HomeMy WebLinkAbout20011443 Ver 1_Complete File_20011003? 11AT?C Michael F. Easley, Governor
`ODD 9pG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
_ Gregory J. Thorpe, Ph.D.
> y Acting Director
p •? Division of Water Quality
October 11, 2001
Burke County
DWQ Project No. 011443
SR 1971, Bollinger Gap Road
APPROVAL of 401 Water Quality Certification with Additional Conditions
Mr. Roger D. Bryan, Division Environmental Officer
NCDOT Division 13
P.O. Box 3279
Asheville, NC 28802
Dear Mr. Bryan:
You have our approval, in accordance with the attached conditions and those listed below, to impact
35 linear feet of an unnamed tributary to Silver Creek in order to upgrade SR 1971 (Bollinger Gap
Road) in Burke County. The project should be constructed in accordance with your application dated
September 27, 2001 (received October 3, 2001). After reviewing your application, we have decided
that this fill is covered by General Water Quality Certification No. 3289 corresponding to the U.S.
Army Corps of Engineers Nationwide Permit Number 14. In addition, you should acquire any other
federal, state or local permits before you proceed with your project including (but not limited 'to)
-Sediment and Erosion Control, Non-Discharge and Water Supply Watershed regulations. This
approval will expire with the accompanying 404 permit unless otherwise specified in the Water
Quality 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 in writing, and 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, or if stream impacts exceed 150 linear feet,
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.
1. Stormwater management, sedimentation and erosion control and buffer requirements for WS-IV
Waters as specified in 15A NCAC 2B .0216.
2. Temporary or permanent herbaceous vegetation shall be planted on all bare soil within 10 days of
ground-disturbing activities to provide long term erosion control.,
3. All culverts required for this project shall be installed in such a manner that the original stream
profiles are not altered (i.e. the depth of the channel must not be reduced by a widening of the
streambed). Existing. stream dimensions are to be maintained above and below locations of
culvert extensions. Culverts shall be installed one foot below the stream to allow for fish and
other wildlife movement.
4. All work shall be performed during low flow conditions.
North Carolina 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)
919-733-1786 (phone), 919-733-6893 (fax), httpJ/h2o.enr.state.nc.us/ncwetiands/
5. All mechanized equipment operated near surface waters must be regularly inspected and
maintained to prevent contamination of stream waters from fuels, lubricants, hydraulic fluids, or
other toxic materials. Heavy equipment shall be operated from the bank. Under no
circumstances shall rock, sand or other materials be dredged from the wetted stream channel
under authorization of this permit, except in the immediate vicinity of the culverts.
6. Existing vegetated buffers shall not be mowed in order to utilize it for storm water sheet flow.
7. Use of rip-rap for bank stabilization is to be minimized; rather, native vegetation is to be planted
when practical. If necessary, rip-rap must be limited to the stream bank below the high water
mark, and vegetation must be used for stabilization above high water.
8. Rock silt screens at culvert outlets shall be removed at project completion.
Upon completion of the project, the NCDOT shall complete and return the enclosed
"Certificate of Completion" form to notify NCDWQ when all work included in the §401
Certification has been completed. The responsible party shall complete the attached form
and return it to the 401/Wetlands Unit of the NC Division of Water Quality upon
completion of the project.
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 that conforms to Chapter 150B of the North Carolina General Statutes to the
Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, N.C. 27699-6714. This
certification and its conditions are 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 Ms. Cynthia Van Der Wiele at 919-733-9646
or Mr. Mike Parker of the Asheville Regional Office at 828.251.6208.
Sincerely, '
o
orpe, Ph. .
WctiDirect
or
At
tachment
FILE COPY
TO: Steve Lund, USACOE
Asheville Field Office
FROM: Ron Linville, Regional Coordinator
Habitat Conservation Program
DATE: October 2, 2001
SUBJECT: North Carolina Department of Transportation (NCDOT), Nationwide
Permit 14 Applications for the following Road Improvement projects:
&8 1971, Bollinger Gap Road, Unnamed Tributary (UT) Silver Creek
&R 2107, Dogwood Ridge Road, UT Little Silver Creek
`$81998, Nowlings Chapel Street, UT Sutterwhite Creek
X81407, Turner Mill Road, UT Steels Creek,
Burke County
These comments are provided in accordance with the provisions of the Fish and
Wildlife Coordination Act (48 Stat. 401, as amended; 16 U.S.C. 661-667d) and the North
Carolina Environmental Policy Act (G. S. 113A-1 through 113A-10; NCAC 25). At each
of the referenced projects, NCDOT proposes to extend one existing culvert on the
tributaries indicated in order to improve safety standards prior to paving the road.
We will not object to the projects as proposed, as they will be installed in a
manner that will maintain existing channel morphology. Culverts or pipes will be
installed below streambed grade. Riparian vegetation will be reestablished. WE
recommend the following conditions for the projects:
1. Culverts larger than 48" in diameter must be buried one foot into the
streambed, to the extent practicable. Smaller pipes must be installed so that
20% of the culvert or pipe is below streambed grade, also as practicable. All
waters must flow through the structure without freefalling or damming on
either end during low flow conditions to maintain aquatic life passage. The
dimension, pattern, and profile of the stream above and below the structure
should not be modified by widening the stream channel or reducing the depth
of the stream.
