20040547 Ver 1_COMPLETE FILE_20040401

;

J5-~d

Office Use Only:

Form Version May 2002

USACE Action ID No. DWQ No. "- i '\" ',h 4 '~~
(Ifany 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 proj ect:
~ Section 404 Permit ~
D Section 10 Permit D
~ 401 Water Quality Certification

Riparian or Watershed Buffer Rules
Isolated Wetland Permit from DWQ
C~aJl'.ul 101

}J( 31 ~".~
. ~(~

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: 0

4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: 0

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: D

II. Applicant Information

1. Owner/Applicant Information
Name:_l/) ,. J/ 11' I~ ", ti (' ~ (:,' l.' (", 2-
Mailing Address:~ '1...0 } V": I" t - '9-'. \ r ~I Kr{,
Z..ch,)hn N c 2'}~,<i7

WETLANDS 1401 GROUP
APR 0 1 2004
WATER QUAl-In'secnoo

Telephone Number: q I q . ;L (;. r, . '') (; t.- ~ Fax Numh~r:
E-mail Address: II.. r oj I~ .r ,,: " r 2. 7 7'7 r;;} '1 {', h. '," ' (' ,? I']
. ) . - \

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

r

III. Project Information

3. Property Identification Number (Tax PIN): 00007 5 (I; I DOC I

4, Location
County: N ('~ 'S h Nearest Town: -z.." _ h l) \ (') f\
Subdivision name (include phase/lot number): L~+II (, Cr- e ".~ J..,t ~ 52.
Directions to site (include road numbers, landmarks, etc.): r:-,(Y\ \-I"VlI '1(.,4 -{..\?~
, -\,\,.J \ I
, J .", +, (.'.' c .. . '\ ,. . 2-
( . . v I 4 ~_ ) ~' , ._'. . ,. v . ,.J .. (
) v". rtl ~ ,~ hJ rn ~i '3 \-y~ On t..:f!' (., C r-e.e k. ~J. 1..0 + ~ 5 ).. ~:> !)!'I ..ft a..)Y.J.;i Y)... .:v, ~ I ~ 0/\ L~+l1 e.
5. Site coordinates, if available (UTM or Lat/Long): G,...t-<tJc,. 'R,
(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 waterbod y.)

~/Oaerrf

6, Property size (acres):

7, Nearest body of water (stream/river/sound/ocean/lake): L,> f f/-t {If.! k

8. River Basin: ;I; e "f.e
(Note - this must be one of N!)rth Carolina's seventeen designated major river basins. The
River Basin map is available at http://h20.enr.state.nc.us/admin/maps/.)

9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application:U"...,./..J /().f oj,VIA 5,-n~,/1 .,f,('C<..... O..<J~5,~.7J. -I/1ro'Jh

Page 6 of 12

~

,J II
~ ~I:?N ')-\' th... S+:;e",tn.
11. Explain the purpose of the proposed work: -r~ h1r ltl.
+'yH'/ ~;,h- ~ H '{Y'\ ~ n r1 r~.err t.,., ~j rd. ..h, t''yH'
:\' . , '
\r...l <'~-\Tt> it in :'l f'\ ,:., v..\ \ \ I

LL (.lr)iJf?...A;{i,1 tel t:ro';';

~I(') fV) e~ ." ~ + (I (1. h 'J 11 {>..

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.

(J d/I..f

V. Future Project Plans

Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
11d./lJl

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

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

Page 7 of 12

~

1. Provide a written description of the proposed impacts:

ree !D:.. #-10

2. Individually list wetland impacts below: AI /A-

Wetland Impact Area of Located within Distance to
Site Number Type of Impact* Impact I DO-year Floodplain** Nearest Stream Type ofWetland***
(indicate on map) (acres) (yes/no) (linear feet)

*

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 htto://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).

filA

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

**

***

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

Type of Impact*

Stream Name**

C U (VII'

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.com,
www.maoquest.com. etc,),

*

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

20ff

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: 1J'/A-
Open Water Impact Area of Name of Waterbody Type of Water body
Site Number Type of Impact* Impact (lake, pond, estuary, sound,
(indicate on map) (acres) (if applicable) bav, ocean, etc.)
+

*

List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc,

5. Pond Creation i~ (.f
If construction of a pc!nJ 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 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 construe ion to reduce impacts.
,~, \ \
- .' I I r~

-

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
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://h20.em.state.nc. us/ncwetlands/strmgide.html.

