19970123 Ver 1_Complete File_19971113

NCDENR - DIVISION OF WATER QUALITY
WETLANDS RESTORATION PROGRAM
RECEIPT
November 13, 1997
Brenda Tisdall
Mountain Neurological Center, P.A.
7 McDowell Street
Asheville, NC 28801
The Wetlands Restoration Program has received a check in the amount of
$37,500, check number 049745, as payment for the compensatory mitigation
requirements of the 401 Water Quality Certification issued for DWQ Project #
970123. This receipt serves as notification that the compensatory mitigation
requirements for this project have been satisfied. Please note that you must also
comply with all other conditions of this certification and any other state, federal or
local government permit or authorization associated with this activity.
If you have any questions concerning this matter please contact Ron Ferrell
at 919/733 -5083 ext. 358.
Sincerely,
cc: John Dorney

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Operator
AMPAD REORDER
EFFICIENCY- #23 -006

State of North Carolina
Department of Environment,
Health and Natural Resources • •
Division of Water Quality
James B. Hunt, Jr., Governor p FE N R IL
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
November 3„ 1997
Buncombe County
DWQ Project # 970123
COE #199702387
APPROVAL of 401 Water Quality Certification and ADDITIONAL CONDITIONS, WRP
Ms. Brenda Tisdale
Mountain Neurological Associates
7 McDowell Street
Asheville, NC 28801
Dear Ms. Tisdale::
You have our approval, in accordance with the attached conditions and those listed below,
to place fill material in and culvert 300 linear feet of streams for the purpose of stabilizing the
streambank at your facility on Nasty Branch„ as you described in your application dated
February 18, 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.
We understand that you have chosen to contribute to the Wetland Restoration Program in
order to compensate for these impacts to wetlands and/or streams. In accordance with 15A
NCAC 2R .0500, this contribution will satisfy our compensatory mitigation requirements under
15A NCAC 2H .0506(h). According to 15A NCAC 2H .0506(h), 300 feet of stream
restoration will be required. Until the Wetland Restoration Program receives and clears your
check (made payable to: DEHNR - Wetland Restoration Program), wetland or stream fill shall
not occur. Mr. Ron Ferrell should be contacted at 919 - 733 -5083 ext. 358 if you have any
questions concerning the Wetland Restoration Program. You have one month from the date of
this Certification to make this payment. For accounting purposes, this Certification authorizes
the fill of 300 feet of streams, in 040302 river and subbasin and 300 acres feet of restoration
are required.
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,
Division of Water Quality - Non - Discharge Branch
4401 Reedy Creek Rd., Raleigh, NC 27607 Telephone 919 - 733 -1786 FAX # [phone]
An Equal Opportunity Aff irmative Action Employer - 50% recycled /10% post consumer paper

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.
jqtolnow
ard, Jr. P
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Asheville Field Office
Asheville DWQ Regional Office
Mr. John Dorney
Central Files
Ron Ferrell; Wetland Restoration Program
Mark Masters; Camille - Alberice Architects
970

