19970351 Ver 1_COMPLETE FILE_19970421

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CIVIL-ENGINEERING DESIGN AND CONSULTING
RECE1V?p
? ,91991E
June 6, 1997 ???c"?'wrALSCiF^iSs
DEHNR - Division of Water Quality
4401 Reedy Creek Road
Raleigh, NC 27607
Dear Mr. Dorney:
This letter is in response to our conversation on June 4, 1997, during your site visitto
Christ The King Lutheran Church.
After careful consideration, it has been`decided that a small wet ponds v4 be constructed
at the opening of the proposed 42 inch-pipe on the. Christ, 'The, King site. 'Moe.issue the
State 401 certification upon receipt of this letter and we will forward to your office a site
plan showing the location of the proposed wet pond. J In addition to issuing-the State 401
Certification,, please notify Steve Lund with the'U. S. Army Corps of Engineers -that a
State 401 Certification has been issued so a Nation Wide Permit #26 can be issued by the
Corps.
Thank you for your help in resolving.this issue and if I can be of any further assistance,
feel free to call me at [phone].
Sincerely,
1
Daniel K. Ziehn' EIT
Project Manager
5605 77 CENTER DRIVE, SUITE 250, CHARLOTTE, N.C. 28217 - OFFICE: 704-527-3440 FAX: [phone]
ISAACS o
CIVIL ENGINEERING DESIGN AND CONSULTING
5605 77 CENTER DRIVE, SUITE 250
CHARLOTTE, N.C. 28217
OFFICE: 704-527-3440 FAX: [phone]
TO ?vcAnEHK)2
'7)V ISIOtJ 01• \NA-TER n%)PALITy
LETTER OF TRANSMITTAL
DATE
0?/ os? JOB NO.
9 oz
ATTENTION
MR. ?o
N RNEY
RE: 04QI_-57 HE t(IMCn OTHE.RAIJ
-1v s2c?H

RECENED
1997,
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WE ARE SENDING YOU X Attached
? Shop drawings ? Prints
? Copy of letter ? Disk
? Under separate cover via
? Plans
?
ENVIRONMENTAL SCIENCES
3n w(1H
the following items:
? Applications ? Specifications
COPIES DATE NO. DESCRIPTION
A i? c? SH W I l? '? r,,Tgk)C-Tt)RP

THESE ARE TRANSMITTED as checked below:
? For approval ? Approved and submitted
? For your use
A As requested
? For review and comment
? Approved as noted
? Returned for corrections
? Resubmit copies for approval
? Submit copies for distribution
? Return corrected prints
REMARKS 7i rMrs, Wp he v2. MY"SIP,c, c»..r plcns -Rnn hrisa _ha king LWV--Proan h m- h
os =er c-,ur -tietAA yrle ;Yic., ar,6 L?rNur IPA-1.er c l 6erk -7-w-ve- IcI -11 ho..v2
. .per-+;c? c_ c,r c-.ornw,P.,n-tS rC.?orc).ir,c.? -t?1eSfZ c?lr??, '??•? ?rae -b c;c111 y1
ie?wn ?' -Tln? 1 sc,.u.cs G.rojNp PC. r,4 «nLA ?j - %LIti0 _1"V1Ly-1k?ptx -:6r
wrsv.Y^__ CISSiS'?GanG?, or 1'11is? ?rc?'?,c? .
COPY TO SIGNED el
State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
AT4
I D FE r***,.J F=?,
June 24, 1997
Mecklenburg County
DWQ Project # 970351
APPROVAL of 401 Water Quality Certification and ADDITIONAL CONDITIONS
Christ the King Lutheran Church
P.O. Box 410521
Charlotte, NC 28241
Dear Sirs:
You have our approval, in accordance with the attached conditions and those listed below, to place fill material
in 417 feet of waters for the purpose of constructing an athletic field at Christ the King Lutheran Church on 13501
York Road in Charlotte, as you described in your application dated 6 June 1997. After reviewing your application,
we have decided that this fill is covered by General Water Quality Certification Number 3108. This certification
allows you to use Nationwide Permit Number 26 when it is issued by the 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, 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
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). For this approval to be valid, you must follow the conditions
listed in the attached certification and any additional conditions listed below. An additional condition is that a final,
written plan for the wet pond (approximately four feet deep at the dam) must be submitted to DWQ by 15 July 1997
for written approval.
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.
Sincerely,
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Asheville Field Office
Mooresville DWQ Regional Office
Mr. John Domey
Central Files
Dan Ziehm; The Isaacs Group
eston d, Jr. E.
970351.1tr
Division of.Water;Quality • Environmental Sciences Branch
Environmental Sciences; Branch, 4401 -Reedy Creek Rd., Raleigh, NC 27607 Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer • 50% recycled/100% post consumer paper
State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
Ja mes & Hunt, Jr., G ove mor
Jonathan & Howes, Secretary
A. Preston Howard, Jr., P.E., Director
LTI.EMAI
?4
?EHNR
Division of Water Quality
Environmental Sciences Branch
4401 Reedy Creek Road
Raleigh, N.C. 27607
FAX:[phone]
FAX TO:
FAX NUMBER:
FROM: I
DATE: o PAGES INCLUDING THIS SHEET:
COMMENTS: CaU
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,
FROM THE ISAACS GROUP 704 527 8335
F ISAACS
CIVIL ENGINEERING DESIGN . AND CONSULTING
DATE: =tea. OF PAGES:- Z
INCLUDING COVER)
TO: D6_cie
FROM: tbm
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SURJECT:.Chrisi `TL,Q King {. ahercw,

