20040173 Ver 1_COMPLETE FILE_20040209

D
A T?,
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
Division of Water Quality
Department of Environmental and Natural Resources
Wetlands/401 Unit
Street Address: 2321 Crabtree Boulevard, Suite 250
Raleigh, NC 27604-2260
Mailing Address: 1650 Mail Service Center
Raleigh, NC 27699-1650
Contact Information: Phone #: [phone]
{{ I Fax #: [phone]
77C,
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Fax To: Fax #:
Company: Date:
Number of pages including cover sheet:
Notes or special instructions:
1
4W
N. C. Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (http://h2o.enr.state.nc.us/ncwetiands
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Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
February 13, 2004
Davidson County
DWQ Project #: 04-0173
APPROVAL OF 401 Quality Certification with ADDITIONAL CONDITIONS
Tim and Lee Yarboro
878 Michael Road
Lexington, NC 27295-6814
Subject Property: Riverview Acres, Lots 27 and 28
You have our approval, in accordance with the attached conditions and those listed below, to place fill
within or otherwise impact approximately 0.038 acres of waters on High Rock Lake for the purpose of
excavation and installing rip-rap to stabilize approximately 103 feet of shoreline, as described within
your application dated February 3, 2003. After reviewing your application, we have decided that this
fill is covered by Nationwide Water Quality Certification Number 3373, which may be viewed on our
website at http://h2o.enr.state.nc.us/ncwetlands. This certification allows you to use General Permit
Number 198200030 when the Corps of Engineers issues it. In addition, you should get any other
federal, state or local permits before you go ahead with your project including (but not limited to)
Sediment and Erosion Control, Coastal Stormwater, Non-Discharge and Water Supply Watershed
regulations. This approval will expire when the accompanying 404 or CAMA permit expires
unless otherwise specified in the General Certification.
This approval is only valid for the purpose and design that you described in your application except as
modified below. If you change your project, you must notify us and you may be required to send us a
new application. If the property is sold, the new owner must be- given a copy of this Certification and
approval letter and is thereby responsible for complying with all conditions. If total wetland fills for
this project (now or in the future) exceed one acre, compensatory mitigation may be required as
described in 15A NCAC 2H.0506 (h) (6) and (7). This approval shall expire when the corresponding
Nationwide Permit expires or as otherwise provided in the General Certification. For this approval to
be valid, you must follow the conditions listed in the attached certification and any additional
conditions listed below.
Conditions of Certification:
Upon completion of the project, the applicant shall complete and return the enclosed
"Certification of Completion Form" to notify DWQ that all the work included in the 401
Certification has been completed. The responsible party shall complete the attached form and
return it to the 401/Wetlands Unit of the Division of Water Quality.

