20000322 Ver 1_COMPLETE FILE_20000317

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
1 ?•
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
March 28, 2000
Bertie County
DWQ Project # 000322
APPROVAL of 401 Water Quality Certification
County Water District II, Bertie County
PO Box 530
Windsor, NC 27983-0530
Dear Sirs:
You have our approval, in accordance with the attached conditions, to excavate up to I acre of wetlands in
Bertie County to construct a water line extension as you described in your application received by the Division of
Water Quality on March 17, 2000. After reviewing your application, we have determined that this action is covered
by General Water Quality Certification Number 3101. This Certification allows you to use Nationwide Permit
Number 12 when issued by the U.S. Army Corps of Engineers. 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,
Non-Discharge and Water Supply Watershed regulations. Also this approval will expire when the accompanying
404 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.
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.
S' rely,
. Stev s
Attachment
cc: Corps of Engineers Washington Field Office
Washington DWQ Regional Office
Albert V. Lewis, McDavid Associates, Inc, PO Drawer 49, Farmville, NC, 27828-0049
File Copy
Central Files 000322
Division of Water Duality • Non-Discharge Branch
1621 Mail Service Center, Raleigh, NC 27699-1621 Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer • 50% recycled/10% post consumer paper
http://h2o.enr.state.nc.us/wetlandc.htmi

1??
000322
DWQ ID: J,'+`"?, m:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #)
PRE-CONSTRUCTION NOTIFICATION APPLICATIOl rn
m
FOR NATIONWIDE PERMITS 'THAT REQUIRE: r MAR i -1: 20M m
1) NOTIFICATION TO THE CORPS OF ENGINEERS ---1
;,P ti
..ANDS GRUUN
2) APPLICATION FOR SECTION 401 CERTIFCATION 1(,)i jai iTr SECTION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN
M COPIES MUST BE SENT TO THE NC DIVISION OF WATER
QUALITY, ATTN: JOHN DORNEY, 4401 REEDY CREEK ROAD,
RALEIGH, NC 27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: County Water District II, Bertie Count
2. MAILING ADDRESS: P.O. Box 530
SUBDIVISION NAME
may; Windsor yA; NC ZIP CODE•27983-0530
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): County Water District II
3. TELEPHONE NUMBER: (HOME) (WORK)
[phone]
4.• IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUivIBER: ,
Agent: Albert V. Lewis, Jr., PE, McDavid Associates, Inc
P.O. Drawer 49, Farmville, NC 27828-0049
[phone]
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Bertie - NEAREST TOWN:
Windsor
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.)
(See Index Sheet)
6. IMPACTED OR NEAREST STREAMIRIVER: r Chowan
RIVER BASIN. Chowan
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURSE WATERS (ORW), WATER _
SUPPLY (WS-I OR WS-IT)? YES ( ) NO (X ) IF YES, EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIROMENTAL CONCERN (AEC)? YES () NO ( X )
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
The nroiect is located in the DOT R/W
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ( ) NO (X ) IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT' AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES ( ) NO ( X) IF YES, DESCRIBE ANTICIPATED WORK:
N/A
9a. ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: N/A
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
N/A
10L NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY.
FILLING: _ 0.00
EXCAVATION: Less than 1.0 acre
FLOODING: • • 0.00. OTHER: 0.00
DRAINAGE : 0.00 TOTAL ACRES TO BE IMPACTED: Less . than 1.0 acre
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
r
LENGTH BEFORE: N/A FT AFTER N/A FT
WIDTH BEFORE (based on normal high water contours): See. 8 }" X 11" Plans FT
AVERAGE DEPTH BEFORESee 8j" X 11" Plante AFTER: Same as before FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PI13E IN CHANNEL: X
CHANNEL EXCAVATION. COONSTRUCTION OF A DAM/FLOODING:
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? N/A WHAT IS THE EXPECTED
POND SURFACE AREA? N/A
12. DISCTIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 81/2 BY 11 DRAWINGS ONLY)
Water line will be placed 4' below the bottom of channel with the use of
•a horizontal directional drilling machine or excavator.
13. PURPOSE OF PROPOSED WORK: Water line extensions are to provide
potable water supply to rural residents.
14. STATE REASONS WHY 17 IS BELIEVED-THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY NIEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
Water line extensions to provide potable water supply to rural residents.
Erosion control measures will be installed (Rlip Rap, gravel filters
and check dams, etc.) to minimum sediments from entering streams
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERIVE REGARDING THE PRESENCE OF ANY FEDERALY
LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR
CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED: Not required.
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED -
Not required..
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES ( X ) NO ( ) (IF NO, GO TO 16) _
a. IF YES, DOES THE PROJECT REQUIRE PREPERA77ON OF AN ENVIRONMENTAL
DOCUMENT PURUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES ( ) NO ( X )
b. IF YES, HAS THE DOCUMENT BEEN REFIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ( ) NO ( X )
IF ANSWER 17b-IS YES, THEN SUBMTr APPROPRIATE DOCUMENTATIONFROM THE STATE
CLEARINGHOUSE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH'CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO
WETLANDS:
a. * WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES, AND
PONDS ON-THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29,
AND 38). • ALL STREAM (INTERMrrIENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET
OF 1 INCH EQUALS 100 FEET OF THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED
BY PRODUCT.
C. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
a. WHAT IS LAND USE OF SURROUNDING PROPOERTY?
DOT Right-of-Ways, Woodsland and Agriculture
E IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
N/A
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
-- NOTE: WTLANDS OR WATEA.S OF THE US MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERIv1IT,'
2) ErTHER THE ISSUANCE OR WAIVER OF A 401 bMSION OF WATER QUALITY
CERTIFICATION, AND
3) (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACITVTTY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL _
MANAGEMENT PROGRAM,
OWNER'S/AGENT'S sFwAtuRE DATE
(AGENT'S SIGNATURE VALID ONLY '
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).

