20000244 Ver 1_Complete File_20000208

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
4 •
IT
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
February 14, 2000
Montgomery County
DWQ Project # 000244
APPROVAL of 401 Water Quality Certification
Eric B. Nelson, NCDOT Bridge Maintenance
PO Box 289
Silier City, NC 27344
Dear Mr. Nelson:
You have our approval, in accordance with the attached conditions and those listed below, to replace a culvert which
will impact 30 feet of Bishop Creek for the purpose of bridge replacement in Montgomery County, as you described in your
application received by the Division of Water Quality on February 8, 2000. After reviewing your application, we have
decided that this action is covered by General Water Quality Certification Number 3103. This certification allows you to use
Nationwide Permit Number 14 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 Water shed 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. 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). For this approval to be valid, you must follow the conditions below and those 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.
Attachment
cc: Corps of Engineers Wilmington Field Office
Fayetteville DWQ Regional Office
File Copy
Central Files
000244
Division of Water Quality • 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. en r. state. nc. us/wetlandc. html
JAMES B. HUNT JR.
GOVERNOR
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
P.O. BOX 25201, RALEIGH, N.C. 27611-5201
January 28, 2000
USACOE {!
Mr. Dave Timpy
PO Box 1890 '
Wilmin,ton, NC 28402-1590
Re: Montgomery Co. Bridge No. 129 Replacement
Location: Montgomery
County, SR 1318, crossing Bishop Creek
Dear Mr. Timpy:
DAVID NICCOY
ACTING SECRETARY
We are providing herewith an application package and copies of hydrographic surveys
(plan and profile), quad map, and water quality map as part of a project involving the
replacement of an existing bridge with a 25'-4"x9'-5" Aluminum Box Culvert.
Construction shall begin in the Spring of 2000.
To our knowledge, no wetlands are involved and total fill in waters is expected to be less
than 0.01 acre. This bridge is located in a high quality water area.
Please review this material, and if additional information is needed, or you have comments.
please contact our office.
Thank you for your cooperation and assistance in this matter.
Sincerelv,
9 ?;Z'e'lc
E.B. Nelson, P.E.
Div. Bridge Maint. Engineer
Attachments
cc: Bill Rosser, P.E. - Division Engineer
John Hennessey - DWQ - 7 copies w/ attachments
Mrs. Renee Gledhill-Earley, State Historic Preservation Officer
Mike Crocker - US Fish & Wildlife Service
?d.A Sivto ?.•! '
PO BOX 289 - SILER CITY- NC - 27344 Pli. [phone] FAX [phone]
P4YA1FIVT
--'C FI i/FU
DWQ ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PER?IIT tt)
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
?) APPLICATION FOR SECTION 401 CERTIFCATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGLNAL AND (1) COPY OF THIS COMPLETED FORM TO TF--- APPROPRIATE
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. OW,1ER'SNA.?iE: t?iL R.f•.l??c.soal - ti(Gr?c?T ?lz2rnc-,? M?4in,rt?,N?NC.r?
2. NIAILING ADDRESS: f?? o K 2 8 9
SUBDIVISION NAME
CITY; S1 LAm2 G?r/ STATE: ALr- ZIP-CODE:-o-73;44
PROJECT LOCATIONADDRESS, INQ.UDING SUBDMSIONNAME (IFID FROM
MAIILLINGADDRESS ABOVE): Mc'M7E,omrr-lz Y Go, gal mac," 179
6p S /L 13 i s 4-liz oS5 13"s"r L2rzz.te-
3. .TEL EoNENUMBER:.(HOME)
(WORK) 919 ?4Z-s?49
4. IFAPPLICA.BLE:AG=S NAlNfE OR7RESPONSIBLE CORPORATE OFFICIAL. ADDRESS,
PHONE NUMBER
SfPivt r?
LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: moNTG-,o,yea4 -NEARESTTOWN: TIZOq

SPECIFIC LOCATION (INCLUDE ROAD NUMMBERS, LANDMARKS, ECT.)