1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed. AI /.11-

,/

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 http://h20.enr.state.nc.us/wrp/index.htm, If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information: AI' IA-

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)

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

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

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

X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ) c&(,l\ 5'~eve p~

I . h I' I ( , ) 'b'l' d . d l' d 11 ,~-J-C(e (f
t IS t e app lcant s or agent s responsl 1 lty to etermme, e meate an map a Impacts to 57
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, 4-?l
and must be clearly identifiable on the accompanying site plan, All buffers must be shown on a
map, whether or not impacts are proposed to the buffers, Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion,

Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), l5A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify Io.c- ~a'(""\\~ co)?
Y e~ ~ If you answered "yes", provide the following information:
r~

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*

Multiplier

'\~ 0 c~
\~~'

103

2 1.5 0

Total I 0 0 t) 0 ()
* Zone 1 extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone I.

Pagellofl2

If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration I Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within l5A NCAC 2B .0242 or .0260.
3l>os""-, nY'\~ +'e...P~ +c) b~ ?\c,~-+l(.~ D..\t~\
LA)o\'~ ~<;. c\n-np

Stormwater (required by DWQl cte" c r ; b ~ ( ~.J {"" ~ ~e;c:~ I f 1-" h/},"/~

XI.

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

r,.)"
~ I (' T

o...f\J.

c;) -1 () {\ f'.

\oo--J "'-.lG..v\
\

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.
Y)o \... \ r.. c,\t"' \})o.\-r" l"- 1~ \ \ ho 0 (\0 r ~:~ p,.\ IJ~CJ, \-'0 t,,^- ~ c,
'1 ~ o~ ~c-\

XIII. Violations (required by DWQ)

Is this site in violation of DWQ Wetland Rules (l5A NCAC 2H .0500) or any Buffer Rules?
Yes D No f2

Is this an after-the-fact permit application?
Yes D No ~

XIV. Other Circumstances (Optional):

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

"1J1.t~ ~~Tl~c ~/2 9 Jo~
App1'icant/Agent1s ~ Date
(Agent's signature is valid only if an authorization letter from the applicant is provided,)

Page 12 of 12

,

Office Use Only:

Form Version May 2002

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

.\ "
i~j

nS41

I. Processing

I. Check all of the approval( s) requested for this proj ect:
o Section 404 Permit ~
D Section 10 Permit D
~ 401 Water Quality Certification

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

Riparian or Watershed Buffer Rules
Isolated Wetland Permit from DWQ

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

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

5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: D

II. Applicant Information

1 . Owner/Applicant Information
Name:~') .. II 11 l\..,d I ~ {. t; (.,2..
Mailing Address: 2'12()} V': 101 - ~'. \ ~ ~l l,z...i.
J?.-<: ~h) h i'l N.c ).. '} ..,., r; 7

~NDS/401GROUP

APR 0 1 20D4
WATER QUALITY SECTION

Telephone Number: q I q . J- (;, r, . 'V; I,. ~ Fax Numb'~r:
E-mail Address: lZ r;) ,-1,(', I I' ( 1. 7 7'7 c;Q 'r' h ',' . { ." 11]
, J '-

2. Agent/Consultant 11lformation (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:

Telephone Number:
E-mail Address:

Fax Number:

Page 5 of 12

,

III. Project Information

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

1. Name of project: If Qui {rv. rrr AJ - l.lclJc<:.y.. e ~ P "f!-~
2. T,I.P. Project Number or State Project Number (NCDOT Only):