NORTH CAROLINA - DIVISION OF WATER QUALITY
401 WATER QUALITY CERTIFICATION
SUMMARY OF PERMITTED IMPACTS AND MITIGATION REQUIREMENTS
In accordance with 15A NCAC 2H .0500, Mountain Neurologicid AssociateL DWQ Project M 970123 is authorized to impact the
surface waters of the State of North Carolina as indicated below for the purpose(s) of stabilizing an ending streambank. All activities associated
with these authorized impacts must be conducted in accordance with the conditions listed in the attached certification transmittal letter. THIS
CERTIFICATION IS NOT VALID WITHOUT THE ATTACHMENTS.
AUTHORIZED IMPACTS:
acres of Class WL wetlands
acres of riparian wetlands
acres of non- riparian wetlands
acres of Class SWL wetlands
300 linear feet of stream channel
(other)
LOCATION: Nasty Branch
COUNTY: Buncombe
BASIN /SUBBASIN: 040302
COMPENSATORY MITIGATION REQUIREMENT FOR WETLAND RESTORATION PROGRAM
As required by 15A NCAC 2H .0506, and the conditions of this certification, you are required to compensate for the above impacts
through the restoration, creation, enhancement or preservation of wetlands and surface waters as outlined below prior to conducting any activities
that impact or degrade the waters of the state.
Note: Acreage requirements proposed to be mitigated through the Wetland Restoration Programs must be rounded
to one - quarter acre Increments according to 15A 2R .0503(b)
acres of Class WL wetlands
acres of riparian wetlands
acres of non- riparian wetlands
acres of Class SWL wetlands
300 linear feet of stream channel
jother)
One of the options you have available to satisfy the compensatory mitigation requirements is through the payment of a fee to the
Wetlands Restoration Fund per 15A NCAC 2R .0503. If you choose this option, please sign this form and mail it to the Wetlands Restoration
Fund at the address listed below. An invoice for the appropriate amount of payment will be sent to you upon receipt of this form PLEASE
NOTE, THE ABOVE IMPACTS ARE NOT AUTHORIZED UNTIL YOU RECEIVE NOTIFICATION THAT YOUR PAYMENT HAS BEEN
PROCESSED BY THE WETLANDS RESTORATION PROGRAM.
Signature Date
WETLANDS RESTORATION PROGRAM
DIVISION OF WATER QUALITY
P.O. BOX 29535
RALEIGH, NC 27626 -0535
(919)733 -5083 ext. 358

. *�
State of North Carolina
Department of Environment,
Health and Natural Resources / AT.RMAI
Division of Water Quality
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary p E H N R
A. Preston Howard, Jr., P.E., Director
April 18, 1997
Ms. Brenda Tisdale
Moutain Neurological Associates
7 McDowell Street
Asheville, NC 28801
Dear Ms. Tisdale:
Re: Stream mitigation options
Mountain Neurological Center
DWQ #970123
Your architect (Mr. Mark Masters) asked that I outline various options available to
your firm in order to allow the N.C. Division of Water Quality to issue the required 401
Water Quality Certification to allow you to culvert 300 linear feet of Nasty Branch at your
facility in Asheville. As outlined in the 21 March 1997 letter from Mr. Max Haner of our
Asheville Regional Office, mitigation will be required according to our rules (15A NCAC
2H .0506(h) (4)) if stream fill exceeds 150 linear feet.
I would suggest that there are five alternatives which you could pursue to allow us to
issue the 401 Certification.
1) Reduce the stream fill to 150 linear feet or less,
2) Divert the portion of the stream which is eroding the base of your building away
from the foundation. However your desire to expand parking would not be
achieved.
3) Contribute $125 per linear foot to the N.C. Wetland Restoration Program in order
to satisfy the mitigation requirement. On 10 April 1997, the N.C. Environmental
Management Commission passed a temporary rule to allow this contribution. The
Wetland Restoration Program would then be responsible for finding and
successfully implementing a stream restoration project. This process will be fully
available as of 6 May 1997.
4) Locate a similar stream in the central French Broad River basin in need of
restoration, purchase the property or obtain a conservation easement, prepare a
stream restoration plan for approval by DWQ, conduct the restoration, monitor it
for five years and then assure us that the mitigation will remain in place (see
attached guidance), or
5) Contact the N.C. Dept. of Transportation (Mr. Tom Kendig at 919 - 733 -7844 ext.
263) to determine whether you might be able to assist them financially with a
stream restoration effort that they are beginning to satisfy a 401 Certification
requirement.
Division of Water Quality • Environmental Sciences Branch
Environmental Sciences Branch, 4401 Reedy Creek Rd., Raleigh, NC 27607 Telephone 919 - 733 -1786 FAX # [phone]
An Equal Opportunity Affirmative Action Employer • 50% recycled /10% post consumer paper

J .
Page 2
DWQ Project #970123
April 18, 1997
The N.C. Dept. of Transportation (or their consultants) would have to agree to
restore 300 additional feet of stream but it may be more cost effective to do your
and their mitigation on adjacent sites.
Please review these options and advise me which of these (or another suitable option)
you plan to pursue. Until this information is provided, your application is incomplete and
our processing time will not restart (15A NCAC 2H .0507(a)(5)). I can be reached at 919-
733 -1786 if you have any questions.
cd�.�
Jot n R. Dorney
cc: Max Haner, Asheville DWQ Regional Office
David Baker, Asheville Field Office Corps of Engineers
Ron Ferrell, Wetland Restoration Program
Central Files
Mark Masters, Camille - Alberice Architects

