20040676 Ver 1_COMPLETE FILE_20040426

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Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources

Alan W. Klimek, P.E.t Director
Division of Water Quality
Coleen H. ~l!II!ns.~~
DIVISI'\Rt I OUP

May 18, 2004

Jeremiah and Erin Batts
P.O. Box 2023
Surf City, NC 28445

JUN 0 8 2004
WATER QUALITY SECTION

SUBJECT:

Approval of 401 Water Quality Certification
and Additional Conditions
Lots 11 & 12 Heron Cove SID
DWQ Project # 040676
Surf City, Pender County

Dear Mr. and Mrs. Batts:

You have our approval, in accordance with the attached conditions (WQC #3402), to do the following
activity at your property located in the Heron Cove Subdivision, Lots # 11 & 12 on Heron Landing Road
in Surf City, Pender County. This approval allows you to:

1. Fill 0.1 acres of Section 404 Wetlands for the purpose of constructing a single-family home on
each lot in Heron Cove Subdivision, specifically on Lots # 11 & 12 Heron Landing Road in Surf
City.

This approval is only valid for the purpose and design that you described in you Pre-Construction
Notification (pCl\T) application received by the Division of Water Quality (DWQ) on April 26, 2004.
After reviewing your application, we have determined that General Water Quality Certification Number
3402 covers this activity. This Certification can also be found on line at:
http://h2o.enr.state.nc.us/ncwetlandslcerts.html.This Certification (#3402) allows you to use your 404
Permit when the Corps of Engineers issues it. Please keep in mind that there may be additional Federal,
State or Local regulations applicable to your project, such as (but not limited to) Sediment and Erosion
Control, Non-Discharge and Water Supply Watershed regulations, NPDES Stormwater and Coastal
Stormwater. In addition, this approval will expire when the accompan)ing 404 Permit expires
unless othenyise specified in the General Certification.

Please be aware that if you change or modify your project, you must notify the Division
(D\VQ) 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. If total wetland fills for this project (now or in the
future) exceed one acre, compensatory mitigation may be required as described in l5A NCAC 2H .0506
(h). For this approval to be valid, you must follow the conditions listed in the attached certification and
the additional conditions listed below and on the following page:

1. No waste, spoil, solids, or fill of any kind shall occur in wetlands, waters, or riparian areas
beyond the footprint of the impacts depicted in the Pre-construction Notice Application. All
construction activities, including the design, installation, operation, and maintenance of
sediment and erosion control Best Management Practices, shall be performed so that no
violations of state water quality standards, statutes, or rules occur. The fill slopes (sediment)
shall remain in place by retaining wall, vegetated slopes or some such mechanism within
the fill footprint;

N. C. Division of Water Quality
Wilmington Regional Office

127 Cardinal Drive Extension
Wilmington, NC 28405

[phone]
[phone] Fax

Cuslomer Service
1 800 623-7748

~'PWA
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!v1r. and Mrs. Batts
Page Two
DWQ Project #040676
May 18, 2004

2. Deed notifications or similar mechanisms shall be placed on all retained jurisdictional wetlands,
waters and protective buffers in order to assure compliance for future wetland, water and buffer
impact. These mechanisms shall be put in place prior to impacting any wetlands, waters and/or
buffers approved for impact under this Certification Approval and Authorization Certificate. A
sample deed notification can be downloaded from the 40l/Wetlands Unit web site at
http://h2o.enr.state.nc.us/ncwetlandsl deednote.htm1;

3. Upon completion of all work approved within the 401 Water Quality Certification or applicable
Buffer Rules, and any subsequent modifications, the applicant is required to return the attached
certificate of completion to this office and a copy to the 40l/Wetlands Unit, North Carolina
Division "of Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650.

Please notify the Wilmington Regional Office at [phone]) if any problem arises during the
construction of the project that may affect water quality.

Please read the attached conditions. rfyou 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 conforming to Chapter l50B 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 fmal and binding unless you ask for a hearing.

This letter completes the review of the DWQ Permit # 040676. If you have any questions, please
telephone Rick Shiver or Joanne Steenhuis at 910-395-3900.

