20051923 Ver 1_Complete File_20051014

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20051923
Office Use Only: - _ --
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USACE Action, I[D?N'o: DWQ :Yo.
(!t'arY pascicu;at kern is sot Applicable to this projeot, tslease enter "Nat Aa.ticab1a"kOr "k nu
I.
Processing
l t? ? Vi/
1, Ch ctc ' al! ofthe approval(s) requested for this project: C?t, ~
Section 404 Permit Riparian or Watershed Buffer Rules
Section 10 Permit Isolated Wetland Permit from DWQ
401 Water Quality Certification J Express 40; Water Quality Certification
1 Nationwide, Regionul or General Permit Number(s) Requested:_ ?A•?;d?•?,:.?i_ ?/?
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here:
4. If payment into the North Carolina Ecosystem Enhancement program ('JCEEP) is proposed
for mitigation of impgots, attach the acceptance letter frost NCEEP, complete section VIII,
and check here: ?
S. [f your project is located in any of North Carolina's twenty coastal counties (listei on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Envirorunental Concern (sea the top of page 2 for further details), check here: P-1-
11.
Applicant information
1. Owner/Applicant Infflrma on
;dame: A :u v-2?
Mailing Address:__ JZT A46, p-%&. FIA1. ,
&oE
Telephone Number: ,? Fax >ti'umber:
E-mail Address: - -
2. Agent(Consultant InfOnnatien (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has si a.ory authonty for the own.-r/applicant.).
Company Affiliation;
Mailing Address;
Telephone Number. Fax Number:
E-mail Address:
Pago a of 12,
oc? 4 2005
IXERQUP
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>lil. Project larormatiou
8.
Attach a vie!Wty map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed gate plan showing property
boundaries and development plans in relation to surrounding properties. Beth 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 Wraps and plans should
iru;lide the appropriato USGiS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined, Plan drawings, or otter 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 I 1 by 17-inch format;
however, D%'Q 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
rrduced to a small scale si4h Vint the final version is illegible, the applicm will be inforrled that
the project has been placed on hold anti I decipherable reaps are, provided,
1. Name of project:
?. T.Y.P. Project Number or State Project Number (NCDOT Only): ___
3. Property Identification Nurnbcr (Tax ?IN):
4. Location I
County., ce P,f Nearest Toww-
Subdivision name (include phase/lot nutnber): & 3&22.eA.4 K6-feawyd, e- J-41
Directions to site (include road numbcrslralnes, landnia,«Ics, etc.):. 4
S. Site coordinates (For linear projects, such as a roar, or utility :ine, attach a sheet that
separately lisle the coordinates for each crossing of a distinct waterbody,)
Decimal Degrees (6 digits minimum): ON
d. Property size {acre&):-,_ _ .fig
7. Name of nearest receiving body of water._rlr_eZ ' ?A
River Basin:___ LJ, a ?' V4V4W-_
(Note - this must be pee of 13artli Carolina's seventeen designated inajor river basins.
River Basin rnap is available at h I/ls2o•e?:r.seAte,nc.}ls/adrrin mans/ l
The
9. Describe the existing conditions on the site a pd, general land use in the v; 'nity fthe project
at the time of this application:_
,-
7 -M
M--13
page 6 of 12
ti+... . c.. . -C rau-, J• UZ!-fLV W1L1'I11`N! ON NI-1. 556 F. q
1 J. Descri
the versu reject in detail, including the type of equipment to be used;
Z4A !r
11. Explain thO p o?Ise of the roposed work:
W. Prior Project History
If jurisdictional determinations and/or permits have been requested ardor 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 wetlartd, stream and
butler impacts, along with amociated mitigation (where applicable. If this Is a NCDO7 project,
list and describe permits issued for prOr segments-of the saute iT.I.P. project, along with
CQIxShvCrYRYT ?[!?,autnLo _ ? _ / t _
V. Future Project Plans
Are ally ftture 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 States.RVaters of the State
It is the applicant's or a ent's responsibility to determine, delineate and map ail impacts to
wetlands, open water, and stroam chards 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,
pertttancnt and temporary, must be listed, aid must be labeled and cle4rly identifiable on an
accompanying site plan. All wetlands and waters, and all streams (internYittent and perennial)
should be shown on a delineation map, whether or not impacts are proposal 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
Nvotland or stream mitigation, list and describe the impact in Section VIII below, If additional
space is needed for listing or description, please attz.-h a separate shee*
1. Pr vide awn en description of the pro os impac s: ?.. ! f
12 r i.
Pass 7 of 12
• .,?.? . c.?. ?c?u.: .. • ?lr?'1 l:SHtl? Wlt.ftll`A.rl t)(y
110, p c
2. Individually list wetland impacts. Types of unp3cts include, but are ,lot limited to
mechanized clearing, grading, fill, excavation, flooding, ditohing/drainage, etc_ For darns,
Separately list irnnae- t Latta to le-0.
Wetland Impact Type of Wetland 1 Locitsd -A iUlirDix&a = to Area u1
Site Wum3er ( Type of Impact (a,g., forested, ayarah, 100-year + Neuaat Impact
(indicate on trap) + hervacootrs, bog, etz.) Floedplain Stm= (acres)
Tout wetland I
mpact (acres)
3. List the total acreage (astirnaied) of all exis,ing wetlands on the property: lytlo ,
3. Individually list all intermittent and perennial stroarn impacts. Ba sure to identify- temporary
impacts. Strearr: impacts include; but are not limited to nlaceniont of till or cu!verti, daru
constmction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib
walls, gabions, etc.), excavation, ditchiny'straightening, etc. If stream relocation is proposed,
plans and profiles showing the linear footprint for both the original and relocated streams
must he e indtl_tdeA Tn 1__- - _ -_... .