5r2
?
13?`. AL(Loss f;/s?I-DP t-ars1;11- . &rTf20
y
6. L'vIPACTED OR NEAREST STRE.kNURIVER: g?s?faT' Lr2?rs?L
RIVER BASIN: VA 014 ?,1 /G
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROTjT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURSE WATERS (ORW), WATER _
SUPPLY (WS-I OR WS-II)? YES (+K) NO ( ) IF YES. E.NPLALN: ?4 r h4 auAt-i2V
WA-'r1F_2 F'oN y- /K PFsrL vur2oni»1 ?r177YL S?Nt ?7 yr3`/ 6,45t- MAP
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
M.INAGE. ENT AREA OF ENVIROMENTAL CONCERN (AEC)? YES ( ) NO ( >' )
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?
8a. HAVE ANY SECTION 404 PERMITS'BEEN PREVIOUSLY_REQUESTEDFOR USE ON THIS
PROJECT? . -YES ( ) NO (x) IF.YES PROVIDE ACTION I.D. MJBER OF PREVIOUS
PERMIT.AND.ANY.ADDITIONAL-INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
8b.. ARE ADDITIONAL"PERMITIZEQUESTS E.YPECTEDFOR= PROPERTY IN TIC'
FUTURE?:-YES( ) NO (x) IFYES,"DESCRIBEANTICIPATED-?VORF:
9a. ESTL 1ATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: N 1A
9b. ESMIATED TOTAL. NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
D
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: 0
FLOODING: 0
DRAENAGE : U
10b. (1) STREAbf CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: Zd FT AFTER: SU
tiVIDTH BEFORE (based on normal high water contours):
EXCAVATION: 0
OTHER: 0
TOTAL ACRES TO BE 1MMPACTED: o
40
AVERAGE DEPTH BEFORE: Q • ,5- FT ,AFTER:
Q,7

77
(2) STRE.kN1 CHANNEL LNIPACTS WILL RESULT FROiv1: (CHECK ALL T11-?T .-APPLY`)
OPEN CHANNEL REI.OCA T ION: FLACEMENTT OF PIPE IN CHAIN-EL:
CHANNEL EXCAVATION: COONSTRUCTION OF A DaNYFLOODD C:
OTHER: ??IaGr?n??nr? c) r ALLtmrMuw 00y '?"•- >-
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF 7=17 WATERSHED
DRAINING TOTHE POND? N//+ WHAT IS THE E.X2ECTr7
POND:SURFACE AREA? _ ajA
12.:DISCTIMON.OFPROPOSED:WORKINCLUDINGDISCUSSIONOFTYPEOFMECH MECHANICAL
EQUIPI=_TO-BEDSED?.(ATTACHPLANS; 8I2-BY I I DRAWINGS ONLY)
2L`:nAoV? I YrS77n?L? Apu7-A^r-ANT TNPc- ?211?c-rr? /NSTk3LL ALUMrNU1?t
f3olC CuLVr2T. T2QL?L TrXL.4vA7-b2 1_fZAt,1F-r- Tb JiT" u-nL12-1En
13. PURPOSE OF PROPOSED WORK: 2 IE PL4-c.e r Xis-r?p?iF+ S-rjzucTU2/4LL-/
Qrxr-TC?SNT 91Z106C--
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO M N TL IIZE `VETLAND UYIPACTS)
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERVE 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: L.mr("ra2 IZ/IS /99
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
L-I-z TT1,:-: 2 1211 !d5 9
17. DOES THE PROJECT LNOLVE AN EX?ENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES (IJC) NO ( ) (IF NO, GO TO 16) _
a. IF YES, DOES THE PROJECT REQUIRE PREPERATION OF AN EV-VItONME\TAL.
