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HomeMy WebLinkAbout20070165 Ver 1_Application_20070130~ r , MSTA7Fo ~, ~~/~; ~ _ry° r.. ~n ~ ~I ~~'~~~ ~%' ~ ~ °. 1i ~ STATE of NORTH CAROLINA DEPARTMENT OF TRANSPORTATION -~ M[CHAEL F. EASLEY LYNDO TIPPETT ''` :~; GOVERNOR SECRETARY January 26, 2007 ~~ U.S. Army Corps of Engineers Raleigh Regulatory Field Office O ~ ~ ~ 6508 Falls of the Neuse Road, Suite 120 ~ ~~1 Raletgh, NC 27609 \~ Attention: Mr. Eric Alsmeyer, NCDOT Coordinator Subject: Pro osed extension of a structure conveying an unnamed tributary to I p ~~ Poplar Creek on SR 2233 (Smithfield Road) in Wake County. The North Carolina Department of .Transportation (NCDOT) proposes to extend the structure and widen the narrow and unsafe shoulder above the outlet (Figures 1 - 3). Impacts to Waters of the United States ~ The project crosses an intermittent stream, an unnamed tributary to Poplar Creek, ~ [NCDENR-DWQ Index No. 27-35, Best Usage Classification C NSW; HUC 03020201] ~ (Figure 3) in the Neuse River Basin. The existing structure that conveys the creek is a 36- U inch concrete pipe. Please note that the roadway shoulder above the outlet is narrow and unsafe. Also the pipe appears to be perched because of blowhole at the outlet. Adding two joints will eliminate this blow hole and allow the pipe to set on grade with the stream bed (Photo~*raphs 1 and 2). In order to widen the associated roadway shoulder, two joints will be added to the outlet of the existing structure. Once the joints are set, the associated roadway shoulder will be rebuilt and the areas surrounding both pipe ends will be stabilized using riprap for armoring. The NCDOT proposes to temporarily dewater the work zone during the construction. This will involve the temporary placement of sandbags in the creek upstream and downstream of construction. Once the stream has been dewatered, the pipe will be extended. Permanent impacts at the site involve a total of 8 feet of surface water. fill and 20 feet of rip rap placed along the streambanks to protect the pipe ends. Concurrent temporary impacts to the stream from this activity will result in the dewatering of 28 linear feet of stream. The work zone will be dewatered for approximately 2 days. All materials used for dewatering will be removed after construction. Riparian Buffer Construction at this site involves a road crossing of a stream that is subject to the Neuse River Riparian Buffer Rules. The UT to Poplar Creek at Site 1 is depicted on the most recent. version of the Knightdale (USGS 1967/1988) topographic quadrangle (Figure 1) as well as the Soil Survey of Wake County (USDA-SCS 1970) (Figure 2). Division 5, 2612 N. Duke Street, Durham, NC 27704 Phone: (919) 560-6081 Fax: (919) 560-3371 ._ Construction impacts at this site total 1,725 ft' in Zone 1 and 1,136 ft' in Zone 2 (totaling 28 linear feet of riparian buffer impacts). Based on the impacts to the riparian buffer at this site, this crossing is EXEMPT. Waters of the U.S. Mitigation Avoidance: All wetlands and surface waters not affected by the project will be protected from unnecessary encroachment. No staging of construction equipment or storage of construction supplies will be allowed in wetlands or near surface waters. Minimization: The side slopes have been steepened to the extent possible at jurisdictional sites. Strict enforcement of sedimentation and erosion control Best Management Practices for the protection of wetlands and surface waters will be enforced during project construction. Continued coordination will occur with maintenance forces and the Environmental Officer during construction to minimize impacts to these sites. Compensatory Miti ag tion: All compensatory mitigation requirements will be left to the discretion of the regulatory review agencies. Protected Species Plants and animals with federal