$uearn Imptacs
Number
(indlcu onm )
`?
Stxa;rn Ir arac of 1
? ?n`? 11- ? •.

1?ennnisl or
j llnmyicte . ? news.., ,11Gµ U
Avnza.e "

Stream Width
Before trc act LV[UG UY vi'JUV.
T... l tr 7
isIICi { Area of
I Leagth Impact
linear feat) ?oresL
fl

? ».. N»,.w....,.,i.».t ter ,caiguL crap acrcage? ? i
5. Individually list all open waiter h4paets (includirg lakes, ponds, estuaries, sounds, Atlantic
Oczan and any other water of the U.S.). Open water impacts include, but are not limited to
fill, excavation, dredging, tloocling, drainage, bulkheads, etc.
I hire Number Na of Wa?urbsdy I Type ofWaterb ody Aiei?
tndlie a ? 0fapptiaswi0) I Type oflmpact (lako, pcr(l: evuary. sound, bay, Impact
- - "-1-"- - - ---- act= etc.)
(3e?as f
- ToW Open Water Impact (acre;)
Page 8 of 12
NV.
G. List the Cia ulativa impact,o all Waters of the U.S.
' Total Impact to Waters of the UI (acres) -?? 1 -`/ y" n" "T 1
! 'Local stream lmpact (linear feet):?-``
7, Isolated Waters
Dn any isolated v'aiers exist on the property? Yes 0'0
Describe all impacts to isolated waters, and include the type of water (wetland or stream) and
tl+e size of the proposed impact (acres or linear feet) Please note that this section only
applies to waters that haves f cally been determined to be isolated by tha USACE. r
8. Pond Creation
If consutctim of a pond is proposed, associated wetland wid straam impacts should be
included above in the wetland srd stream impact sections. Also, ty: proposed pond should
be described here and illustrated on any maps tncludod with Chia 33pl.,cation.
Pond to be created in (check all that apply): n uplands atrearn wetlands
Describe the method of construction dam/embankruent, excavatiaa, installation of
draw-down valve or spillway, etc.);
Proposed use or purpose of pond (e.g., livestock watering, irrialiGn, aesthetic, trout pond,
local stomuwater requirement, etc.):
Curreut land use in the vicinity of the pond:
Sizr of watershed draining to pond: Expected pone surface area:
S'II. ImpactJustitlcatlnn (Avoidance and :Minimization)
Specifically describe meoures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints each as topography, building crdiranccs, accessibility, and
fir...artciA viability of the project, The applicant may attach drawings of alternative, to rr-impact
site layouts, and explain why these design options were not feasible. Also discuss haw impacts
were minimized ones the desired site plan was developed, Ir applicable, diwtrss construction
technijue% to be ?pllvwed during consuwtion to reduce imnarts. _ _
VI11. Mitigation
DWQ - In accordaneo with 15A \CAC 211 .0500, mitigation may be required by the NCB
Division of Water Quality for projects involving greater than or Neal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear fee, of total impacts to perennial
streams.
Page 9 of 12
kr.c:i.duu-? Jo.?Hm LSD WILMV-rr4N N(t,5 F. 11
USAGE -- In acconlance with the Final Notice of Issuance and Mollification of Nationwide
Permits, published in tho Federal Register on January 15, 2O02, mitigation will be required when
necessary to ensure that adverse effects to the aquatic env;ronment arc mir.,mut. 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 a, proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to. reducing the size of the projoct; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic roaource functions and values by creating, restoring, enhancing, or preserving similar
functions aid values, preferable in the same watershod.
If mitigation is required for this project, it copy of the mitigation plan must he attached in order
f'or 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 alsQ choose to review the current guidelines for stream restoration in DWQ's
Draft Technical Guide for Stream Work in :Yeah Carolina, availab:e at
htfp ?/2o.enr.st?te.ri? cs/ncwetland?/ trmt*ide html,
I, provide a brief description of the proposed mitigation plan. T,.e descripticrr ShoL;ld provide
as mach tnformatiou aS possible, including, but not limited to: site location (attach directio»s
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 mechavisrtt (e.g., deed restrictions, conservation eusetnent, etc.), and a
description of the currant site conditions and proposed rnetlzod of constru;,tion. Please atmel,
a separate sheet if more space is need.-4d.
2, -litigation may also be trade by payment into the 'Xonh Carolina FcUsystem Enhancement
Program (NCEEP), Please note it is the applicant's responsibility to contact the NCEEP xt
019) 715-0476 to determine avAitability, and whuen approval from the NCEEP indicating
that they are will to accept payment for the litigation must be attached to this form. For
additional information regarding the application process for the NCBZPF check the XCEEP
website at l r te.nc, ax.htr?mI If use of the NCEEP is proposed, please
check the appropriate box on page frve and provide the fnllov? ing information:
Amount of stream mitigation requested (linear feet).
Atzlount of buffer mitigation requested (square feet):'
Amount of Riparian wetland mitigation requested (acres):_._
Amount of Nett-ripsrien wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):
Page 10 of 12
.ter , e e91z, : -101(1 U`?H V WILMI VT! iN
Ix.
x
NO. 535 P. i2
Environmental Documentation (required by DWQ)
1. Doan the project involve an expenditure of public (federaVstate al) funds or the use of
public (foderallstate) land? Yes [] ;1I0
2. If yes, does the project require preparation of 3n onvirouutental document pursuant to the
mquirc:Mlts of the Natioual or Nonh Carolina Enviromner,W Policy Act (NEPA/SEPA)?
Note: I? you arc not sure whether a NEPA/SEPA document is required, call the SEPA
cootdi mor at (914) 73 3 to review current thresholds for crivironmentai do.^urnentation.
Yes Q No F
3. If yes, has the document review been finalized by the State Clearinghouse?, please
attach a copy o: the NEPA or SEPA final approval, letter. Yes r No
Proposed impacts on Riparian and Watersded Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state sad local buffers a8w-iated with the project. The applicant must also provide
justification for these impacts in Section VII above. All pmposed it lp acts must be 19so herein,
and must be clearly identifiable on the accompanying site plan, All buffet must ?c shown on a
trtap, whether or not impacts am proposed to the buffers. Corresporda:tce from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's Qiscretfon.
I. Will the project impact pictectod riparian buffers identified within 15A NCAC 2B .0.x,33
(Neusel I3A NCAC 2B .0259 (Tar-Famlico), 15A NCAC 023.0243 (Catawba) 1SA NCAC
28 .0250 (Raadten Rules and Water Supply Buffer Requirements), or ether (please
identify )? Yes Q No
2. If "°yes", identify the square feet and acreage of impact to each zone of the riparian buffers.
If buffer mitigation is required calculate the required amount of mitigation by applying tl e
huffer MAtilmho-M
' 7,on.* ? impact ?
?-- R?gairc0-'7
s URM YCCt Multiplier --- imd
I
1 3 (s for Catawba)
2 Ls
Total
* Loam 1 exiettds o.tt 3d ra4t perpend?culpr from tha top of the nau b" of chAwz ; zo•, e ` errands on
aidtt =120 thet from tho oafs ofzoae I.
3. If buffer mitigation i3 required, please discuss what type of mitigAticul is proposed (i.e.,
Donation of Property, Riparian Buffer Restoration ; Enhancement, or Payment into he
Ripwian Buffer Restoration Pund)_ Please attach all appropriate in ormation as identified
within 15A NCAC 28.O14ARr .0244, or .U250.
Page 11 of 12
-U.23.2005 3:33pri . LSD WILr1It,6T0N
?CI. Storritwater (required by DWQ)