Sincerely,

\~L-\t- ./l~~~1

~\

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

Attachments: GC # 3402
Certificate of Completion

cc: Lillette Granade - Corps of Engineers Wilmington Field Office
Cyndi Karoly - 40l/Wetland Unit, Central Office
WiRO
Steve Padgett - LPO Surf City

MEMORANDUM

TO:

John Dorney
Non-Discharge Branch

Regional Contact:
we Supervisor:
Date:

J Steenhuis
R ShivAr

SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS

County

Mitiaation

Is Wetland Rating Sheet Attached? 0 YON Did you request more info? 0 YON
Have Project Changes/Conditions Been Discussed With Applicant? 0 YON

Is Mitigation required? 0 Y @ N

Recommendation: 0 Issue @ Issue/Cond 0 Deny

Provided by Region: Latitude (ddmmss)

Longitude (ddmmss)

Comments:

This Office has no objection to the project as proposed provided that all of the conditions of the
Water Quality General Certification # 3402 and the additional conditions written in the 401 Water
Quality Certification are met

~ 4~ I ~'8r QuaiityCe~~edolif\iiayT8~~(t.),@if'W{~~:1EI~

cc:

Regional Office
Central Office

Page Number 1

Triage Check List

Date: '11'>Oltl'i

To: 0 ARO Mike Parker'
D FRO Ken Aventte
D :MRO Alan Johnson
D RRO Steve Mitchell
. From: o ()dl VI '/ Svn d- i-t

D WaRO
~ WiRO
D WSRO

Tom Steffens
Noelle Lutheran
Daryl Lamb

Telephone: [phone] (

The file attached is being forwarded to y~ur for your evaluation.
Please call if you need assi~tance. .

. D Stream length impacted
o Streaill determination
D Wetland determination 8.r,1d distance to blue-line surface waters on USFW topo maps
D Minimization/avoidance issues
o Buffer Rules (Neuse, Tar-P~co, Catawba, Randleman)
o Pond fill .
o Mitigation Ratios
o Ditching
o Are the stream and or wetland mitigation sites available arid viable?
o . Check drawings for accuracy
o Is .the application consistent with pre-application meetings?
o . Cumulative impact concern .

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Comments: '(flt/I'vt". Je't/ Y1of"liC<tf;(}h .t". bi nJ'ved OM bel-t.. Lok If,J.. /1..

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Office Use Only:

D.. 4 0 ,." FormVersion May 2002
6 7"'.'.
, . \,/.
USACE Action ID No. DWQ No.

(If any particular item is not applicable to this project, please entef "Not Applicable" Of "N/A".)

I.

Processing

FILE COpy

1. Q}eck all of the approval(s) requested for this project:
@J Section 404 Permit D Riparian or Watershed Buffer Rules
D Section 10 Permit D Isolated Wetland Permit from DWQ
~01 Water Quality Certification

2. Nationwide, Regional or General Permit Number(s) Requested:---1'1 'wf I r

3. If this notificat,ion 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 .CNCWRP) 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

WETLANDS/401GROUP

1. Owner! Applica.n.t Informa1ion
Name: J-BYt
Mailing Address:

N

Telep~one NumberJ1J~~q-lqq8' Fax Numbe.r: qW" ~:;lq'- t..f1t3Lf
E-maIl Address:-d I~__ID fA 0'" CJ)t'\.fl.,

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: N-+-ft
Mailing Address: ._

Telephone Number:
E-mail Address:

Fax Number:

Page 5 of 12

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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 ofproject:

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

3. Property Identification Number (Tax PIN):

JCl J q q

4.

5. Site coordinates, if available (UTM or LatlLong):
(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):

4 ' Z'5 OLre-S

7. Nearest body of water (streamlriver/sound/ocean/lake):~COI.l.<ct]J \NCLtr(WO,y

8. River Basin:
(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.

Page 6 of 12

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10. Descrige t.h.. e overall p. roj.e. ct in detail, includi,ng the type of equi,ptpent to b. e ~ ittenJi Ocl ~

~e~~ oV' blil1aw -my
i I . ().,. .. ; r )U .. . I I 0 . . 0.,,(\ O1'fe/ vrE-i .

11. Explain the purpose of the proposed work:

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 US ACE 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.LP, project, along with
construction schedules.

. N nUL

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 )Vork from the current application.
. PDSSr~l~

VI. Proposed Impacts to Waters of the United States/W aters 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

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1. Provide a written description of the proposed impacts:

2. Individually list wetland impacts below:

Wetland Impact
Site Number
indicate on ma )

Type ofImpact*

Located within
IOO-year Floodplain**
yes/no)

Type ofWetland***

* 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.
** lOO-Year floodplains are identified through the Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM)t 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.t freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate ifwetIand is isolated (determination of isolation to be made by USACE only).

List the total acreage (estimated) of all existing wetlW on the property: 4- (leaS
Total area of wetland impact proposed: . i-n O-cte.;

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

Stream Impact Length of Average Width Perennial or
Site Number Type ofImpact* Impact Stream Name * * of Stream Intermittent?
(indicate on map) (linear feet) Before Impaet (please specify)
.. I
lJ\ 11[1-
- J '!. {' "

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 blf 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 1-800-358-9GIGt or online at
wWW.tlSgS.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., WWW.toDozone.com,
www.mapQueSLcom, etc.).