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 C? ROLcl;A
DEPART' NIENT OF ADMINISTRATION STATE CLEARl GHOUSE YES ( ) NO ( )
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUNIENTATIONRROM THE STATE
CLEARINGHOUSE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TOMS. CHRYS:BAGGETT,-DIRECTOR STATE. CLEARINGHOUSE; NORTH
CAROLINA DEPARTMENT:ORADMINISTRATION, 116 WEST JONES 61 -7,7RALEIGH.
NORTH CAROLINA27603=8003,-TELEPHONE [phone].
18. THE FOLLOSVINGTTEIvIS:SHOULD?BEINCLUDED:WITHTHISAPPLICATIONIFPROPOSED
ACTIVITY.INVOLVESI DISCHARGE =CAVATED OF_FJLL MATERIAL INTO
WETLANDS:
a. WETLANDUEL-RIEA'ITON MAP?SHOWING ALL-WETLANDS.-SIRE MS. LAkES, AND
PONDS ON=TROPERTY: (FORNATIONWIDEYERMIT NUiMBERS 14, 18, 21.26.29,
AND.38). ALL STREAM (INTEPaUITENT AND PERMANENT) ONT"r-~. PROPERTY
MUST-BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS 60 FEET
OF 1 INCH EQUALS 100 FEET OF THEIR EQUIVALENT.
b. IF AVAILABLE. REPRESENTATIVE PHOTOGRAPH OF WE TT ANTDS TO BE aMPACTED
BY PRODUCT.
c. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE AI.L DATA
SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LEINE.
d. ATTACH A COPY OF THE STORMWATER MANAGE?NlENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPOERTY? 12FSlwanrr7A-L._
IF APPLICABLE. WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? MIA
SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WTLANZ DS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF WATER QUAL.Ti Y
CERTIFICATION, AND
3) (ET THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORT'ri
CAROLINA DIVISION OF COASTAL MANAGEME`+ 1 STATING TI-E PROPOSED
ACTIVITY IS CONSISTENT WTT I THE NORTH C.-?-ROLENA COASTAL _
,LkNAGE. NT PDCGR l:%1,
Z?16 -??L /Z- IL - t>?
OWNER'SIAGENT'S SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
JAIv11?s B. HUNT JR. P.O. Box 25201, RALEIGH, N.C. 27611-5201 DAVID MCCOY
GOVIERNOR ACTING 5L•CRLT\It']
January 28, 2000
Division of Environmental Management
John Hennessey, WQ Certification Unit PAYMENT
P.O. Box 29535
RECEIVED
Raleigh, N.C. 27626-0535 A a 1? 1 `?
Dear Mr. Hennessey:
Please find seven (7) copies of an application form attached for your review.
If I can answer any questions you may have or if you have any comments, please call me
at 919-742-5649.
Thank you for your assistance in this matter.
c?
g
Sincerely,
E.B. Nelson, P.E.
Div. Bridee Maint. Enaineer
attachments
PO BOX 289 - SILER CITY - NC - 27344 PH. [phone] FAX [phone]
l55(t-e
v I q -0
P, _RE-CONSTRUCTIOX NOTT.FXCATTON (PON)
NATIONWIDE 14
TO: NATIONAL MARINE FISHERIES/BEAUFORT, NC
FISH & WILDLIFE SERVICE/RALEIGH, NC + f,I , tr1
NC DIVISION OF WATER QUALITY/RALEIGH, NC
EPA/ATLANTA, GA
STATE HISTORIC PRESERVATION OFFICE/RALEIGH, NC
1. ACTION ID. 200000813
2. APPLICANT: NCDOT/BRIDGE NO. 129/_S 318
3. DATE OF TRANSMITTAL: 14 FEB '000
4. RESPONSE DEADLINE 1.8 FEB 2000
5. COMMENT DEADLINE (10 days from response deadline):
28 FEB 2000
6. SEND COMMENTS TO WILMINGTON DISTRICT CORPS OF ENGINEERS.
WILMINGTON REGULATORY FZFI?D OFFICE
ATTN: DAVE T MRX
FAX NO. [phone].
