 0 ~ 11) ~

VIII. Mitigation

DWQ - In accordance with I5A NCAC 2H .0500, mItIgation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.

Page 9 of 12

USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Pennits, 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
httn ://h20. enr .state. nc. us/n c\ vet lands/strm u ide. htm 1.

I. 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.
,
0Ct f\T\l\~tt.2~) ~,,"-' Or ~~~ (; (,..J2-clZ S \11'~QW II-J~

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 httt1:I/h2o.enr.state,!1c.lls/wm/indcx,htm. Ifuse of the NCEEP is proposed, please
check the appropriate box on page five and provide the following information:

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

Page 10 of 12

IX. Environmental Documentation (required by DWQ)

I. Does the project involve an expenditure of public (federal/state/local) funds or the use of
public (federal/state) land? Yes 0 No 'qJ

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

3. If yes, has the document review been finalized 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 sho\\ln 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.

I. 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 )? Yes 0 No [2J
1\
\
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' I'

er mu tlpllers.
Zone* Impact Multiplier Required
(square fect) !\fitigation
I 3 (2 for Cata\vba)
2 1.5
Total

Zone 1 eAiends out 30 feet perpendicular from the top oftlle near bank of channel; Zone 2 eAiends an
aJditiona120 feet fi.om the cdge of Zone J.

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

Page II of 12

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.
f\ )T1 Nc

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.

~) n{'-J~

XIII. Violations (required by DWQ)

Is this site in violation of DWQ Wetland Rules (l5A NCAC 2H .0500) or any Buffer Rules?
Yes 0 No~
\

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

NoW
/ \

XIV. Cumulative Impacts (required by DWQ)

Will this project (based on past and reasonably anticipated future impacts) result in ~itional
development, which could impact nearby downstream water quality? Yes 0 No l2U
If yes, please submit a qualitative or quantitative cumulative impact analysis in accordanc'e with
the most recent North Carolina Division of Water Quality policy posted on our website at
1l11n://h2Q.enr.st:1te,nc.lIsiJ1C\\etlands. Ifno, 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
\york 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).
I
'''\Q;-J to: I L

\iJ)---; i ( ~I I ~ \

Applicant/Agent's Signature bate/
(Agent'$' signaturj'is valid only if an authorization letter from the applicant is provided.)

Page 12 of 12

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;;/1.11,\ Certificate of Completion

DWQ Project N~~ County: <.: ~ d6 L-~ N.t

Applicant: \..\.. L r" R ~ t (\\ c

, .
.~H~\l...._,_.,,'r 4

'- '\:;:;OURCES

"' ,':: !:"I_~ ~~.

NOV 2 9 200:

Project Name: s.'r\~(tt. L\ Nt .s\t+~ \t.-\ Gt\\\()j~ l'Y\o~ ~ L~ \<..c
Date ofIssuaoce of 401 Water Quality Certification: \ t:>' 2....~ \ o~
'\ '-"".. -~--

. .: ;' "; , ,,:~ i L

Upon completion ofall work approved within the 401 Water Quality Certification and Buffer Rules, and
any subsequent modifications, the applicant is required to return this certificate to the 401fWetlands Unit,
North Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC, 27699-1621.. This form
may be returned to DWQ by the applicant, the applicant's authorized, agent, or the project engineer. It is
not necessary to send certificates from all of these.

Applicant's Certification

I, \-\-.. L C, Q ~t I~ Z , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be
built within substan' cornp ance and intent of the 401 Water Quality Certification and Buffer Rwes, the
approved plans and ecific ions, and other supporting materials.

Signature: '/, Date: ~

Agent's

I, . hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be
built within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rwes, the
approved plans and specifications, and other supporting materials.

Signature:

Date:

If this project was designed by a Certified Professional

I, . as a duly registered Professional (Le.,
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized to
observe (periodically, weekly, full time) the construction of the project, for the Permittee hereby state that,
to the best of my abilities, due care and diligence was used in the observation of the construction such that
the construction was observed to be built within substantial compliance and intent of the 401 '\Vater Quality
Certification and Buffer Rules, the approved plans and specifications, and other supporting materials_

Signature:

RegistratiOp~ fate:
DEe 7 20D5

DENR - WATEB QUAli' .
WETlANDS ,AJjD STCfUAWATb< L;'J,iJCH

t

,

H. L. Greene
144 Oak Pointe Dr
Cherryville, NC 28021

Edge of Lake Front Property Before Rip Rap

Lake Front Edge After Rip Rap Installation

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