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5605 77 CENTER DRIVE, SUITE '250, CHARLOTTE, N.C. 28217 - OFFICE: 704-527-3440 - FAX: [phone]
6-05-1997 3:18PM
State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
Christ the King Lutheran Church
P.O. Box 410521
Charlotte, NC 28241
Dear Sirs:
A LT.N?FA
1410 0
C) FE F1
May 7, 1997
DWQ #970351
Mecklenburg County
On 21 April 1997, you applied to the N.C. Division of Water Quality (DWQ) for a 401 Water
Quality Certification to impact 0.30 acres of wetlands (including 417 feet of streams) for your project to
construct parking and athletic fields located at 13501 York Road in Charlotte, Mecklenburg County. Your
project has been forwarded to Mr. Mike Parker [phone] of DWQ Mooresville Regional Office for
review. This review will likely require an on-site inspection prior to the approval, modification or denial of
your project site. If you have sent additional information to the U.S. Army Corps of Engineers concerning
this project, please be certain that our staff have copies of this material so we can use it in our process in
making a decision. This letter replaces one sent to you on 25 April 1997 which had a typographical error.
According to our preliminary, in-house review since you propose to disturb greater than 150 feet of
streams, it is likely that compensatory mitigation. will be required by DWQ for this project as described in
15A NCAC 2H .0506 (h). Our Regional Office staff can make this decision during their site visit. If
adequate mitigation is required but not provided, this project will likely have to be denied. Also if a
mitigation plan is required, we will place this project on hold until its receipt in our Central Office.
Enclosed are materials describing compensatory mitigation requirements for this program. Please call me at
919-733-1786 to discuss these matters if necessary. Until a mitigation plan is provided, this application is
considered to be incomplete and our processing time will not start.
We recommend that you not impact any wetlands or waters on your project site until a 401 Water
Quality Certification has been issued from Raleigh, The issuance of a Corps of Engineers 404 Permit does
not mean that your project can proceed. According to the Clean Water Act, the 404 Permit is not valid
until a 401 Certification is also issued. If DWQ staff observe impacts which are not allowable, you will be
required to remove the fill and restore the site to its original condition. I can be reached at 919-733-1786 if
you have any questions about the 401 Certification process.
Sincerely,
late R. Dorney
J
r Quality Certifi ati n Program
cc: Mooresville DWQ Regional Office
Central Files
Dan Ziehm; The Isaacs Group
970351.rovst
Division of Water Quality • Environmental Sciences Branch
Environmental Sciences Branch, 4401 Reedy Creek Rd., Raleigh, NC 27607 Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer • 50% recycled/10% post consumer paper