State of North Carolina
Department of Environment,
Health and Natural Resources
Ja mes B. Hunt, Jr., Governor
Jonathan B. Howesy Secretary
Steven J. Le vi to s, Deputy Se c re to ry
IF
1TQM?rA
C)EHNFi
(7 Division of Water Quality
Environmental Sciences Branch
4401 Reedy Creek Road
Raleigh, N.C. 27607
FAX:[phone]
FAX TO: ��� I 't0,� FAX NUMBER: -70q
FROM: —�
PHONE:
NO. OF PAGES INCLUDING THIS SHEET:
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State of North Carolina
Department of Environment,
Health and Natural Resources
James & Hunt, Jr., G ovemor
Jonathan & Howes, Secretary
Steven J. Levitas, Deputy Secretary
Al 7 X-;
�EHNF=?L
pA Ty Division of Water Quality
`t _ 1 Environmental Sciences Branch
i
4401 Reedy Creek Road
Raleigh, N.C. 27607
FAX:[phone]
FAX TO: 'e"40-- f �o
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NO. OF PAGES INCLUDING THIS SHEET: J�
FAX NUMBER: I P ?60
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A18 AMPAD REORDER
EFFICIENCY® p23.ppp

03/27/1997 07:45 7042516452
State of North Carolina
Department of Environment,
Health and Natural Resources 1 •
Division of Water Quality
James B. Hunt, Jr„ Governor
Jonathan B.-Howes, Secretary
A. Preston Howard, Jr„ P.E., Director
Asheville Regional Office
WATER'QUALITY SECTION
March 21, 1997
Mr. Mark Masters
Camille, Alberice Architects, P.A.
Post Office Box 18682
Asheville, North Carolina 28814
Dear Mr. Masters;
PAGE 02
subject: Review of Nationwide 26
Application to Fill
Nasty Branch
1D # 970123
Mountain Neurological Center
Buncombe County, N.C.
This letter is to confirm our conversation concerning the review
in this office of the proposed culverting of some 300 linear feet of
Nasty Branch downstream of its crossing of the of. McDowell Street and
Asheland Avenue intersection. The stated purpose of this fill ira to
stabilize the foundation of the Sun Heating Building which has been
damaged or eroded over the years by Nasty Branch.
Conditions for a water quality certification by this Agency
apply to proposed projects that will bury or culvert streams in
excess of 150 linear feet, This Agency recognizes that placing more
than a 150 linear feet of stream in a culvert removes a significant
use of this stream as habitat for propagation and survival of aquatic
organisms. The rules require that a fill in excess of the 15q feet be
mitigated in accordance with provisions of 1SA North Carolina
Administrative Code 2H .0506(h)(4) (copy attached). This provision
discusses restoration as the mitigation method of preference.
Another form of satisfying the restoration requirement would be use
Of the wetlands RaRtoration Fund provided for in North Carolina
General. Statute 143- 214.12. As we discussed, this wetland "bank"
when established will provide a repository for monetary contributions
or dedications of real property in lieu of compensatory mitigation.
Unfortunately, thia fund is not operational at this time and it is
unlikely that thin alternative will be available for use within the
next six (6) months.
Interchange Building, 59 Woodfin Place r* FAX [phone]
Asheville, North Carolina 28801 N4oCAn Equal Oppo►1uNiy /AfArm &9 Action Employer
voice 704 -251-6208 �,w.., ...:��.,.,,.�,,,�,�,,. 50% recycles/ 10% post-consumer paper