N. C. Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (http://h2o.cnr.state.nc.us/ncwetlands
Page 2
Tim and Lee Yarboro
February, 2004
2. This project is for the installation of rip rap to prevent further erosion of the property due to
wave action. The use of mechanical equipment on the beach must be minimized.
3. Equipment and materials may be offloaded to the beach at the bulkhead site, but steps must be
taken to keep all equipment out of the reservoir.
Violations of any condition herein set forth may result in revocation of this Certification and may result
in criminal and/or civil penalties. This Certification shall become null and void unless the above
conditions are made conditions of the Federal 404 and/or coastal Area Management Act Permit.
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, which conforms to Chapter 150B of the North Carolina General Statutes to the Office of
Administrative Hearings, P.O. Box 27447, Raleigh, N.C. 27611-7447. 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 John Dorney at 919-733-9646 or Daryl Lamb of our
Winston-Salem Regional Office at 336-771-4600.
Sincerely,
JRD/bs
Attachments
W. Klimek, P.E.
cc: Corps of Engineers Raleigh Field Office
Winston-Salem DWQ Regional Office
File copy
Central Files
Page 2
Tim and Lee Yarboro
February, 2004
2. This project is for the installation of rip rap to prevent further erosion of the property due to
wave action. The use of mechanical equipment on the beach must be minimized.
3. Equipment and materials may be offloaded to the beach at the bulkhead site, but steps must be
taken to keep all equipment out of the reservoir.
Violations of any condition herein set forth may result in revocation of this Certification and may result
in criminal and/or civil penalties. This Certification shall become null and void unless the above
conditions are made conditions of the Federal 404 and/or coastal Area Management Act Permit.
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, which conforms to Chapter 150B of the North Carolina General Statutes to the Office of
Administrative Hearings, P.O. Box 27447, Raleigh, N.C. 27611-7447. 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 John Dorney at 919-733-9646 or Daryl Lamb of our
Winston-Salem Regional Office at 336-771-4600.
Sincerely,
JRD/bs
Attachments
cc: Corps of Engineers Raleigh Field Office
Winston-Salem DWQ Regional Office
File copy
Central Files
I
W. Klimek, P.E.
The following is an abbreviated application form for those applying for a 401 Water
Quality Certification to impact FERC (Federal Energy Regulatory Commission)
regulated lake shore or bottom under the U.S. Army Corps of Engineers Permit
GP30. This Application cannot be used for wetland or stream impacts. Please
provide seven (7) copies of this application and supporting information as well as a
non-refundable application fee to the Division of Water Quality of $200.00 for
impacts of to lake bottom of less than 1 acre and $475.00 for impacts to lake bottom
of greater or equal to 1 acre.
Applications should be sent to: FILE Copy
Division of Water Quality Wetlands Unit
1650 Mail Service Center
Raleigh, NC 27699-1650
040173 ?NETLANQS / 401 GROUP
1. Applicant Information FEB 0 `) 2004
Owner/Applicant Information WATER QUALITY SECTION
Name: -rim AIND LEE JA-?-f2(e-0
Mailing Address:_ 51p.) em"Acet- i.Ap
l,ExiNV7oN NG 'Z?2?tS m8 t?
Telephone Number: 31'3 653 - 165(o Fax Number: 3 ? 8S?
E-mail Address: a a rc_ ee a, f e,yc co t. , w e+
2. Agent 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: n1 1a
Company Affiliation:
Mailing Address:
Telephone Number:
E-mail Address:
Fax Number:
II. 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. You may use the diagram below to make a hand sketch of