3. Property Identification Number (Tax PIN): 00007 5 ~ I GQO I

4. Location
County: N c...sh Nearest Town: 2.:l,hl}\'')f'\
Subdivision name (include phase/lot number): L~t-II ~ C("' e",~ L,t ~ .5 2
Directions to site (include road numbers, lant1J}~rks, etc.): r:-,I"" I-I....,y l(.,'-/-e,,\?t
. J .".. + . (.' \.. . c. '. . " ,. - 2.
( I ""I -'" .,- . ., ~ ~ ~ (.
I v" .rt)~ I~ hJrn ~7'3h4 On t..:+t I", C\e.d~. ~J, Lot ~5 ';L ~ ~ .:H\ ...f.f a..h:J-.;t Y')... M~ I~ 0/\ L~f/ Ie.
5. Site coordinates, if available (UTM or Lat/Long): Gr~1c. 'Rd
(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):

~/Oa&reF

7. Nearest body of water (stream/river/sound/ocean/lake): L,> f II"! {r,-t k

8. River Basin: ;fj ev.f.e
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h20.enr.state,nc.us/admin/maps/,)

9, Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: 4/..,., ,./t> (1 j().j 0/"1), <,-n~,// .,i,('n-n C"")~5'~'''J' ..j/1Y'o~~/)

Page 6 of 12

I

-\-ht.- ~ I:? '" ') -\' tht. <) +,' e. un ,
11. Explain the purpose of the proposed work: -r~ hi/: lc..
+\r>.?/ ~','h-e(\'fY'\ ~n (),"'.e~ -t.,., 8eJ -h, tr-<'
-\'-".. <"~~'Ci1 "1"\ :'l !'\ ,~ \,." \ \ I '

n. ,.lrJ;,/t'..,.;{lI, +(, r:ro';';
\")(") 1"\ e~ ":. ~ -\. e (!.. b 'J II l'.

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.

(I d/J"{

V. Future Project Plans

Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
I1cJ/l..Jl.

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

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

Page 7 of 12

1. Provide a written description of the proposed impacts:

f<?e 1J:f.40 #/0

2. Individually list wetland impacts below: !\I /A-

Wetland Impact Area of Located within Distance to
Site Number Type of Impact* Impact I DO-year Floodplain * * Nearest Stream Type of Wetland * * *
(indicate on map) (acres) (yes/no) (linear feet)

*

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).

V#

List the total acreage (estimated) of all existing wetlands on the property:
Total area of wetland impact proposed: N/A-

**

***

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

Stream Impact
Site Number
(indicate on ma

Type of Impact*

Stream Name**

CU(\I,I'

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.tooozone.com,
www.maOQuesLcom, etc.).

'"

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

20!f

Page8ofl2

4, Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic

Ocean and any other water of the U.S.) below: ~/A-
Open Water Impact Area of Name of Water body Type of Waterbody
Site Number Type of Impact'* Impact (lake, pond, estuary, sound,
(indicate on map) (acres) (if applicable) bay, ocean, etc.)
+
. .

*

List each Impact separately and Identity temporary Impacts. Impacts mclude, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, elc.

5. Pond Creation IU!.f
If construction of a pc!nJ 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 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 construe ion to reduce impacts,
.. I .' " It"-

-

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
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://h20,enr.state,nc. us/ncwetlands/ strmgide.html.

1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (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.

A1~
/;

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 http://h20.enr.state.nc.us/wrp/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information: AI' /Jf-

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)

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

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

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

X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ) C'q l\ 5' ~e Ve pu.

I' h l' '( , ) 'b'l' d . d l' d 11 . ~-,-\-C(e {(
t IS t e app lCant s or agent s responsl 1 lty to etermme, e meate an map a Impacts to 57
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, 4-'11
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers, Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.

Will the project impact protected riparian buffers identified within 15A NCAC 2B ,0233
(Neuse), 15A NCAC 2B ,0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identifYlo.c- ~a'(""\\~ cO )?
Ye~ ~ 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 calculatt: the required amount of mitigation by applying the buffer
multipliers.

o

3
1.5

'\ ~ 0 c~
\~~'

1
2

Multiplier

Zone*

o

Total loot) 0 ()
Zone I extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone I.