McDAVIDAsSOCUTES, INC.
INC. Engineers • Planners • Land Surveyors
CORPORATE OFFICE COLDSBORO OFFICE
[phone] • Fax [phone] [phone] • Fax [phone]
120 N. Main Street • P.O. Drawer 49 109 E. Walnut Street • P.O. Box 1776
Farmville, NC 27828 Goldsboro, NC 27533
NC Department of Environment
and Natural Resources
Division of Water Quality
P.O. Box 29535
Raleigh, NC 27626
ATTN: John Dorney
PAYMENT
RECEIVED
Dear Mr. Dorney:
March 7, 2000
0000 22
i W/
MAR I• 7 20(
WETLAND GR01,
,ITER QUALITY SECW 1
SUBJECT: Nationwide Permit Request
Contract No. 20 - Water Distribution and
Booster Pump Station
1999 Clean Water Project for Water System
Improvements
County Water District II
Bertie County
In reference to the subject project, please find enclosed the following:
One (1) set of the following plan excerpts:
A. Index map and creek crossing plan drawings from
Sheets No. 6, 32, 39, 45, 48, 49 and 53 for County
Water District II, Contract No. 20 - Water
Distribution and Booster Pump Station, 1999 Clean
Water Project For Water System Improvements,
Bertie County (MAI B-1301 Red).
B. Standard Drawing (SD 070001) which shows typical
creek crossing, plan and section views.
2. Seven (7) copies of signed permit forms.
3. Copy of letter to US Army Corps of Engineers.
D405BCGOO 1 10:49am
BERC-I1-CN20-C W P-NATION W D-DEM-401-PRMT. LTR:3 000307
This project consists 48± miles of water line serving the residents of rural Bertie County.
All water lines will be constructed within DOT right-of-way, private road right-of-way, or acquired
easements and will be installed on the road shoulder as much as possible. Water lines constructed
across creeks shall have minimum bury depth of 4 feet. We are not aware of any wetlands that will
be affected by this project.
Please find enclosed Check No. 12827 in the amount of $200.00 for Nationwide DEM 401
Permit. Request DEM 401 Permit or permit waiver at your earliest convenience.
Please advise if I may further assist.
Sincerely,
McD VID ASSOCIATES, INC.
Charles A. J ner, Jr., P.E.
Farmville Office
CAJ/BCG:Icm
Enclosures
cc: Jack Williford
Rick Spivey
i f 7 n
' '' 1,R t
i _ UALITY SECTION
D405BCG00
BERC-II-CN20-C W P-NATION W D-DEM-401-PRMT. LTR; 3
Ina .,
INC
2 10:49am
M0307
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60'
. 2000
l WFa'.. ANI;S GROUP
,.,nTf.(? [)ilM ITY SECTION
R/W
20' -?
- - - - - CASING PIPE
BRIDGE OR C EVERTS
t 7

SILT FENCE
CLASS I RIP-RAP
CARRIER PIPE
CASING
MINIMUM ACCEPTABLE
RIP-RAP DEPTH TO
BE 11/2 TIMES ID MAX.
LARGEST STONE SIZE
FILTER FABRIC TO BE PLACED
UNDER ALL RIP-RAP.
STREAM
4' MINIMUM
SECTION
The CONTRACTOR at a minimum shall install and maintain
the following sedimentation and erosion control measure at all
ditch, stream, and creek crossings :
1. All land disturbed areas on the banks and approaches
to ditch, stream or creek crossings shall be graded not
to exceed 2:1 ratio if possible. Surface water " be
diverted from land disturbed areas if possible.
2. In areas of concentrated runoff preventative measures
to include but not limited to silt fences, rip rap, slope
drainage, or a combination thereof shall be installed the
same day crossings are constructed. Silt fences Shall
be installed on the low side or at the toe of all land
disturbed areas to prevent sedimentation from entering
the waterway.
3. All land disturbed areas on the banks and approaches
to ditch, stream or creek crossings shall be fertilized,
limed, seeded and mulched within twenty-four' (24)
hours.
R --
PLAN VIEW
SILT FENCE
CLASS I RIP-RAP
i