Burke County Road Paving Projects 2 October 2, 2001
2. If concrete will be used, work must be accomplished so that wet concrete does
not contact stream water. This will lessen the chance of altering the stream's
water chemistry and causin A f' hill
3. Heavy equipment should be operated ff'bi `tlre Uiank rather than in the stream
channel in order to minimize sedimentation and reduce the likelihood of
introducing other pollutants into the stream.
4. Stringent erosion control measures should be installed where soil is disturbed
and maintained until project completion.
5. Temporary or permanent herbaceous vegetation should be planted on all bare
soil within 10 days of ground disturbing activities to provide long-term erosion
control. We encourage NCDOT to utilize onsite vegetation and materials for
streambank stabilization when practicable.
Thank you for the opportunity to review and comment on this project during the
early planning stages. If you have any questions regarding these comments, please
contact me at 336/769-9453.
Cc: Roger Bryan, NCDOT
Cynthia Van Der Wiele, DWQ
...sago
01 1443
STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY LYNDO TIPPETT
GOVERNOR SECRETARY
PO BOX 3279, ASHEVILLE, NC 28802
September 27, 2001
01 1443
Mr. Steve Lund
US Army Corps of Engineers
151 Patton Avenue, Room 208
Asheville, NC 28801-5006
Subject: Nationwide Permit #14
SR 1971, Bollinger Gap Road
Burke County, NC
Dear Mr. Lund:
I have enclosed a straight-line diagram with erosion control plan, a PCN application for
NWP #14, and a location map relative to the proposed paving project on SR 1971,
Bollinger Gap Road, Burke County, NC.
Bollinger Gap Road is currently a 14-16 feet wide gravel road. Division of Highways
plans to pave the road 18 feet wide and increase the typical section. Grading wilLbe
light.
We propose to extend one existing culvert on an unnamed tributary to Silver Creek at
station 30+75. Existing channel morphology will be maintained upstream and
downstream of the culvert. The culvert will be placed below existing streambed
elevation. Riparian vegetation will be reestablished along disturbed areas associated with
the culvert extensions.
No significant effect on federally listed species (threatened or endangered) or their
critical habitats is anticipated.
By copy of this letter, we request Ron Linville, North Carolina Wildlife Resources
Commission Western Piedmont Coordinator, to comment directly to the Corps
concerning the permit request.
v
Mr. Steve Lund
Page -2 SR 1971, Burke County
September 27, 2001
By copy of this letter, we are asking Mr. Ed Ingle, Area Roadside Environmental
Engineer, to comment on the above project. Temporary encroachment into the buffer
zone will be required for the project. The stream is not classified as trout.
By copy of this letter, I am forwarding seven (7) copies of the application package to
Cynthia Van der Wiele, NC DENR, Division of Water Quality, 401/Wetland Unit for
review and comment. A $200.00 check is enclosed for application processing. Please
forward comments directly to the Corps with copy to Division 13 Environmental Officer.
Your earliest consideration for this request would be greatly appreciated. If you have any
questions or information needs, please contact me at (828) 251-6287.
Sincerely,
PT'0' ??
Roger D. Bryan
Division 13 Environmental Officer
Enclosures
cc: F. D. Martin, P.E.
G. R. Spangler
Bruce Taylor, P.E.
Ed Ingle
Ron Linville
Cynthia Van der Wiele
Office Use Only: (V, 1443 Form Version April 2001
USACE Action ID No. DWQ No.
If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A" rather than
leaving the space blank.
1. Processing
Check all of the approval(s) requested for this project:
X Section 404 Permit
? Section 10 Permit
X 401 Water Quality Certification
? Riparian or Watershed Buffer Rules
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 14
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 (see section VIII - Mitigation), check here: ?
II. Applicant Information
1. Owner/Applicant Information
Name: NC Department of Transportation
Mailing Address: P.O. Box 3279
Asheville, NC 28802
Telephone Number: 828-251-6287 Fax Number: 828-251-6394
E-mail Address: rdbryan@dot.state.nc.us
2. Agent 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:
Telephone Number: Fax Number:
E-mail Address:
Pagel of 8
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: SR 1971 Bollinger Gqp Road
2. T.I.P. Project Number (NCDOT Only):
3. Property Identification Number (Tax PIN):
4. Location
County: Burke Nearest Town: Glen Alpine
Subdivision name (include phase/lot number):
Directions to site (include road numbers, landmarks, etc.): SR 1971 is located off of US 64
qpproximately 0.6 miles northeast of the McDowell/Burke County line.
5. Site coordinates, if available (UTM or Lat/Long): N/A
(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. Describe the existing land use or condition of the site at the time of this application:
Existing secondary road
7. Property size (acres)
8. Nearest body of water (stream/river/sound/ocean/lake): UT to Silver Creek
9. River Basin: Catawba
(Note - this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.ne.us/admin/maps/.)