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr.. Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
IVCW;W
A4
?EHNR
April 25, 1997
DWQ #970351
Mecklenburg County
Christ the King Lutheran Church
P.O..Box 410521
Charlotte, NC 28241
Dear Sirs:
On 21 April 1997, you applied to the N.C. Division of Water Quality (DWQ) for a 401 Water
Quality Certification to impact 0.30 acres of wetlands (including 417 feet of streams) for your project to
construct parking and athletic fields located at 13501 York Road in Charlotte, Mecklenburg County. Your
project has been forwarded to Mr. Mike Parker [phone] of DWQ Mooresville Regional Office for
review. This review will likely require an on-site inspection prior to the approval, modification or denial of
your project site. If you have sent additional information to the U.S. Army Corps of Engineers concerning
this project, please be certain that our staff have copies of this material so we can use it in our process in
making a decision.
According to our preliminary, in-house review since you propose to disturb greater than one acre of
wetlands, it is likely that compensatory mitigation will be required by DWQ for this project as described in
15A NCAC 2H .0506 (h). Our Regional Office staff can make this decision during their site visit. If
adequate mitigation is required but not provided, this project will likely have to be denied. Also if a
mitigation plan is required, we will place this project on hold until its receipt in our Central Office.
Enclosed are materials describing compensatory mitigation requirements for this program. Please call me at
919-733-1786 to discuss these matters if necessary. Until a mitigation plan is provided, this application is
considered to be incomplete and our processing time will not start.
We recommend that you not impact any wetlands or waters on your project site until a 401 Water
Quality Certification has been issued from Raleigh, The issuance of a Corps of Engineers 404 Permit does
not mean that your project can proceed. According to the Clean Water Act, the 404 Permit is not valid
until a 401 Certification is also issued. If DWQ staff observe impacts which are not allowable, you will be
required to remove the fill and restore the site to its original condition. I can be reached at 919-733-1786 if
you have any questions about the 401 Certification process.
Sincerely,
J n R. Dorney
ater Quality Certific Program
cc: Mooresville DWQ Regional Office
Central Files
Dan Ziehm; The Isaacs Group
970351.rovst
Division of Water Quality - Environmental Sciences Branch
Environmental Sciences Branch, 4401 Reedy Creek Rd., Raleigh, NC 27607 Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer • 50% recycled/10% post consumer paper
. __ y
KEMORANDUM PRINT NAMES:
Reviewer: ,5RA " 861.1-t-,114 111-
PO : JOHN DORNEY WQ SUPV.: C?L?- u ,?
ENVIRONMENTAL SCIENCES BRANCH DATE:-'7
SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS
***EACH ITEM MUST BE ANSWERED (USE N/A FOR NOT APPLICABLE) **
PERMIT YR:
APPLICANT NAME:
PROJECT-TYPE:
COE #:
RCD_FROM _CDA:
REG-OFFICE:
97 PERMIT NO: 0000351 COUNTY:
CHRIST THE KING LUTHERAN CHURCH
PARKING LOT & FIELD PERMIT TYPE:
DOT #
APP DATE_FRM_CDA:
MRO
RIVER-AND-SUB-BASIN-#: 030834
STREAM-CLASS: C
WL IMPACT? : QN
WL -REQUESTED: 417 1'E6?-
WL_S CORE (#) : „)/?
MITIGATION?: Y/N
MITIGATION-SIZE:
STR_INDEX NO: 11-137-10
MECKLENBURG
NW26
04/21/97
F 4? ?F®
Tye J
,? sc?Fti
cFs
WL TYPE : 57W61-P4
WL_ACR_EST?: Y/N
WATER IMPACTED BY FILL?: (DIN
MITIGATION-TYPE: nJo A P- M T i M E
DID YOU REQUEST MORE INFO?: YAP
IS WETLAND RATING SHEET ATTACHED?: YW
HAVE PROJECT CHANGES/CONDITIONS BEEN DISCUSSED WITH APPLICANT?: Y/(t?
RECOMMENDATION (Circle One): ISSUE ISSUE/COND DENY
COMMENTS : ?9- 2 ez- - NIA- Z--
Tgc-kM ?u.%. TO WADK 2 13QRr1cO?. Ty,P f? AJATVec OF N1TI&A710.J is 7-0 96:
3,A M
cc: Regional Office
Central Files
i ry{
?'o
DEM ID: ACTION ID: vz- *c
Nationwide Permit Requested (Provide Nationwide Patmit N): K)wP *?Q 4'1 ;p F/11
Ap,
JOINT FORM FOR
Nationwide permits that require notif cation to the Cos of Engineers ti 2ql? 99?
Nationwide prmits that require application for Section 401 certincation y ??2
970351 In M f- " 0
VnLMINGTON DISTRICT ENGINEER WATER QUALITY PLANNING
CORPS OF ENGINEERS DIVISION OF ENVIRONMENTAL MANAGEMENT
DEPARTMENT OF THE ARMY NC DEPARTMENT OF ENVIRONMENT, HEALTH,
P.O. Box 1890 AND NATURAL RESOURCES
Wilmington, NC 2&102-1890 P.O. Box 29535
ATTN: CESAW-CO-E Raleigh, NC 27626-0535
Telephone [phone] A : MR. JOHN DORNEY
Telephone [phone] ' -
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS OF ENGINEERS.
SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT.
PLEASE PRINT.
I. Owners Name: CHRIS-,T- -TH1<_KiQC; uTHERAtI CHL)ROi-1
2. Owners Address: 'f.a= 41Q 2-1 CHARLOTTE i\-)C, ?R2yI
3. Owners Phone Number (Home): ?2Q? J.). R- 00:Z':? (Work): 0 OBI - 0C)3:?
4. If Applicable: Agent's name or responsible corporate olFcial, address, phone numben-
1 HE 1SAFIC.S C&rZnup, P. C,. LEM, QAtz Zz1,[ H1\A rSZ?-' ??
-- C,H t?R ?R t I?G 2,$21 ? .
5. Location of work (MUST ATTACH MAP). County: _-MEGA L_E US3URC4
Nearest Town or City: __-C J4 Wi-cMF_
Specific Location (Include road numbers, landmarks, eta.): 15a t 1 YORK fAaR D
P,c?v oss -?ro.. Siwnad. I-lonnQ?'72ye1onme;,1 C14P%& Q TE. 1,x 282-7 R
6. Name of Closest Stream/Rive.. !-TeF l F CRE K
7. River Basin: C/M w f3A 13,P-SJN?