PAGE 03
03/27/1997 07:45 7042516452
Page 2.
March 21, 1997
In consideration of the above discussion, z would reoommend that
the application to enclose this stream be amended or modified to
either reduce the total length of culvert to a maximum of 150 linear
feet while employing other meane of stabilizing the building
foundation. Diverting this stream from the foundation would appear
to allow other stabilizing methods to be used. on site evaluation
indicates that moving the stream away from the foundation and
stabilizing the foundation by construction of a wall or another
suitable structure to support for this foundation could be completed
with minimal difficulty. From this Ageneyle perspective, this
alternative would be more supportable.
Thank you for your attention to this matter. We look forward to
your response_ Should you have questions in the interim, please
contact either Mike Parker or me at this oftice (704) 251 -6208,
Yv rs tru ,
L. Haver
Environmental Chemist
Enclosure
xc: John. Dorney
Forrest R. West I
Mike Parker

PAGE 04
03/27/1997 07:45 7042516452
MEMORANDUM PRINT NAMES
Reviewer
TO: JOHN DORNEY WQ SUPV
ENVIRONMENTAL SCIENCES BRANCH DATE
SUBJECT: WETLAND STAFF REPORT AND RECOMMENDATIONS
*" - *EACH ITEM MUST BE ANSWERED (USE N/A FOR NOT APPLICABLE) " ^*
PERMIT YR: 97 PERMIT NO: 0000178 COUNTY: MACON
APPLICANT NAME: QUEENS CREEK PROJECT- NANTA. POWER& LIGHT
PROJECT TYPE: AYDRO POM PERMIT TYPE: FERC RE
PROJECT—TYPE:
#: DOT #:
RCD FROM CDA: APP DATE FPX CFA: 03/06/97
RFG OFFICE: ARO
ZIVER_AND_SUB_BASIN #: 040403
STREAM CLASS: C
WL ^IMPACT? : Y
WL_REQUESTED:
WL SCORE(#):
KITIGATION? : Y.@
STit INDEX NO: 2 -57-51
WL_ME :
Wl, .ACR, EST? : YIN
WATER IMPACTED BY FILL ?: YIN
MITIGATION—TYPE:
MITIGATION—SIZE: DID YOU REQUEST MORE INFO ?: Y
IS WETLAND RATING SHEET ATTACHED ?. Y0
HAVE PROJECT CHANCES /CONDITIONS BEEN DISCUSSED WITH APPLICANT ?: Y(DN
RECOMMENDATION (Circle One): ISSUE ISSUE /COND DENY
:OMMENTS : We. Sha,i1a ,.,� ke�sttr P F���� /t ,
fi ti.C, ttii[ s y r j � .' w • %0 bZ lit �L4b1 i� ► ! A e& ud .�Jj ��1 r�l ^ Zl Y .1.1 t,1„° ke y^
IedhbBj� i��•�� ileaJA�i�l4- ..�vJTA f ilia �ti• - Ir1 )
� 7
n O r / 14j4 P y4� i .� �o
•/l Co N.. r.. Qw,dad
Regional Office
Central Files
li
�1

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
Asheville Regional Office
DEHN
WATER QUALITY SECTION
March 21, 1997
Mr. Mark Masters
Camille, Alberice Architects, P.A.
Post Office Box 18682
Asheville, North Carolina 28814
Subject:
Dear Mr. Masters:
> ! f {f,
FN9, 991
�c
s
Review of Nationwide 26
Application to Fill
Nasty Branch
ID # 970123
Mountain Neurological Center
Buncombe County, N.C.
This letter is to confirm our conversation concerning the review
in this office of the proposed culverting of some 300 linear feet of
Nasty Branch downstream of its crossing of the of McDowell Street and
Asheland Avenue intersection. The stated purpose of this fill is to
stabilize the foundation of the Sun Heating Building which has been
damaged or eroded over the years by Nasty Branch.
Conditions for a water quality certification by this Agency
apply to proposed projects that will bury or culvert streams in
excess of 150 linear feet. This Agency recognizes that placing more
than a 150 linear feet of stream in a culvert removes a significant
use of this stream as habitat for propagation and survival of aquatic
organisms. The rules require that a fill in excess of the 150 feet be
mitigated in accordance with provisions of 15A North Carolina
Administrative Code 2H .0506(h)(4) (copy attached). This provision
discusses restoration as the mitigation method of preference.
Another form of satisfying the restoration requirement would be use
of the Wetlands Restoration Fund provided for in North Carolina
General Statute 143- 214.12. As we discussed, this wetland "bank"
when established will provide a repository for monetary contributions
or dedications of real property in lieu of compensatory mitigation.
Unfortunately, this fund is not operational at this time and it is
unlikely that this alternative will be available for use within the
next six (6) months.
Interchange Building, 59 Woodfin Place 1A FAX [phone]
Asheville, North Carolina 28801 N�� An Equal Opportunity /Affirmative Action Employer
Voice 704- 251 -6208 , , , , ,, 50% recycles/ 100% post- consumer paper