*

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

Nlft

Page 8 of 12

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4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water ofthe U.S.) below:

Open Water Impact Area of Name of Water body Type of Water body
Site Number Type ofImpact* Impact (lake, pond, estuary, sound,
(indicate on map) (acres) (if applicable) bay, ocean, etc.)
1\ I, /1,
I \J ; ,~

*

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
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., live toc 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
teclmiques to b. efOllOW~~~.ring cwstruc!" on. t ..0._ reduce i1-fP~ 0 . _, ~J
~llV\.lze Se O-r Q1' e, . I'\t~.
.'\ ,n W(l 5 ye~' of .

VIII. Mitigation

DWQ - In accordance with l5A 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 l.\i[;ar feet of total impacts to perennial
streams. , NI \

Page 9 of 12

,.

USACE - In accQrdance with the Final NQtice of Issuance and Modification of Nationwide
Permits, published in the Federal Register an 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 Qf proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability af appropriate and practicable
mitigation as praposed. Examples af mitigatian that may be appropriate and practicable include,
but are not limited to: reducing the size of the praject; 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 Qf the mitigation plan must be attached in order
for USACE or DWQ to cQnsider the application complete for prQcessing. . Any application
lacking a required mitigatiQn plan or NCWRP concurrenc.e shall be placed on hold as
incomplete. An applicant may also choose to. review the current guidelines far stream restoration
in DWQ's Draft Technical Guide far Stream Wark in North Carolina, available at
http:/&20.enr.state.nc.us/ncwetlands/strmgide.html.

1. Provide a brief descriptian of the proposed mitigation plan. The descriptiQn should provide
as much information as possible, including, but not limited to: . site lac.ation( attach directians
and/or map, if offsite), affected stream and river basin, type and amaunt (acreage/linear feet)
af mitigation propased (restoration, enhancement, creatian, or preservation), a plan view, .
preservatian mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditians and proposed method Qf canstruction. Please attach
a separate sheet if more space is needed.

r ,I ~
V I f

2. MitigatiQn 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 Qf mitigation priQr
to submittal Qf a PCN. For additional information regarding the application process far the
NCWRP, check the NCWRP website at http://h2o.enr.state.nc.us/wrp/index.htm. If use af
the NCWRP is proPQsed, please check the appropriate bQX Qn page three and provide the
following infarmation:

,.,"?

Amount of stream mitigation requested (linear feet):
AmQunt Qfbuffer mitigation requested (square feet): =Jst1 f:\:
Amount of Riparian wetland mitigation requested (acres): I
Amount of Non-riparian wetland mitigation requested (acres):
Amount of Coastal wetland mitigation requested (acres):

Page 10 of 12

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IX. Environmental Documentation (required by DWQ)

Does the project involve an exp~nditure of public (federal/state) funds or the use of public
(federal/state) land? .--I
Yes 0 No M

If yes, does the project require preparation of an ~nvironmental document pursuant to the.
requirements of the National or North Carolina Environmental Policy Act (NEP NSEP A)?
Note: If you are not sure whether a NEP NSEP A document is required, call the SEP A
coordinator at (919) 733-5~to review current thresholds for environmental documentation.
Yes 0 No ~

If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEP A or SEP ~al approval letter.
Yes 0 No M

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 provi"de
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 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), l5A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requ~ents), or other (please identify )?
Yes 0 No bLI 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 Multiplier Required
(square feet) Mitigation
1 3
2 1.5
Total

*

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.

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
downstream from the property.

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XII. Sewage Disposal (required by DWQ)

XIII. Violations (required by DWQ)

Is this site in vi,6lation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ISZI No D

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

XIV. Other Circumstances (Optional):

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

8uru tai/# Lf-;;IS{ -(jf

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

Page 12 of 12

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Office Use Only:

Form Version May 2002

USACE Action ID No.

(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)

DWQCk~ 0

I. Processing

1. 9Jeck a~l of the appr~val(s) requested for this project:
~ SectIOn 404 PermIt 0
o Section 10 Permit 0
~01 Water Quality Certification

2. Nationwide, Regional or General Permit Number(s) Requested:--..N w-r I r

Riparian or Watershed Buffer Rules
Isolated Wetland Permit from DWQ

3. If this notifica~ion 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: 0

II. Applicant Information

1. ~:~IAPPliC';;f1~Jion It~ rjV'L. ~t\s
Mailing Address: , , ~9 ,9. oa '3
-- (' 4~ ~<bygs

. WETLANDS / 401 GROUP

WA~:'~Y;::nON

Telephone Number:JlJ]:-?'01Cf-,QQ8' Fax Number: q 10- ~-;:tq- wt34-
E-mail Address:-d l~ rAn' ~ ~

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: N+-ft
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 l7-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.