NUMBER OF PAGES, INCLUDING THIS SHEET: .11
Tff NOLIDIIXIIIA QMa SZObTGZOT6 ZT:tT 000Z,6T'933
tnn•a Agi
Toga
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
JANMS B. HUNT JR. P.O. BOX 25201, RALEIGH, N.C. 27611-5201 DAvm McCOY
GOVERNOR ACTINU SLUWI'ARY
January 28, 2000
USACOE
Mr. Dave Timpy p.: c i atl ?;'
PO Box 1890
Wilmington, NC 28402-1890 1 '
I-fi-1,; 1. 1r 1-o I..
Re: Montgomery Co. Bridge No. 129 Replacement
Location: Montgomery County, SR 1318, crossing Bishop Creek
Dear Mr. Timpy:
We are providing herewith an application package and copies of hydrographic surveys
(plan and profile), quad map, and water quality map as part of a project involving the
replacement of an existing bridge with a 25'-4"x9'-5" Aluminum Box Culvert.
Construction shall begin in the Spring of 2000.
To our knowledge, no wetlands are involved and total fill in waters is expected to be less
than 0.01 acre. This bridge is located in a high quality water area.
Please review this material, and if additional information is needed, or you have comments,
please contact our office.
Thank you for your cooperation and assistance in this matter.
Sincerely,
9 ? ,
E.B. Nelson, P.E.
Div. Bridge Maint. Engineer
Attachments
cc: Bill Rosser, P.E. - Division Engineer
John Hennessey - DWQ - 7 copies w/ attachments
Mrs. Renee Gledhill-Earley, State Historic Preservation Officer
Mike Crocker - US Fish & Wildlife Service
F0 SOX 20 - SILER CITY - NC - 27344 PH. [phone] FAX[phone]
3001a 66£T# NOICHIbIUM aMn 9Z0DTGUT6 ZT:bT 000z'bT'g33

`s , a n
DWQ ID: CORPS ACTION ID:
NATIONWIDE PER,vIIT REQUESTED (PROVIDE NATIONWME PERMIT #)
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERIMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGUIMERS
2) APPLICATION FOR SECTION 401 CERTIFCATION
3) COORDINATION WITH TIM NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGNAL AND (I) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE
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 DORNE'Y. 4401 REEDY CRERK ROAD.
RALEIGH. NC 27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME; ERt& 9.rJ4re-.S.oJ - Ale- Pn'f'Ig¢inlirx AAAlrvrrja?.,raw4
2. MAILING ADDRESS: IVv o x 2 v
SUBDIVISION NAME
CITY: S ? rz 6#7-/ STATE: ur- =p CODE: 27s44
PROJECT LOCATION ADDRESS. INCLUDING SUBDIVISION NAME (IF DWFEREN'Y' FROM
9
MAILING ADDRESS ABOVE): AAoprb0Mej--I2-Y Gay 9 ai 17e+w. 12,
DH ?2I31? 1?L2aS5 J3?irh+P LfL?T.t"r-IL
3. TELEPHONE NUMBER: (HOME)
(WORK) 1o4i9
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER:
5A-MhE_
S. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC
MAP OR AERIAL. PHOTOGRAPHY WITH SCALE):
COUNTY: NA 0Mrlm D1A Fs41/ -NEAREST TOWN: -r J001
C00'd 66CT#
NoInNIX711d a3Ksn 9Z05T9ZOT6 CT:bT oo0Zl5T's3d

SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.)
40ZTH
,512 13i g Az-aoSS 6,P 720`/
6. IMPACTED OR NEAREST STREAIvi/RIVER: 9l t2-1ftF L rain i4-
RIVER BASIN 14014l? 121U(f-a
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER. (SA).