*

Page 11 of 12

If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration / Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within l5A NCAC 2B .0242 or .0260.
3 l> 0 S 'C.., n Y'\~ +,e..-~ ~ +c) b e ~ \ c, ~-+ l(. ~ D..\t~ \"
LA)O\'~ ~<;. c\n-np

XI. Stormwater (required by DWQl cte,> c r ; b ~ ( ~.J {"" ~ ~eQ'c:~ I f 1-" h/},.l~

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

r.)"
~ I (' T

o...f\~

cJ () {\ f'

\' oo--J "'-.lG..v\
\

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.
Y)o \...\l'.lC,\,., \})o.\r" 1"-1~ \\ ho 7j (\0 r ~-\P"\ IJ~CJ, \-'^ t,,^-~ c,
'1 ~ o~ ~c_\

XIII. Violations (required by DWQ)

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

Is this an after-the-fact permit application?
Yes D No ~

XIV. Other Circumstances (Optional):

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

'--I~ftQ, ~9":'CcU1~ ,." b 91o~
App1icant/Agent1s Signa r. Date
(Agent's signature is valid only if an authorization letter from the applicant is provided.)

Page 12 of 12

..

DWQ# D~.6S4~

Date

L4..l~, O~

Who Reviewed:

ez.

Plan Detail Incomplete

~-

.~ .1 \'+0 ...~~
.~ ,~'V~~~

,

L,,~C. r.,4<er~

~ 1-0 L/'). Q ~J7..~
Please indicate proposed lot layout as overlays on the site plan. .iJ... ~ "'c..l4~

Please indicate the location of the protected buffers as overlays on the site plan. n - w~u::
cY/d-O -""'> \ "
~lease locate all isolated or non-isolated wetlands. streams and other waters of the State as overlays on the si . E~~ ~

o Please provide cross section details showing the provisions for aquatic life passage. ~ UIUL

o Please locate any planned sewer lines on the site plan. j\J ~ :3<; I b <.. 3~.l
O but \ l~
Please provide the location of any proposed stormwater management practices as required by GC

o

o

o

o

o

X Please provide a location map for the project.

~ Please show all stream impacts including all fill slopes. dissipaters. and bank stabilization on the site plan.

o

Please show all wetland impacts including fill slopes .on the site plan.

Please indicate all buffer impacts on the site plan.

p -

i- t I ~

Please provide detail for the stormwater management practices as required by GC

J-1-.a_.

l tI t;'.

Please specify the percent of project imperviousness area based on the estimated built-out conditions.

Please indicate all stormwater outfalls on the site plan.

Please indicate the diffuse flow provision measures on the site plan.

Please indicate whether or not the proposed impacts already been conducted.

A voidance and/or Minimization Not Provided

o The _labeled as _ on the plans does not appear to be necessary. Please eliminate the _ or provide additional
information as to why it is necessary for this project.

o This Office believes that the _ labeled on the plans as
. Please revise the plans to avoid the impacts.

can be moved or reconfigured to avoid the impacts to the

o This Office believes that the _ labeled on the plans as
. Please revise the plans to minimize the impacts.

o The stormwater discharges at the location on the plans labeled will not provide diffuse flow through the buffer because
. Please revise the plans and provide calculations to show that diffuse flow will be achieved through the entire buffer. If it
is not possible to achieve diffuse flow through the entire buffer then it may be necessary to provide stormwater management
practices that remove nutrients before the stormwater can be discharged through the buffer.

can be moved or reconfigured to minimize the impacts to the

Other

V The application fee was insufficient because over 150 feet of stream and/or over 1 acre of wetland impacts were requested. Please
r provide $ l!;1YJ . This additional fee must be received before your application can be reviewed.

o Please complete Section(s) on the application.

o Please provide a signed copy of the application.

o Please provide _ copies of the application. _ copies of the site plans and other supporting information.

Mitigation

o of compensatory mitigation is required for this project. Please provide a compensatory mitigation plan. The
plan must conform to the requirements in 15 A NCAC 2H .0500 and must be appropriate to the type of impacts proposed.

o Please indicate which 404 Permit the USACE would use to authorize this project.