20031350 Ver 1_COMPLETE FILE_20031031

Certificate of Completion
DWQ Project No.: D 3 - /"0 47'01
County: y
Applicant:
Project Name:
Date of Issuance of 401 Water Quality Certification: Z,,, 6 o*04e3
Upon completion of all work approved within the 401 Water Quality Certification and Buffer Rules, and any
subsequent modifications, the applicant is required to return this certificate to the 401/Wetlands Unit, North
Carolina Division of Water Quality, 1621 Mail Service Center, Raleigh, NC, 27699-1621. This form may be
returned to DWQ by the applicant, the applicant's authorized agent, or the project engineer. It is not
necessary to send certificates from all of these.
Applicant's Certification
I, jLlkdf' "(l , hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
-00 -
Date: c 04/
Signature: (
Agent's Certification
hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance and intent of the 401 Water Quality Certification and Buffer Rules, the
approved plans and specifications, and other supporting materials.
WETLANDS 1401 GROUP
Signature: Date: _
JUN 1 S 2004
If this project was designed by a Certified Professional ?-VAi"ER UUAL11Y SECTION
I, , as a duly registered Professional (i.e.,
Engineer, Landscape Architect, Surveyor, etc.) in the State of North Carolina, having been authorized to
observe (periodically, weekly, full time) the construction of the project, for the Permittee hereby state that,
to the best of my abilities, due care and diligence was used in the observation of the construction such that
the construction was observed to be built within substantial compliance and intent of the 401 Water Quality
Certification and Buffer Rules, the approved plans and specifications, and other supporting materials.
Signature: Registration No.: Date:
F VWATF Michael F. Easley, Governor
?o
9p William G. Ross Jr., Secretary
Q North Carolina Department of Environment and Natural Resources
`
r Alan W. Klimek, P.E., Director
O Y Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
November 6, 2003
Buncombe County
DWQ Project #: 03-1350
APPROVAL of 401 Water Quality Certification and AUTHORIZATION CERTIFICATE
Country Creek Homeowners Association
Attn: Tom Webb
Post Office Box 33
Weaverville, NC 28787
Subject Property: Village of Country Creek, Wagner Branch (Creek)
Dear Mr. Webb:
You have our approval, in accordance with the attached conditions, to impact 60 feet of stream for the
purpose of bank stabilization as you described in your application dated May 31, 2003 and received on
October 31, 2003. After reviewing your application, we have decided that this fill is covered by
General Water Quality Certification Number 3399, which may be viewed on our website at
http//h2o.enr.state.nc.us/ncwetlands. This certification allows you to use Nationwide Permit Number
13 when the Corps of Engineers issues it. In addition, you should get any other federal, state or local
permits before you go ahead with your project including (but not limited to) Sediment and Erosion
Control, Coastal Stormwater, Non-Discharge and Water Supply Watershed regulations. This approval
will expire when the accompanying 404 or CAMA permit expires unless otherwise specified in the
General Certification.
This approval is only valid for the purpose and design that you described in your application except as
modified below. If you change your project, you must notify us and you may be required to send us a
new application. If the property is sold, the new owner must be given a copy of this Certification and
approval letter and is thereby responsible for complying with all conditions. If total wetland fills for
this project (now or in the future) exceed one acre, compensatory mitigation may be required as
described in 15A NCAC 2H.0506 (h) (6) and (7). This approval shall expire when the corresponding
Nationwide Permit expires or as otherwise provided in the General Certification. For this approval to
be valid, you must follow the conditions listed in the attached certification and any additional
conditions listed below.
Conditions of Certification:
Upon completion of 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 the 401/Wetlands Unit, North Carolina Division of
Water Quality, 1650 Mail Service Center, Raleigh, NC, 27699-1650.