classifications of Endangered, Threatened, Proposed Endangered, and Proposed Threatened are protected under provisions of Section 7 and Section 9 of the ESA. There are four federally protected species listed for Wake County. They include bald eagle (Haliaeetrrs lerrcocephalrrs), red-cockaded woodpecker (Picoides borealis), dwarf wedgemussel (Alasmidonta heterdon), and Michaux's sumac (Rhtrs michcrrrrii): The project site is not adjacent to nor is it surrounded by open water suitable of supporting foraging habitat for the bald eagle. The open residential and agricultural land surroµnding this roadway do not offer suitable forging or nesting habitat for red-cockaded woodpecker. Roadway shoulders along this section of. SR 2233 are heavily maintained, eliminating the possibility for Michaux's sumac to exist in this area. Additionally, this small UT to Poplar Creek is within the headwaters of its system and does not provide suitable habitat for dwarf wedgemussel. Based on lack of suitable habitat observed during the 01/17/07 site visit and a review of the Natural Heritage Database last updated Fall 2001`d, biological conclusions of No Effect have been rendered for each of these species. Summary The NCDOT proposes to extend the existing structure and rebuild the roadway shoulder above the outlet. Rip rap armoring will be added to stabilize both ends of the pipe. Permanent impacts at the site associated with this work involve a total of 8 feet of surface water fill and 20 feet of rip rap placed along the streambank to protect the pipe ends.'The work zone will be dewatered for approximately 2 days. Concurrent temporary impacts to the stream from this activity will result in the dewatering of 28 linear feet of stream. The materials used for dewatering will be removed after construction. Riparian buffer impacts at Site 1 associated with this maintenance activity total 1,725 ft'- in Zone 1 and 1,136 ft2 in Zone 2 (totaling 28 linear feet of riparian buffer impacts). Based on the impacts to the riparian buffer at this site, this crossing is EXEMPT. Application is hereby made for a Department of the Army Section 404 Nationwide Permit (NWP) 3 and NWP 33. Additionally, this application provides notification to the NCDWQ as Section 401 Water Quality Certification (WQC) No. 3494 and No. 3366 will be utilized for construction of this project. The NCDOT will comply with all applicable NWP and WQC conditions. Apre-construction notification is attached with this request. If you have any questions or need additional information, please contact Ms. Heather Montague at (919) 560-6081. Sincerely, ~~~~~, J,~, J.W. Bowman, P.E. ` Division Engineer cc: Mr. Rob Ridings, NCDWQ Transportation Permitting Unit Mr. Battle Whitley, P.E., NCDOT District 1 Engineer Mr. Jason Holmes, NCDOT Wake County Maintenance Engineer Mr. Donald Pearson, NCDOT Roadside Environmental Field Ops t' `~'~~ '" ! ::$~ ..arv~' g' ,. ., r ., ,. g ~; ate' ~'~~ ... E, ' P . - `~ f i .., ";'~..~. r ~ 4 ~ ~ ~. Photograph 1. View of Outlet, perched because of blow hole. - . ~ t ~" ,~:~, F ~~~. Photograph 2. View downstream of Nutlet. .a „~~: ~. '- '. .~ ~~ ~- ~ .~ ~'~~x: SR 2233 (Smithfield Road) -Wake County -~ _ .., 5 d j ~Y12g}3~dA~t: ~ `~ rte' ~,~' ~- roar *''~O(ij. --~\c~(~' ~j'J/•- J 1 rI, .. ~"` "~ v t ~ yp/ , Nf ~ ~ r,. -..~ L,,7 I ~~ • i • OS ~. ~~; } :~ ~ '_~ l~o~ ~ ~ ~.. f ~ `~~,_ ~ Y ~ '.7~ _ . - ~"- r,, ., ~ 1: ' ' ,-,a v ~r, J _ i ~ _ . _ -: _ _ ~ 1. 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'~' '` s' \. s z ~ '~- ~k 3' _, -___ ~ ~,'. ,~ ~ , ~ I x _r.xA ,1\ Q ~ APB ~ v ~2 ~ ~. ,.y A;.B ~ ~ LoB l 't / ~ ~WmC2 ;~ .~a C~C~ w PAe /` 1 0 ~~ ~~4~. ~ ~ ~~„a ~z APB2 ~, ~WmCZ i ~~~ ' ~Jlsu-~` Cr ~~~ i u ?~~32 Ap8 Cn T U v c ~ o ~ + m + v m a v L C v 3 0 0 ~ N N d U C C ~ v ~ L m ~ N N O Q C O _ L .- ~ LL. m -F- ", O Z _ O D O D ~ ~ ~ C O L N m 4- O O 3 N i- ~ C N L E o a~ ~ U O d ° ~~ ~ o .