Page 2 of 8
10. Describe the purpose of the proposed work: We propose to grade drain base pave and
install erosion control measures for SR 1971(Bollinger Gap Road). We propose to extend
one existing culvert on an UT to Silver Creek. Total culvert extension will be 35 linear feet.
The culvert will be installed to insure aquatic life passage within the stream
d
11. List the type of equipment to be used to construct the project: Excavator, backhoe, an
trucks.
12. Describe the land use in the vicinity of this project: Rural, homes and pasture.
IV. Prior Project History
if jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action 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
construction schedules.
V. Future Project Plans
Are any additional permit requests anticipated for this project in the future? If so, describe the
anticipated work, and provide justification for the exclusion of this work from the current
application: No no future plans
VI. Proposed Impacts to Waters 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.
1. Wetland Impacts
Wetland Im act Type of Impact* Area of Located within Distance to
Page 3 of 8
Site Number
(indicate on ma) Impact
acres) 100-year Floodplain**
es/no) Nearest Stream
linear feet Type of Wetland***
N/A
* List each impact separately and identify temporary impacts. impacts include, but are not limited to: mechanized clearing, grading, Tin,
excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding.
** 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 http://www.fema.siov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.)
List the total acreage (estimated) of existing wetlands on the property: 0.0
Total area of wetland impact proposed: 0.0
2. Stream Impacts, including all intermittent and perennial streams
Stream Impact
Site Number
(indicate on ma)
Type of Impact* Length of
Impact
(linear feet
Stream Name** Average Width
of Stream
Before Impact Perennial or
Intermittent?
leasespecify)
Sta. 30+75 Culvert 35 UT to Silver Creek 2 ft P
* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can 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.gov. Several internet sites also allow direct download and printing of USGS maps (e.g., www.usozone.com,
www.riiap uest.corn, etc.).
Cumulative impacts (linear distance in feet) to all streams on site: 35 feet.
3. Open Water Impacts, including Lakes, Ponds, Estuaries, Sounds, Atlantic Ocean and any
other Water of the U.S.
Open Water Im act T e of Impact* Area of Name of Waterbod Type of Waterbod
Page 4 of 8
Site Number
indicate on ma) Impact
(acres) (if applicable)
, sound,
(lake, pond, estuary
bay, ocean, etc.
N/A
* List each impact separately and identity temporary impacts. impacts mciuae, ou[ are ?ui 11n1ftcu W. ,u,, cA?avauvu, -Ur,"'5,
flooding, drainage, bulkheads, etc.
4. 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.):
Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.):
Size of watershed draining to pond: Expected pond surface area:
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It may be useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
The existing secondary road must be improved to meet current safety standards for a paved
road The culvert extension requested is the minimum necessary to establish an appropriate
typical section for the roadway that will be stable and prevent future erosion. Riparian
vegetation will be established on disturbed areas associated with the project construction.
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 5 of 8
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.html.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
N/A
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP) with the NCWRP's written agreement. Check the box indicating that
you would like to pay into the NCWRP. Please note that payment into the NCWRP must be
reviewed and approved before it can be used to satisfy mitigation requirements. Applicants
will be notified early in the review process by the 401/Wetlands Unit if payment into the
NCWRP is available as an option. For additional information regarding the application
process for the NCWRP, check the NCWRP website at lutp:.'h2o.enr.state.nc.us:/w?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):
IX. Environmental Documentation (DWQ Only)
Page 6 of 8
Does the project involve an expenditure of public funds or the use of public (federal/state/local)
land?
Yes X 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 (919) 733-5083 to review current thresholds for environmental documentation.
Yes ? No X
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 (DWQ Only)
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 2B .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 X 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
* Zone 1 extends out 3U teet perpendicular from near oanx or cnannei; cone L exienas an
additional 20 feet from the edge of Zone 1.
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.
Page 7 of 8
XI. Stormwater (DWQ Only)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
The existing compacted gravel roadway acts as an impervious surface. Paving of the roadway
should eliminate sedimentation from fines associated with gavel surface treatment. The
roadway surface will be 40% of right of way surface area. Stormwater will diverted through
settling basins or grass lined buffers prior to entering the streams.
XII. Sewage Disposal (DWQ Only)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
XIII. Violations (DWQ Only)
Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500) or any Buffer Rules?
Yes ? No X
Is this an after-the-fact permit application?
Yes ? No X
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).
With regard to hazardous spill basins the road is not classified as an arterial route, therefore
hazardous spill basins are not required
Ap?licot/Agent's Si
(Agent's signature is
re D e
only if an authorization letter from the applicant is provided.
Page 8 of 8
1
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BURKE COUNTY
C L E V E L A N
IF INCORRECT RETURN TO
NC DEPARTMENT OF TRANSPORTATION
DIVISION 11OPFICE
Z 8282516136
WARRANT NO. 8802 INVOICE NUMBER INVOICE DATE INVOICE AMOUNT
SR1971 109/26/2001
$200.00
DATE
I a,3/?
09/26/2001
NET AMOUNT
$200.00