your project. Also, see the example below for guidance. Both the vicinity map and
site plan must include a scale and north arrow. The footprints of all buildings,
impervious surfaces, or other facilities must be included.
Location
County: DA- i I D S-a ?J Nearest Town: LE LiO&7o(
Subdivision name or site address (include phase/lot number): V-1 uep-yIew Acgf" (.x"75 ZJ-t
Directions to site please include road numbers, landmarks, etc. (This is not
necessary if an adequate vicinity map is included): T-85 ?o Ex IT SW I -MLE Wmcli;
VSOUTP , KI6HT d?N WI OWCOD 4souT"Mr-v i 12r..A7 %So IIAA\ P?l GU -r -I
2. Describe the existing land use or condition of the site at the time of this
application: $'tnlL; F**riIL-q lifu13PIVIs+0N.
F}6uS& UA1t>G-r?(zQI.,r2EccTmrJ
I Property size (acres): A-eg iz x , () , 3 Ayzc- 5
4. Nearest body of water (stream/river/sound/ocean/lake): ?h 64 rL6c*- tAk:l?
5. Describe the purpose of the proposed work:_ ST V) I w LE f,,4Lt 5TIn) G aN?7tc UNE
PgoTCc--r Facyw Fu R:r RM `::(lo si ct J .
6. List the type of equipment to be used to construct the project: bnaAt L T(WToR
6 CAT- o 1?- TRA C V- Vto F-
7. Amount of impact (including all excavation, backfill, rip rap, retaining walls,
etc.) below the normal pool lake level in square feet or acres:
&16 5Q- FT-
8. a. Amount of impact (including all clearing, back fill, excavation, rip rap,
retaining walls, etc.) above the normal pool lake level and 50 feet land-ward in
square feet or acres: i 13';i S021 lr-T;
b. Please describe vegetation above the normal pool lake level and 50 feet land-
ward to be impacted (number of trees for instance): AP(R©X • to TIZfEs Aw,)
P,?t.?SNEs/ ?,I 511 W)t L, be R wVEo Tn 1Ne.TiN-l. S1+cAfwNE IjvIP(zcVciitEN7S
3
Applicant/Agent's Signature Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
US Army Corps Of Engineers Field Offices and County Coverage
Asheville Regulatory Field Office Alexander Cherokee Iredell Mitchell Union
US Army Corps of Engineers Avery Clay Jackson Polk Watauga
151 Patton Avenue Buncombe Cleveland Lincoln Rowan Yancey
Room 208 Burke Gaston Macon Rutherford
Asheville, NC 28801-5006 Cabatrus Graham Madison Stanley
Telephone: [phone] Caldwell Haywood McDowell Swain
Fax: [phone] Catawba Henderson Mecklenburg Transylvania
Raleigh Regulatory Field Office Alamance Durham Johnston Rockingham Wilson
US Army Corps Of Engineers Alleghany Edgecombe Lee Stokes Yadkin
6508 Falls of the Neuse Road Ashe Franklin Nash Surry
Suite 120 Caswell Forsyth Northampton Vance
Raleigh, NC 27615 Granville Orange Wake
Telephone: [phone] Davidson Guilford Person Warren
Fax: [phone] Halifax Randolph Wilkes
Washington Regulatory Field Office Beaufort Currituck Jones Pitt
US Army Corps Of Engineers Bertie Dare Lenoir Tyrrell
Post Office Box 1000 Camden Gates Martin Washington
Washington, NC 27889-1000 Carteret' Green Pamlico Wayne
Telephone: [phone] Chowan Hertford Pasquotank
Fax: [phone] Craven Hyde Perquimans •Croatan National Forest Only
Wilmington Regulatory Field Office Anson Duplin Onslow
US Army Corps Of Engineers Bladen Harnett Ponder
Post Office Box 1890 Brunswick Hoke Richmond
Wilmington, NC 28402-1890 Carteret Montgomery Robeson
Telephone: [phone] Columbus Moore Sampson
Fax: [phone] Cumberland New Hanover Scotland
US Fish and Wildlife Service / National Marine Fisheries Service
US Fish and Wildlife Service US Fish and Wildlife Service National Marine Fisheries Service
Raleigh Field Office Asheville Field Office Habitat Conservation Division
Post Office Box 33726 160 Zillicoa Street Pivers Island
Raleigh, NC 27636.3726 Asheville, NC 28801 Beaufort
NC 28516
Telephone: [phone] Telephone: [phone] ,
Telephone: [phone]
North Carolina State Age ncies
Division of Water Quality Division of Water Quality State Historic Preservation Office
401 Wetlands Unit Wetlands Restoration Program Department Of Cultural Resources
1650 Mail Service Center 1619 Mail Service Center 4617 Mail Service Center
Raleigh, NC 27699-1650 Raleigh, NC 27699-1619 Raleigh, NC 276994617
Telephone: [phone] Telephone: [phone] Telephone: [phone]
Fax: [phone] Fax: [phone] Fax: [phone]
CAMA and NC Coastal Counties
Division of Coastal Management Beaufort Chowan Hertford Pasquotank
1638 Mail Service Center Bertie Craven Hyde Pender
Raleigh, NC 27699-1638 Brunswick Currituck New Hanover Perquimans
Telephone: [phone] Camden Dare Onslow Tyrrell
Fax: [phone] Carteret Gates Pamlico Washington
NCWRC and NC Trout Counties
Western Piedmont Region Coordinator Alleghany Caldwell Watauga
3855 Idlewild Road Ashe Mitchell Wilkes
Kernersville, NC 27284-9180 Avery Stokes
Telephone: [phone] Burke Surry
Mountain Region Coordinator Buncombe Henderson Polk
20830 Great Smoky Mtn. Expressway Cherokee Jackson Rutherford
Waynesville, NC 28786 Clay Macon Swain
Telephone: [phone] Graham Madison Transylvania
Fax: [phone] Haywood McDow ell Yancey
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VEGETATION AND EROSION
\
CONTROL FABRIC
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EXISTING GR ADE