N. C. Division of Water Quality, 401 Wetlands Certification Unit,
1650 Mail Service Center, Raleigh, NC 27699-1650 (Mailing Address)
2321 Crabtree Blvd., Raleigh, NC 27604-2260 (Location)
[phone] (phone), 919-733-6893 (fax), (http:/th2o.enr.state.nc.us/ncwetlands
Page 2
Mr. Webb, Country Creek Homeowners Association
November 6, 2003
Violations of any condition herein set forth may result in revocation of this Certification and may result
in criminal and/or civil penalties. This Certification shall become null and void unless the above
conditions are made conditions of the Federal 404 and/or coastal Area Management Act Permit.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing.
You must act within 60 days of the date that you receive this letter. To ask for a hearing, send a written
petition, which conforms to Chapter 150B of the North Carolina General Statutes to the Office of
Administrative Hearings, P.O. Box 27447, Raleigh, N.C. 27611-7447. This certification and its
conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water
Act. If you have any questions, please telephone John Dorney at 919-733-1786 or Kevin Barnett at our
Asheville Regional Office at 828-251-6208.
Sincerely,
JRD/bs
Attachments
cc: Corps of Engineers Asheville Field Office
Asheville DWQ Regional Office
File copy
Central Files
.E., Dire for
WETLANDS 1401 GROUP
CCT 3 1 2003
Office Use Only:
WATER QUALITY SECTION Form Version May 2002
USACE Action ID No. DWQ No. Q .
(If any particular item is not applicable to this project, please enter "Not Applicable" or /A".)
1.
H.
Processing
1. [halol of the approval(s) requested for this project:
Sectin 404 Permit
? Section 10 Permit ? Riparian or Watershed Buffer Rules
? Isolated Wetland Permit from DWQ
["401 Water Quality Certification
N 13
2. Nationwide, Regional or General Permit Number(s) Requested: 4
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ?
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: [?
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ?
Applicant Information
1. Owner/Applicant Information
Name: - c7 t
Mailing Address. Cr ,zv, r G e-eIr - ,,c /I W ! =T
Telephone Number: [? ?` !,/ 6 5T • / © o a Fax Number:
E-mail Address:_ . ai e b h c .. CC, 07
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:
ietepnone 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: Vi'//"? iI C C. 4 C-14" Al L P>/ Cr C C /1_/, L 14 c1h C r {-71" 4 c 4
2. T.I.P. Project Number or State Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN): 1 7,-3 a I 'V 3 1,T) 7 8
4. Location
County: Nearest Town: ?? e ?? v t r v i l ?e
Subdivision name (include phase/lot number): n dry Cp e-e
Directions to site (include road numbers, landmarks, etc.):ct_j-cc f<<-i7 c7`'
New V E-ck' Pei'. ?'//cre el Jr,
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): r 7
7. Nearest body of water (stream/river/sound/ocean/lake): ?c 22 h r- fjjna'i' c h
8.
River Basin: r ? m f / 1
(Note - this must be one of North Carolina's seventeen designated major river basins.
River Basin map is available at http://h2o.enr.state.ne.us/admin/maps/.)
The
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: (l r1 C: c n C A r e ct ;
Page 6 of 12
10. Describe the overall project in detail, including the type of equipment to be used: J lee-
-Jr l ?! ?i c < ? c?h cu , n S' -_-
41 1,? L, it// <j,=- . . c-----
%.4tvC-2
-11A 1,-f I& Lt/-? wh ?--- I ?<j ?- re, ??-i
11. Explain the purpose of the proposed
e ho 510tj o -f' &jIlcrenema
Cle / v c e
v
CAftdc ?, i' Goo/i-c'i^ j4,
IV. Prior Project History
vork: 4> 5 r ?? (? r t? f /? ?y ??? r,??. ?.?
-IJT, reev-1 6 z f it s'r,-?? v 7?
?i?i. UCcdS7vnA/ (.cJv• I??r CJ'c?? exc?«-/?5??.c'Y`?? Z`i.`tCS 29 yr???- Cc.?ricrl`1,.,.
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
conssruction schedules.
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.
AIO
VI. Proposed Impacts to Water, 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:A?c- 0 C'
2. Individually list wetland impacts below:
Wetland Impact
Site Number
indicate on ma
Type of Impact* Area of
Impact
acres Located within Distance to
100-year Floodplain** Nearest Stream Type of Wetland***
(es/no linear feet)

* List each impact se
excavation, floodin parately and identify temporary impacts. Impacts include, but are not limited to: mechanized clearing, grading, fill,
g, ditching/drainage, etc. For dams, separately list impacts due to both stmefivre. And nnA, ' ,,.
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 hap://www.fema.tzov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USACE only).
List the total acreage (estimated) of all existing wetlands on the property: c h ?-
Total area of wetland impact proposed:
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Site Number
indicate on ma
3749e P 1-# 14 a
dK?l?t•,
Type of Impact*

ft.a a
LrAw,x Length of
Impact
linear feet

y(?'
Stream Name**

GJ%1 nw- C.re.cfC Average Width
of Stream
Before Im act

-r Perennial or
Intermittent?
leasespecify)