8. Is this project located in a watershed classified as Trout, SA, HQW, ORW, WS I, or WS IN YES [) NO Q<j
9. Have any Section 404 permits been previously iequested for'use on this propcny7 YES [ ] NO N
If yes, explain.
10. Estimated total number of acres of waters of the U.S., including wetlands, located on project site: 1.0 c, -e.s
11. Number of acres of waters of the U.S.. including wetlands, impacted by the proposed project:
Ftllt:d: O.:.0 "rC&
......
Drained: d
Flooded: n _..
Excavated: n
Total Impacted: 0
w i.t
12. Description of proposed work (Attach FLANS-8 V2" X 11" drawings only): -1, ccznste1,?
?, : _ _ S „ • 1 ;-t ' n ? c? c?.-i h 1 P 1f ? `? i C? ? C? - i ? ? ? ? ?f1Q., ? il i ? ? ?? l_??.CT . "f c_? - --
r
?? rnC? -the ?x'?slinu c-v-esek L?v.de? -third cl Cdh1p?-t*%C -?Jc-lek
a
13. Purpose of proposed work: lei chrl<-lruci ??.?^c 1? 1 C, king 4cxj ;lie -, ?.n (xxlhlQ.iic_
la. State reasons why the applicant believes that this activity must be carried out in wetlands. Also, note measures
taken to minimize wetland impacts. rr
.S-'tOrm r b anC? 1v.re?
15. You are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National Marine. Fisheries Service
(NMFS? regarding the presence orany Federally listedorproposed forlisting endangered or threatened species or critical
habitat in the permit area that may be affected by the proposed project. Have you done so? YES P NO(
RESPONSES FROM THE USFWS AND/OR MM SHOULD BE FORWARDED TO CORPS.
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? Have you done s97 YES N NO
RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17. Additional information required by DEM:
A. Wetland delineation map showing all wetlands, stream:, and lakes on the property.
B. If available, representative photograph of wetlands to be impacted by project.
C. If delineation was performed by a consultant, include all data sheets relevant to the placement of the
delineation line.
D. If a stormwatcr management plan is required for this project, attach copy.
E. What is land use of surrounding property? Mi)c of re.sle?.P,n-11o.1 oncf.
F. If applicable, what is proposed method of sewage disposal? ?clri-ic..r SPLoe,y- c ??,niT STS-}em
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State of North Carolina
Department of Environment,
Health and Natural Resources • •
Division of Water Quality
, A A9
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary p H N F1
A. Preston Howard, Jr., P.E., Director
May 14, 1997
Christ the King Lutheran Church
P.O. Box 410521
Charlotte, NC 28421
WQC #970351
Mecklenburg County
Dear Sirs:
The Division of Water Quality has reviewed your plans for the discharge of fill material
into 417 linear feet of perennial stream located at Christ the King Lutheran Church in
Mecklenburg County for parking lots and athletic fields. Based on this review, we have
identified existing uses which would be removed by this project. These uses are the aquatic
life in the stream. Furthermore, insufficient evidence is present in our files to conclude that
your project must be built as planned in waters and/or wetlands in accordance with 15A NCAC
2H .0506. Therefore, we are moving toward denial of your 401 Certification as required by
15A NCAC 2H.0507(e). Until we receive additional information, we are requesting (by copy
of this letter) that the U.S. Army Corps of Engineers place your project on administrative hold.
Our processing time will not start until we receive this information.
Please provide us with information supporting your position that your project must be
constructed as planned and that you have no practicable alternative to placing fill in these waters
and/or wetlands. Specifically can you construct your facility and relocate (rather than culvert)
the stream? Any documentation such as maps and narrative that you can supply to address
alternative designs for your project may be helpful in our review of your 401 Certification.
Also this project as proposed will require compensatory mitigation as described in 15A NCAC
2H .0506(h). Your mitigation proposal is insufficient because none has been proposed.
Please respond within two weeks of the date of this letter by sending a copy of this information
to me and one copy to Mr. Sumar Bou-Ghazale at the Mooresville Regional Office at 919
North Main Street, Mooresville, NC 28115. If we do not hear from you in two weeks, we
will assume that you no longer want to pursue this project and we will consider the project as
withdrawn. I can be reached at 919-733-1786 if you have any questions.
S' rely,
Jon R. Dorney
W ter Quality Ce on Program
cc: Mooresville DWQ Regional Office
Wilmington Office Corps of Engineers
Central Files
Asheville Field Office Corps of Engineers
Daniel Ziehm; The Isaacs Group
97035 Lnty
Division of Water Quality - Environmental Sciences Branch
4401 Reedy Creek Rd., Raleigh, NC 27626-0535 - Telephone [phone] - FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post-consumer paper
ISAACS o
CIVIL ENGINEERING DESIGN AND CONSULTING
5605 77 CENTER DRIVE, SUITE 250
CHARLOTTE, N.C. 28217
OFFICE: 704-527-3440 FAX: [phone]
TO WP'TtR QUALITY Pl.AlytiltyC?.
?-0- sox 29535
Z?L? l U H , K)c' 2762L - os 3s
WE ARE SENDING YOU A Attached
? Shop drawings ? Prints
? Copy of letter ? Disk
LETTER OF if RANSMTTAL
DATE JOB N0.
O
ATTENTION
2. --<Y v 1O -
RE: G LIST CIS)
CH U><2
REZVED