000322
DWQ ID:

CORPS ACTION ID:
?t tai l?1?71 i•
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #)
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS'THAT REQUIRE:
r
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFCATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL [?? fiNT
?' GROUP
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE oUA?.1?I
FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN
(7) COPIES MUST BE SENT TO THE NC DIVISION OF WATER
QUALITY, ATTN: JOHN DORNEY, 4401 REEDY CREEK ROAD,
RALEIGH, NC 27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: County Water District II, Bertie County ,
2. MAILING ADDRESS: P .0 - Box 530
SUBDIVISION NAME
CITY: Windsor STATE: NC 21P CODE:27983-0530
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILINGADDRESSABOVE)• County Water District II
3. TELEPHONE NUMBER (HOME)
(WORK) [phone]
4.' IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER ,
Agent: Albert V. Lewis, Jr., PE, McDavid Associates Inc.
P.O. Drawer 49, Farmville, NC 27828-0049
[phone]
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: Bertie . NEAREST TOWN' Windsor
rTi 'v
F__T I
rT-1
rT',
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.)
(See Index Sheet)
6. IMPACTED OR NEAREST STREAM/RIVER: r Chowan
RIVER BASIN: Chowan
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING AESOURSE WATERS (ORW), WATER _
SUPPLY (WS-I OR WS-In? YES ( ) NO (X ) IF YES, EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF MOMOMENTAL CONCERN (AEC)? YES ( ) NO ( X )
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
The nroiect is located in the DOT R/W
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ( ) NO (X ) IF YES, PROVIDE ACTION I.D. NUNSER OF PREVIOUS
PERMIT 'AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES( ) NO (X) IF YES, DESCRIBE ANTICIPATED WORK:
N/A
9a. ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: N/A
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
N/A
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY.
FILLING. 0.00 EXCAVATION: Less than 1.0 acre
FLOODING: 0.00. OTHER : 0.00
DRAINAGE : 0.00 TOTAL ACRES TO BE IMPACTED: Less-than 1.0 acre
10b. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
r
LENGTH BEFORE: N/A FT AFTER: N/A
WIDTH BEFORE (based on normal high water contours): See. 8 }" X 11" Plans FT
AVERAGE DEPTH BEFORESee 8j" X 11" Planwr AFTER:Same as before FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL: X
CHANNEL EXCAVATION: COONSTRUCTION OF A DAM/FLOODING:
OTHER:
1 I. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? N/A
WHAT IS THE EXPECTED
POND SURFACE AREA? N/A
12. DISCTIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 81/2 BY 11 DRAWINGS ONLY)
Water line will be placed 4' below the bottom of channel with the use of
•a horizontal directional drilling machine or excavator.
13. PURPOSE OF PROPOSED WORK: Water line extensions are to provide
potable water supply to rural residents.
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO NIINIl = WETLAND IMPACTS)
Water line extensions to provide potable water supply to rural residents.
Erosion control measures will be installed (Rlip Rap, gravel filters
and check dams, etc.) to minimum sediments from entering streams
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERIVE REGARDING THE PRESENCE OF ANY FEDERALY
LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR
CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED
PROJECT. DATE CONTACTED: Not reauired.
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAYBE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED •'
Not required.,
17. DOES THE PROJECT vuivm E AN LXPENDTTURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES ( X ) NO ( ) (IF NO, GO TO 16)
a. IF YES, DOES THE PROJECT REQUIRE PREPERATION OF AN ENVIRONMENTAL
DOCUMENT PURUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES ( ) , NO ( X )
b. IF YES, HAS THE DOCUMENT BEEN REFIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ( ) NO ( X )
IF ANSWER 17b-IS YES, THEN SUBMIT APPROPRIATE DOCUUENTATIONFROM THE STATE
CLEARINGHOUSE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH'CAROLINA 27603-8003, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO
WETLANDS:
a. ' WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES, AND
PONDS ON-THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29,
AND 38).. ALL STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET
OF 1 INCH EQUALS 100 FEET OF THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED
BY PRODUCT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPOERTY?
DOT Right-of-Ways, Woodsland and Agriculture
E IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
N/A
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE,
-- NOTE: WTLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,`
2) ETTHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF WATER QUALITY
CERTIFICATION, AND
3) (Ili THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROL NA DMSION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL _
MANAGEMENT PROGRAM,
C- .3- 8
Owltk'S/AGENT'S S ATURE DATE
(AGENT'S SIGNATURE VALID ONLY '
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).