Pei,' es 11 0
s..fi l

LAaL WLaIA IMIJa%A DFJA=aLcjy auu tut:ututy temporary impacts. impacts tnciuoe, 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. ov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.topozone.com,
www.mgpguest.com. etc.).
.f
Cumulative impacts (linear distance in feet) to all streams on site: ?U
Page 8 of 12
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact Area of T e of Waterbod
Site Number Type of Impact* Impact Name of Waterbody Y PC
indicate on (if applicable) (lake, pond, estuary, sound,
acres bay, ocean, etc.
List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
flooding, drainage, bulkheads, etc. gmg,
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): ? uplands ? stream ? wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N /A
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): N/A
aize or watershed dratntng to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
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://h2o.enr.state.nc.us/ncwetlands/stnngide.htm].
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.
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.ear.state.nc.us/M/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):
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 ? No
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether a NEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ? No ?
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ? No ?
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 15A NCAC 213 .0233
(Meuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify_ )?
Yes ? No K If you answered "yes", provide the following information:
Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Zone* Impact
(square feet Multiplier Required
Mitigation
1 3
2 1.5
Total
T f-one i extenas out 3u ieet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
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 15A NCAC 213.0242 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
downgream from the property.
A
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
ait??er generated from the proposed project, or available capacity of the subject facility.
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No ?
Is this an after-the-fact permit application?
Yes ? No 9
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).
N%A
Applicant/Agent's Signature Da c
(Agent's signature is valid only if an authorization letter from the applicant is provided.)
Page 12 of 12
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Notes:
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DEPARTMENT OF THE ARMY
WILMINGTON DISTRICT, CORPS OF ENGINEERS
151 PATTON AVENUE
ROOM 208
ASHEVILLE, NORTH CAROLINA 28801-5006
REPLY TO
ATTENTION OF:
Permit Number: 200330914
Permit Type: NW13
Name of County: Buncombe
Name of Permittee: Country Creek Homeowners Association
Date of Issuance: July 22, 2003
Upon completion of the activity authorized by this permit and any mitigation
required by the permit, sign this certification and return it to the following
address:
U.S. Army Corps of Engineers
Attention: CESAW-RG-A
151 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
Please note that your permitted activity is subject to a compliance inspection
by an U.S. Army Corps of Engineers representative. If you fail to comply with
this permit you are subject to permit suspension, modification, or revocation.
I hereby certify that the work authorized by the above referenced permit has
been completed in accordance with the terms and conditions of the said permit,
and required mitigation was completed in accordance with the permit
conditions.
Signature of Permittee
Date
U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. 00130914 County Run .mnhe Quad WFAVFRVILLF.
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Property owner: Country Creek Homeowners Association, Attn: Tom Webb
Address: PO Box 33
Weaverville, NC 28787
Telephone No: [phone]
Zone: 44 UTM or LAT/LONG: North: 3950276 East: 644197
Size and Location of project (water body, road name/number, town, etc.) along Wagner Branch at the intersection
of New Stock Road and Hillcreek Drive near Weaverville, Buncombe County, North Carolina
Description of Activity: to stabilize eroding banks along approximately 40-feet of Wagner Branch and 20-feet of an
unnamed tributary at the entrance to the Village of Country Creek subdivision off of New Stock Road in
Weaverville, North Carolina.
Applicable Law: _X` Section 404 (Clean Water Act, 33 U.S.C. 1344)
(check all that apply) Section 10 (River and Harbors Act of 1899)
Authorization: NW 13 Nationwide Permit Number
Your work is authorized by this Regional General (RGP) or Nationwide Permit (NWP) provided it is accomplished
in strict accordance with the attached conditions and your submitted plans. If your activity is subject to Section 404
(if Section 404 block above is checked), before beginning work you must also receive a Section 401 water quality
certification from the N.C. Division of Environmental Management, telephone [phone].
Please read and carefully comply with the attached conditions of the RGP or NWP. Any violation of the conditions
of the RGP or the NWP referenced above may subject the permittee to a stop work order, a restoration order, and/or
appropriate legal action.
This Department of the Army RGP or NWP verification does not relieve the permittee of the responsibility to
obtain any other required Federal, State, or local approvals/permits. The permittee may need to contact appropriate
State and local agencies before beginning work.
If there are any questions regarding this authorization or any of the conditions of the General Permit or Nationwide
Permit, please contact the Corps Regulatory Official specified below.
Date: July 22, 003
Corps Regulatory Official: David K. Baker Telephone No.: [phone] x 6
Expiration Date of Verification: July 22, 2005
SURVEY PLATS, FIELD SKETCH, WETLAND DELINEATION FORMS, PROJECT PLANS, ETC., MUST BE
ATTACHED TO THE FILE COPY OF THIS FORM, IF REQUIRED OR AVAILABLE.
CESAW Form 591
Revised July 1995