Page 2
March 21, 1997
In consideration of the above discussion, I would recommend that
the application to enclose this stream be amended or modified to
either reduce the total length of culvert to a maximum of 150 linear
feet while employing other means of stabilizing the building
foundation. Diverting this stream from the foundation would appear
to allow other stabilizing methods to be used. On site evaluation
indicates that moving the stream away from the foundation and
stabilizing the foundation by construction of a wall or another
suitable structure to support for this foundation could be completed
with minimal difficulty. From this Agency's perspective, this
alternative would be more supportable.
Thank you for your attention to this matter. We look forward to
your response. Should you have questions in the interim, please
contact either Mike Parker or me at this office (704) 251 -6208.
V Lru Haner
Environmental Chemist
Enclosure y/
xc: John Dorney
Forrest R. Westall
Mike Parker

DEPARTMENT OF THE ARMY
WILMINGTON DISTRICT, CORPS OF ENGINEERS
P.O. BOX 1890
WILMINGTON, NORTH CAROLINA 28402 -1890
March 14, 1997
IN REPLY REFER TO
Regulatory Branch
Action ID No. 199702387 and Nationwide Permit No. 26 (Headwaters and
Isolated Waters)
Ms. Brenda Tisdale
Mountain Neurological Center
7 McDowell Street
Asheville, North Carolina 28801
Dear Ms. Tisdale:
Reference your application of February 14, 1997, for Department of the
Army (DA) authorization to install approximately 300 linear feet of culvert in
Nasty Branch behind the Sun Heating store on McDowell Street in Asheville,
Buncombe County, North Carolina. The project is to stabilize the
deteriorating building foundation and parking area. The proposal has been
reviewed by the North Carolina Wildlife Resources Commission (WRC).
For the purposes of the Corps of Engineers' Regulatory Program, the
"December 13, 1996 Federal Register, Final Notice of Issuance, Reissuance, and
Modification of Nationwide Permits (61 FR 65874)" listed nationwide permits.
Authorization was provided, pursuant to Section 404 of the Clean Water Act,
for discharges of dredged or fill material into headwaters and isolated waters
provided that the activity meets all of the following criteria:
a. The discharge does not cause the loss of more than three (3) acres of
waters of the United States nor cause the loss of waters of the United States
for a distance greater than 500 linear feet of a stream bed,
b. For discharges causing the loss of greater than 1/3 acre of waters of
the United States, the permittee notifies the District Engineer in accordance
with the "Notification" general condition;
C. For discharges causing a loss of 1/3 acre or less of waters of the
United States, the permittee must submit a report within thirty (30) days of
completion of the work, containing the following information:
(1) Name, address and telephone number of the permittee;
(2) Location of work;
(3) Description of the work; and,
(4) Type and acreage (or square feet) of the loss of waters of the
United States (e.g., 1 /10 acre of marsh and 50 square feet of a stream);