3 -?
1
CLASS 2 RIP RAP
I NWS

2
W- 112
EROSION CONTROL FABRIC-S

LAKE BOTTOM - -
TYPICAL CONDITIONS
36" TO 72" ERODED CUT
WAVE EXPOSURE

FOR: 11/10/99
TIM & LEE YARBORO
LOCATION: LOTS 27 & 28, RIVERVIEW ACRES
RESERVOIR: HIGH ROCK LAKE
PROJECT: SHORELINE STABILIZATION PROGRAM
PHASE I SITE EVALUATION
YADKIN, INC. - BADIN, NORTH CAROLINA
DRAWING TITLE: DETAIL
MODERATE RIP RAP STABILIZATION 3
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?, SHORELINE MANAGEMENT PLAN
Feb 06 04 02:01p

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FEB-6-2004 FRI 13:58 TEL:[phone] HAME:[1140-WETDHlIEi'_; P. 1
U.S. ARMY CORPS OF ENGINEERS
Wilmington District
Action ID: 200420201 County: Davidson
Incomplete Application Notification
Property
Owner Tim & Lee Yarboro
Address 878 Michael Drive
Lexington N.C. 27292
Telephone Number 336-983-8265
1NETt ARC i a.;;A ?7,r?ZOUP

-ION
Location/Description of Proposed Activity: The proposed project is located on the west side of
Riverview Drive (SR 1335) in Lexington, Davidson County, North Carolina.
Type of Permit Applied For (check one): IP ( ) NWP # ( ) GP # 30 (X )
Applicable law: Section 404 of the Clean Water Act ( X ); Section 10, Rivers and Harbor Act ( )
YOUR APPLICATION/PRECONSTRUCTION NOTIFICATION IS INCOMPLETE AND
CANNOT BE EVALUATED UNTIL THE FOLLOWING INFORMATION IS RECEIVED
(CHECK ALL THAT APPLY):
Your application/pre-construction notification form has not been completed and/or signed (see remarks).
Under the conditions of Nationwide Permit # , you are required to submit an aquatic resource mitigation
plan. The required plan is either insufficient or has not been included with your notification (see remarks).
Your application/pre-construction notification did not include information describing measures you have
implemented to avoid and minimize impacts to Waters of the United States.
Your submitted project plans or maps were insufficient, too large, or not legible (see remarks).
Your application/pre-construction notification did not include a delineation of affected special aquatic sites,
including wetlands, vegetated shallows, and riffle and pool complexes as required.
Your project is in a designated trout water county. Nationwide permit regional conditions require that a
copy of your application be submitted to the local NC Wildlife Resources Commission (WRC) for comment.
(Address: Western Piedmont Regiqn Coordinator, 3855 Idlewild Road, Kemersville, NC 27284-9180)
X Other (see remarks) Please complete and submit the enclosed Pre-Construction Notification form.
REMARKS: Please provide a legible map of impact areas (City of King Recreation Areas).
If you have any questions regarding the Corps of Engineers regulatory program, please contact
Andrea Wade at telephone number (919) 876 - 8441 extension 31.
Project Manager Signature Date December 11, 2003
? r,
Office Use Only:
USACE Action ID No.
(if any partic%
1. Processing
DWQ No.
is not applicable to this project, please enter "Not
Form Version May ZOUZ
or
1. Check all of the approval(s) requested for this project:
Riparian or Watershed Buffer Rules
Section 404 Permit
Section 10 Permit Isolated Wetland Permit from DWQ
[401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: c?
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here:
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: (]
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: n
if. Applicant information
1. Owner/Applicant Information
Name: -T1- 2/t 4
Mailing Address:?"_/ ,
Telephone Number: aS 3 ' f 5? Fax Number: 1I5 5
E-mail Address: (Jrk,dcc- Q lex C,,min c= /7e--/-
2. Agent/Consultant Information 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:
Pax Number:
Page 5 of 12
Ill. Project Information
iwach 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 fill-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:
i `
2. T.I.P. Project Number or State Project Number (NCDOT Only): Q/
3. Property identification Number (Tax PiN):_&_`?_Q
4. Location
County:??! ?, CI S n Nearest Town: t_?Yl
Subdivision name (include phase/lot numbcr):__9_, - U
Directions to site (include road numbers, landmarks, etc.):
-12_ Rd.nn+ IC_d L'" C.(ru?e ?S?? nvn?n
1 V,2,4 In a vy, D J / l1.lIDl.-i/-'o? /j/ v d _ - 1 7z)-v ua_ w c a-n 5 r. a
5. Site coordinates, if available (UTM or Lat/Long): V
(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres):
7. Nearest body of water (stream/river/sound/ocean/lake):ku-&K Rex-
8. . River Basin: V (t SJ !St v'?
(Note - this m st be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at littp://li2o.enr.St itC.nc.us/admiii/maps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
_? bYYte_Cl??!/?o ray
at the time of this application:
11aue 6 of" 12
10. Describe the overall project in detail, including the type of equi ment to be used:
H n 6-W fu.
?J 0 G -
f ?? Y O
X ??! b`/ "r. a. m ? /mss a'
o ?
Explahn the purpose of the proposed work: r t/aO a
a
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.
None
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and providAe?ustification for the exclusion of this work from the current application.
IV`e/1C
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility.. t^ determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be lisLcd herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
Page 7 of 12
(ide a written description of the proposed impacts:_ h1(t'I r r 6,1 10 f- Qi, 1A l ?'1ma Lis- fia de a_ _ -1!?I-,
2. Individually list wetland impacts below:
Wetland Impact
Site Number
(indicate on map)
Type of Impact* Area of
Impact
(acres) Located within
100-year Floodplain**
(yes/no) Distance to
Nearest Stream
(linear feet)
Type of Wetland***
Mont