~ o ~~~ ~" V ~ GA ~ ~ ~ ~ ~ ~ ~ a N ~ ~° a ~ w ~ ~ ~Z v n a' D C C ~ O ~ N + ~ O O 3 N } ~ C d L E O N ~ U O a ~ 4 ~ ~ w w Office Use Only: Form Versi< iVlarch O$ 2 0 0 7 0 1 6~ USACE Action ID No. DWQ No. (If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".) I. Processing 1. Check all of the approval(s) requested for this project: ® Section 404 Pec-mit ® Riparian or Watershed Buffer Rules ^ Section 10 Permit ^ Isolated Wetland Permit from DWQ ® 401 Water Quality Certification ^ Express 401 Water Quality Certification 2. Nationwide, Regional or General Permit Number(s) Requested NWP 3 and NWP 33 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 Ecosystem Enhancement Program (NCEEP) is proposed for mitigation of impacts, attach the acceptance letter from NCEEP, complete section VII[, and check here: ^ 5. If your project is located in any of North Carolina's twenty coastal counties (listed on page 4), and the project is within a North Carolina Division of Coastal Management Area of Environmental Concern (see the top of page 2 for further details), check here: ^ II. Applicant Information Owner/Applicant Information Name: NCDOT Division 5 J.W. Bowman Mailing Address: 2612 N. Duke St., Durham, NC 27704 Telephone Number: (919) 560-6851 Fax Number: (919) 560-3371 E-mail Address: wbowman adot.state.nc.us 2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter must be attached if the Agent has signatory authority for the owner/applicant.) Name: Company Affiliation: Mailing Address: Telephone Number: E-mail Address: Fax Number: Page 1 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 USAGE 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: Proposed extension of a structure conveying, an unnamed tributary to Poplar Creek on SR 2233 (Smithfield Road) in Wake County. 2. T.LP. Project Number or State Project Number (NCDOT Only): N/A 3. Property Identification Number (Tax PIN): N/A 4. Location County: Wake Nearest Town: Knig~tdale Subdivision name (include phase/lot number): N/A Directions to site (include road numbers, landmarks, etc.): From Raleigh, take the 64 Bypass east towards Knightdale Exit onto SR 2233 (Smithfield Road) and travel south. The project site is between Walton Hill Road and Dunn Road (approximately 3,000 ft south of the exit ram junction with SR 2233) and is adiacent the driveway for a church. 5. Site coordinates (For linear projects, such as a road or utility line, attach a sheet that separately lists the coordinates for each crossing of a distinct waterbody.) Decimal Degrees (6 digits minimum): 35.7627 °N 78.4569 °W b. Property size (acres): 0 2 acre 7. Name of nearest receiving body of water: UT Poplar Creek 8. River Basin: Neuse (Note -this must be one of North Carolina's seventeen designated major river basins. The River Basin map is available at htt~//h2o enr.state.nc.us/adminhnaps/.) 9. Describe the existing conditions on the site and general land use in the vicinity of the project at the time of this application: Site is surrounded by wooded area and development. Page 2 of 8 10. Describe the overall project in detail, including the type of equipment to be used: NCDOT will extend the existing_pipe in order to widen the narrow and unsafe shoulder above the outlet. Also rip rap armoring will be added to stabilize the stream banks and shoulder till section above both pipe ends. The NCDOT will also dewater the work zone during construction. Equipment may include excavator, backhoe, bulldozer, grader, and crane. 11. Explain the purpose of the proposed work: NCDOT will extend the existing_pipe in order to widen the narrow and unsafe shoulder above the outlet. 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. N/A V. Future Project Plans Are any future permit requests anticipated for this project? If so, describe the anticipated work, and provide justification for the exclusion of this work from the current application. 