Describe impervious acreage (existing and proposed) vers?js total acreage on the site. Discuss
sto:mwster controls proposed in order to protect surface waters and wetlands downstrerrn frorn
the; property. If percent impervious surface exceeds 20%, plea-se provide c cutations
demonstrating total proposed'miArvious level. A.. ,. __ rq
MI. Sewage Disposal (required by DWQ)
Clouly detail the ultimate treatment methods and disposition (non-discl:urge or discharge) of
wastewater gerieratus? m the proposed project, or available capacity of the subject facility.
Xlli. Violations (required by DWQ)
Is this site in violation of DWQ?tUnd R41rs (15A NCAC 2H .0500) or any Buffer Rules?
Yes ED No G?
Is this an after-thc-fact permit application? "Yes [I No ZK'
X.YY.Cumulative Impact,% (required by VWQ)
fill this project (based on past and reasonably anticipated future impacts) result in additional
development, which coutd impact nearby downstream water quality`s Yes M No Q
If yes, please subtilit a qualitative or quantitative cumulative impact analysis in accordance wzta
the most recent North Carolina Division of Water Quality policy pc)sted on our website at
bAi2:0b2o.e` n, r.at?,nc. sg et ar. 3s, If no, please provide a shoe narrative dcscription:
XV. Other Circumstances (Optional):
ft is the applicant's responsibility to subunit the, application
sufftGiesttly in advance of desirc;ti
construyction dates to allow processing time for these permits. However, an applicant may
eboosc to list constraints associated with construction or scgrencing that may irm,) limit, on
work schedules (e .g., draw-down schedules for lakes, dates associated with Eudangerni and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
fflieasVAgentls Signature ---
signature i6 valid onty'fan authorization letter from the applicant is provided.)
Page 12 of I2

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