HIGH QUALITY WATERS (FIQW). OUTSTAlWING RFSOURSE WATERS (ORW), WATER
SUPPLY (WS-T OR WS-In? YES (K) NO ( ) IF YES. EXPLAIN: 1l I g,µ QuAt Lj!j
WA,Mjz amN Af, p&4? ?„??????rrnrn? ? ,?< <•n v.rr Frlisr2i-AXAP
7b. IS THE PROJECT LOCATED Vet A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF FNVIROMENTAL CONCERN (AEC)'? YES ( ) NO ( ?K,)
7c. IF THE PROJECT IS LOCATED WIIH3N A COASTAL COUNTY (SEE PACE 7 FOR LIST OF
COASTAL COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION?
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:
9a. ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: _ NI'
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
D
10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
600'd 66C1# NOMONIM11A Q3VSn SZO?TGZOT6 CT:UT O0OZaST'933
EXCAVATION: 0
FILLING.
FLOODING: 0
DRAINAGE
OTHER:
v
U TOTAL ACRES TO BE IMPACTED: 0
10b. (I) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF
RELOCATED, PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: 10 FT AFTER: SU FT
WIDTH BEFORE (based on normal high water contours): 0 FT
AVERAGE DEPTH BEFORE: 0 - -5- FT AFTER: 0. 7 _ FI'
(Z) STREAM CHANNa IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACE.1vffiNT OF PIPE IN CHANNEL:
CHANNEL. EXCAVATION: COONSTRUCTION OF A DAMIFLOODING:
OTHER: i*21.4Ltt. A ip-n+-7' c .:,r- At-unti u.i uw IT" '"- `- 11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAZQNG TO THE POND? x jA WHAT IS THE EUECTED
POND SURFACE AREA?
12. DISCTIP'PION OF PROPOSED WORK INCLUDING-DISCUSSION OF TYPE OF 1ECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; S 1/2 BY I I DRAWINGS ONLY)
f`-AM ve -4jeM#4h A Lrr -.NT TN( P- Rloh?? NS LJ- 4LUAA1jU lWt
(3o`it GuLVrFrnT T(L/yG(G tc`dv?Ya2 d /?f? rat - T& .Eta. urlLtZ-rvn
13. PURPOSE OF PROPOSED WORK: 2C!PL"f rt x??-rl??? -rrf'i? Lf!Ttt2<Lu.`I
Qt?- G1 CI P: ,%xr gF-1f7F{p?
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY IMEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
con•a fiSEI' AIOZ9I3IIvIIld Q3tiSl1 4Z03T9ZUT6 Et?bi Oo0Z,g1's33

15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERVE 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
PROTECT. DATECONTACTED: Lm-rrr,-a alo l97
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
147'*2 17-115fl9
17. DOES THE PROTECT DNOLvB AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES (L4) 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 (p<)
b. IF YES. HAS THE DOCUMENT BEEN REFIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ( ) NO ( )
IF ANSWER 17b IS YES, THEM SUBMIT APPROPRIATE DOCUMENTATIONFROh1 THE STATE
CLEARINGHOUSE WITH TM NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING TIM STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CHRYS BAGC;M, DIRECTOR STATE CLEARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION. 116 WEST JONES STREET. RALEIGH,
NORTH CAROLINA 27603-8003, TELEPHONE [phone].
13. 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 MiTERMITrENT AND PERMANENT) ON THE PROPERTY
MUST BE SHOWN ON TIM MAP. MAP SCALES SHOULD BE I INCH EQUALS 30 FEET
OF I 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 DEL 24EATION LINE.
d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT ISLAND USE OF SURROUNDING PROPOERTY?-?it?
O
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IF APPLICABLE. WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? NZA
Z. SIGNED AND DA'Z'ED AGENT AUTHORIZATION LETTER IF APPLICABLE.
NOTE: WTLANDS OR WAFERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERIIYIIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DMSION 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
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL
MANAGE,'`!'T PROGRAM,
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OWNER'S/AGENT'S SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LSTT'ER FROM
THE OWNER IS PROVIDED).
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