d. For discharges in special aquatic sites, including wetlands, the
notification must also include a delineation of all affected special aquatic
sites, including wetlands; and
e. The discharge, including all attendant features, both temporary and
permanent, is part of a single and complete project.
Whenever any other nationwide permit is used in conjunction with this
nationwide permit, the total acreage of impacts to waters of the United States
of all nationwide permits combined cannot exceed three (3) acres.
Your work is authorized by this nationwide permit provided it is
accomplished in strict accordance with the enclosed conditions, those outlined
in the attached February 24, 1997 WRC letter, and provided you receive a
Section 401 water quality certification from the North Carolina Division of
Water Quality (NCDWQ). You should contact Mr. John Dorney, telephone (919)
733 -1786, regarding water quality certification. This nationwide permit does
not relieve you of the responsibility to obtain other required State or local
approval.
This verification will be valid until the nationwide permit expires,
which will occur on December 13, 1998. All activity under the terms and
conditions of this nationwide permit must be completed before the permit
expires. It is incumbent upon you to remain informed of changes to the
nationwide permits, which will be announced by public notice when they occur.
We have evaluated potential impacts of your activity, and we have
determined that your proposal will not affect any endangered species.
When you have completed your work and any required mitigation, please
sign and return the enclosed certification form.
Questions or comments may be addressed to Mr. David Baker in our
Asheville Regulatory Field Office, telephone [phone].
Sincerely,
/ r
Robert W. Johnson
Office Manager
Asheville Regulatory Field Office
Enclosures: 2/24/97 WRC letter

3
Copies Furnished (without enclosures):
Mr. John Dorney
Division of Water Quality
North Carolina Department of
Environment, Health and
Natural Resources
4401 Reedy Creek Road
Raleigh, North Carolina 27607
Robert Camille
Camille Alberice Architects PA
Post Office Box 18682
Asheville, North Carolina 28814

ter^ 1*c�����
DEM ID: 970123 ACTION ID:
Nationwide Permit Requested (Provide Nationwide Permit fit): Z41
JOINT FORM FOR
` :'.Nationwi`cfe permits thatrequire notiffcatibir to the Corps of Engineers
Nationwide permits that require application for Section 401 certification
WILMINGTON 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 28402 -1890 P.O. Box 29535
ATTN: CESAW -CO -E Raleigh, NC 27626-0535
Telephone [phone] ATTN: 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. DMSION OF ENVIRONMENTAL MANAGEMENT.
PLEASE PRINT.
1. Owners Name ;OUI�Ti�1 IUJLGYcir'Al� G�l1lT-
2. Owners Address: % M<:-� G, LL
3. Owners Phone Number (Home): (Work): 7.77 ,;--
4. If Applicable: Agent's name or responsible corporate official, address, phone number
�-Ak,1 IL LLE v X�lt k Ml.
5. Location of work (MUST ATTACH MAP). County:
Nearest Town or City:
SpeciificcLLocation'(Include road numbers, landmarks, etc.): ZZ ��-%/ `aDt T
6. Name of Closest Streammiver. /vas fy
7. River Basin:��
8. Is this project located in a watershed classified as Trout, SA, HQW, ORW, WS I, or WS U? YES [ ] NO [ ✓�
9. Have any Section 404 permits been previously requested for'use on this property? YES [ ] NO [17
If yes, explain.
IEstimated total number of acres of waters of the U.S., including wetlands, located on project site:
11. Number of acres of waters of the U.S., including wetlands, impacted by the proposed project:
Filled: CX _ v` 1 �i •ti r.�. 'r
Drained:
Flooded:
Excavated:
Total Impacted: 1�,%C • 2

12. Description of proposed work (Attach PLANS -8 1R" X 11" drawings only):
13. Purpose of'proposed'work: �'� �� - U�1IJ -AJ
State reasons why the applicant believes that this activity must be carried out in wetlands. Also, note measures
taken to minimize wetland impacts.
1 You are required to contact the U.S. Fish and Wildlife Service ( USFWS) and/or National Marine. Fisheries Service
regarding the presence or any Federally listed orproposed for listing endangered orthreatened species or critical
habitat in the permit area that may be affected by the proposed project. Have you done so? YES [ ] NO [ ]
RESPONSES FROM THE USFWS AND /OR NMFS SHOULD BE FORWARDED TO CORPS.
You are required to contact the State Historic Preservation Officer (SHPO) regarding the presence of historic
roperties in the permit area which may be affected by the proposed project? Have you done so? YES [ ] NO [ ]
RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS.
. 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, include all data sheets relevant to the placement of the
delineation line.
D. If a stormwater management plan is required for this project, attach copy.
E. What is land use of surrounding property?
F. If applicable, what is proposed method of sewage disposal?
04mer's. Si Date

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