APR 2 191
? Under separate cover via
? Plans

Applications
?j
=1yVEKUNMENTAL SCIENCES
;:?a nick
the following items:
? Specifications
COPIES DATE NO. DESCRIPTION
I P

" C'w i 1T =

THESE ARE TRANSMITTED as checked below:
)9, For approval ? Approved and submitted
? For your use
? As requested
? For review and comment
? Approved as noted
? Returned for corrections
? Resubmit copies for approval
? Submit copies for distribution
? Retu
rrected prints
REMARKS I"'Ar. ??rng4 , 1ec se- rextie-, o cwvc),. issk,..2 !E c, 'jnn 40l c mjj c?r-
-Shres]cnA 60,ck ^Fo `J?rw% -Licknn ad -The, I--'Ckg-CjS ?4rov.42 rnmmem G or-
C., t]rhC1ricn'Fer facrvms . --T4- :ye-,%N nezA ac)•c).i-Fic e.l c&QP1icCdi0n5, Skit- , or'
1 brce Site, plc?.n< , &R-A T rye. io c r l \ 'T i_erhwl o. (.'4Oy) 527 - X440 , -Thy
-?ol o.?fhti 0?ir-'@ A kf'ye. C'J"'o i^='P.iv2,C? C" cjop" ar C'nck sae, ikY1 :
I? U-s- Pw-rny (_n of E?nGInePr'S
2? V.S l-;s?c,,..cl, \?.??Ic)\li?e, ?,-v;cQ, - J 1?A,1i0h Fie1e? O?ic?
3? ?C?'ic?nb..? Mc,,rir?e. ?-iS1?e,r1E,S ??rviCk. NC??-?. ??jn5e,-??I'iO,r1 I Jiv'?_Si(?
111 _ cxiP_ Ristnric. Frew.-yccticWn C) ice ??.. 1---)iyisiW cry P?rchives
COPY TO SIGNED