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

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.usgs.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.coni,
www.mapqucst.coni, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 41 ME
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact
Site Number
(indicate on map)
Type of Impact* Area of
Impact
(acres) Name of Waterbody
(if applicable) Type of Waterbody
(lake, pond, estuary, sound,
bay, ocean, etc.)
t- -}i O
.c 2 vo i r

* List each impact separately and identify temporary impacts. impacts mciude, but are not umuea to: mi, excavanon, oreagtng,
flooding, drainage, bulkheads, etc.
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): R uplands [] stream wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
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VIII. Mitigation (Ah a wl e d b.y G4 ?Z b n e? h , fe ox ?4r
Q u'st, J . Popased e xc "r& ? tin l I'M 4- om r>? e" 0#4 k t
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.
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(' ci Va h"o j7. ?3 a e 9 of 12 l?
USACE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USACE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed. on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http://h2o.enr.state.nc.us/ncwetlaiids/stmigide.hti-i-il.
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.
N o n,-
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at hi."Ph2o.crinstate.nc.us/wip/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet): ' N11
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)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes 0 No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] o review current thresholds for environmental documentation.
Yes F] No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes n No d
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to detennine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 213 .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 213 .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes [-] No [2 If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* impact
(square feet) Multiplier Required
Mitigation
1 3
2 1.5
Total
* Zone I extends out Su tect perpenaicular from near nanK of cnannei; Gone G extenus an
additional 20 feet from the edge of 'Lone 1.
Page 1 1 of' 12
Davidson Co., NC -- Printable Map
r urc i vi i
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or.0260.
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
dow tre from the property.
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.
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H.0500) or any Buffer Rules?
Yes ? No M
Is this an after-the-fact permit pplication.
Yes ? No li?
XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction, date.; to allow processing 'ime fi;r these pcnmts. 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).
W b rl e-,
,Zt-
Appf cant/Agent's Signature Date
(Agent's sighature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
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