1. Name ofproject:

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

3. Property Identification Number (Tax PIN):

)ctJ~q

4.

5. Site coordinates, if available (UTM or Lat/Long):
(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): LJ, 26 (liftS

7. Nearest body of water (streamJriver/sound/ocean/lake):~00~<ct]j \NfLterW {),-y

8. River Basin:
(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.l1c.us/admin/maps/.)

9.

Page 6 of 12

10. Descril.?e the o:;rerall pr.oj ect in detail, inc~udi.ng the type of equ,ip1fJ:ent to be Rsed: res; clenJ-i ~ l.JJ:

~ AA-~~~ oV blMl? ~
It .~ . ... \ )1I .... -. ..'10 0_ on (l('ft" w~-r

11. Explain the purpose of the proposed work:

IV. Prior Project History

If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ill Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.

. N nUL

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.
.. fo~<; r h1e-f I er

VI. Proposed Impacts to Waters of the United States/W aters 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:

2. Individually list wetland impacts below:

Wetland Impact
Site Number
indicate on ma )

Type ofImpact*

Located within
lOO-year Floodplain**
(yes/no)

Distance to
Nearest Stream
(linear feet)

Type ofWetland***

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fiJI,
excavation, flooding, ditchingldrainaget etc. For dams, separately list impacts due to both structure and flooding.
** 100-Year floodplains are identified through the Federal Emergency Management Agencyts (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.lwv.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsht forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by US ACE only).

List the total acreage (estimated) of all existing wetla~s on. the property: 4- arfRS
Total area of wetland impact proposed: il O-~

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

Stream Impact Length of Average Width PerelUlial or
Site Number Type of Impact* Impact Stream Name** of Stream Intermittent?
(indicate on map) (linear feet) Before Impact (please specify)
\
.. I
!l\ I /{J"
- -, ~ 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.), excavationt 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
downst~eam named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
WWW.llSgS.gOV. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mapQuesLcom, etc.).

*

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

NiA

Page 8 of 12

4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water ofthe U.S.) below:

Open Water Impact Area of Name of Water body Type of Water body
Site Number Type of Impact* Impact (lake, pond, estuary, sound,
(indicate on map) ( acres) (if applicable) bay, ocean, ete.)
1\ I. [1,
1\J '\

*

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

5. 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 ~n (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., live toe watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):

Size of watershed draining to pond:

VII. Impact Justification (Avoidance and Minimization)

Expected pond surface area:

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 befollow:~strucron to reduce i1rP~ 0, J ~.J
~lr\'Ilze Se Ot' <, Q'1 . . "e~
.'\ \" n W(l 5 ye~' et' , .

VIII. Mitigation

DWQ - In accordance with l5A 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 ,~iA.ar feet of total impacts to perennial
streams. NI \

Page 9 of 12

US ACE - 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:/&20.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.

t ,I ~
VII

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://h2o.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:

;:,;.

Amount of stream mitigation requested (linear feet):
Amount of buffer mitigation requested (square feet): ==N1 '"
Amount of Riparian wetland mitigation requested (acres): I
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? .-I
Yes D No M

If yes, does the project require preparation of an ~nvironmental document pursuant to the"
requirements of the National or North Carolina Environmental Policy Act (NEP A/SEP A)?
Note: If you are not sure whether a NEP A/SEP A document is required, call the SEP A
coordinator at (919) 733-5~to review current thresholds for environmental documentation.
Yes D No 5J

If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEP~al approval letter.
Yes D No M

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.

Will the project impact protected riparian buffers identified within l5A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requ~ents), or other (please identify )?
Yes D No bLI 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 Multiplier Required
(square feet) Mitigation
1 3
2 1.5
Total

*

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.

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
downstream from the property.

N/A

hJ~ rtf Si~t~ ~~

XII. Sewage Disposal (required by DWQ)

XIII. Violations (required by DWQ)

Is this site in vi,6lation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ISZI No D

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

XIV. Other Circumstances (Optional):

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

twv J3ai1# Lf-d~-ijf

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

Page 12 of 12

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419 JOttNSON 8LVO. JACKSONVILLE. He.
PHONE: [phone] DAlE: NOV. 18. 1985

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PENDER CO., N.C.

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