DEM ID: ACTION ID:
Nationwide Permit Requested (Provide Nationwide Permit M): n * v
JOINT FORM FOR°??? Ga
Nationwide permits that require notification to the Corps of Engineers 29< ?o
Nationwide permits that require application for Section 401 certification
WILMINGTON DISTRICT ENGINEER WATER QUALITY PUNNING
CORPS OF ENGINEERS
DEPARTMENT OF THE ARMY
P.O. Boa 1890
Wilmington, NC 28402-1890
AM: CESAW-CO-E
Telephone [phone]
DIVISION OF ENVIRONMENTAL MANAGEMENT
NC DEPARTMENT OF ENVIRONMENT, HEALTH,
AND NATURAL RESOURCES
P.O. Box 29535
Raleigh, NC 77626-0535
ATrN: MR. JOHN DORNEY
Telephone [phone]
ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS OF ENGINEERS.
SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT.
PLEASE PRINT.
1. OwnersNamo: CHRIS? 71R KILKn LUTHERAN) LHOR014
2. Owners Address: `L., Q-. 2?.?y I r ?I CHAR LQZ_I iy>C, ? R?=y I
3. Owners Phone Number (Home): C2Qy 00?'-:? (Work): 00H) OC>?
4. If Applicable: Agent's name or reapom1blo corporate official, address, phone number.
E15A
Hr? - 2 21
5. Location of work (MUST ATTACH MAP). County: _ ECA I = LZURC„
Nearest Town or City: - CJ4 L-MTt=
Specific Location (Include road numbers, landmarks, eta.): )r a tz)1 YORK ESA D
l?c_ro,55 -?ro,r wwood. -?e?m2? 1?2yelonmen't CAA&zUE: , Nc 2R2?R
6. Name of Closest Strearn/Rive.. 'i-TEE 1 P---CREEK
7. River Basin: Q/MNw RR SFNSut3
8. It this project located in a watershed classified as Trout, SA, HQW, ORW, WS I, or WS II? YES [ j NO K
9. Have any Section 404 permits been previously'requested foi use on this propeny7 YES f J NO N
If yes, explain.
10. Estimated total number of acres of waters of the U.S., including wetlands, located on project site: / • O cc---e-.s
11. Number of acres of waters of the U.S.. including wetlands, impacted by the proposed project:
Filled: o. AQ 2GrrA
Drained: G
Flooded: n
Excavated: n
Total impacted: 0

12, Description of proposed work (Attach PLANS-8 112" X 11" drawings only): :a ..scuStr-%&99i c, c.bi .r- ,
ri xls^1 i rSJ r- rez-k xir .r -the ojDosc-,r>, c)- h le-t *%c icy Icy
13. Purpose of proposed work: In enn<-Fr.?ri c CL+?rrl? i-.. kin jai ,_$ G?hlP?ic
-Lsalcx -c, ti fie' bu Rh2 Inri?a the K(0 L'.-th mr? G??.rc?n ccrec.rP.C.?c_ ic?Y\
14. State reasons why the applicant believes that this activity must be carried out in wetlands. Also, note measures
taken to minimize wetiand impacts. Ac*i via kQd 6e &&?'rrikd cm)-i ivy wPJ1cWa-' c ?P, of _
.S-i orrn r b RAPW??,Qy? 0.!-Cx rt v rub
15. You are required to contact the U.S. Fish and Wildlife Service (USFWS) and/or National Madne.Fisheries Servicc
(NMFS) regarding the presence or any Foderall listed orproposed for listing endangeredor threatened species or critical
)
habitat in the permit area that may be affected by the proposed project. Have you done ao? YES V NO[
RESPONSES FROM THE USFWS AND/OR NHPS SHOULD BE FORWARDED TO CORPS.
16. You are required to contact the State Historic Preservation Officer (SHPO) regarding the presence or historic
properties in the permit area which may be affected by the proposed project? Have you done so? YES Pq NO [ ]
RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
17. Additional information required by DEM:
A. Wetland delineation map showing all wetlands, streams, and lakes on the property.
B. If available, representative photograph of wetlands to be impacted by project.
C. If delineation was performed by a consultant. includo all data sheets relevant to the placement of the
delineation line.
D. If a swrrnwatcr management plan is required for this project, attach copy.
E. What is land use of surrounding property? Mik 4 reSicaP,,n?io l anc). c c>mmPr?.ica?
F. If applicable, what is proposed method of sewage disposal? ?c.,,i-??,,.,, ?P?,, ,- C ?,t,,niT 57?_?
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