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. Each impact must be listed separately in the tables below (e.g., culvert installation should be listed separately from riprap dissipater pads). Be sure to indicate if an impact is temporary. All proposed impacts, pernanent and temporary, must be listed, and must be labeled and clearly identifiable on an accompanying site plan. All wetlands and waters, and all streams (intermittent and perennial) should 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. Provide a written description of the proposed impacts: A total of 8ft of surface water fill will result from adding two joints of ape to the outlet end. Additionally 10 ft of rip rap arnoring_will be added to both the inlet and the outlet of the structure. Also 28 ft of concurrent dewatering is proposed. Page 3 of 8 Individually list wetland impacts. Types of impacts include, but are not limited to mechanized clearing, grading, fill, excavation, flooding, ditching/drainage, etc. For dams, separately list impacts due to both structure and flooding. Wetland Impact Type of Wetland Located within Distance to Area of Site Number Type of Impact (e.g., forested, marsh, 100-year Nearest Impact (indicate on map) herbaceous, bog, etc.) Floodplain Stream (acres) (yes/no) (linear feet) N/A N/A N/A N/A N/A N/A Total Wetland Impact (acres) N/A 2. List the total acreage (estimated) of all existing wetlands on the property: N/A 3. Individually list all intermittent and perennial stream impacts. Be sure to identify temporary impacts. Stream impacts include, but are not limited to placement of fill or culverts, dam construction, flooding, relocation, stabilization activities (e.g., cement walls, rip-rap, crib walls, 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. To calculate acreage, multiply length X width, then divide by 43,560. Stream Impact Perennial o Average Impact Area of Number Stream Name Type of Impact j Intermittent' Stream Width Length Impact (indicate on ma) . Before Im act (linear feet) (acres) Site 1 UT Poplar Creek Fill (piped length) intermittent I.5 8 0.0003 Rip rap armoring 20 0.0007 glop stream bank Temporary (28) (0.0010) dewatering concurrent concurrent Total Stream Impact (by length and acreage) 28 0.0010 4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic Ocean and any other water of the U.S.). Open water impacts include, but are not limited to fill excavatinn rlrerluina flnndinu_ drainaee_ hulkheads_ etc. Open Water Impact Name of Waterbody Type of Waterbody Area of Site Number (if applicable) Type of Impact (lake, pond, estuary, sound, bay, Impact (indicate on ma) ocean, etc.) (acres) N/A Total Open Water Impact (acres) N/A 5. List the cumulative impact to all Waters of the U.S. resulting from the project: Stream Impact (acres): 0.0010 Wetland Impact (acres): NONE Open Water Impact (acres): NONE Total Impact to Waters of the U.S. (acres) 0.0010 Total Stream Impact (linear feet): 28 Page 4 of 8 6. Isolated Waters Do any isolated waters exist on the property? ^ Yes ®No Describe all impacts to isolated waters, and include the type of water (wetland or stream) and the size of the proposed impact (acres or linear feet). Please note that this section only applies to waters that have specifically been determined to be isolated by the USAGE. N/A 7. Pond Creation If construction of a pond is proposed, associated wetland and stream impacts should be included above in the wetland and stream impact sections.. Also, the proposed pond should be described here and illustrated on any maps included with this application. Pond to be created in (check all that apply): ^ uplands ^ stream ^ wetlands Describe the method of construction (e.g., dam/embankment, excavation, installation of draw-down valve or spillway, etc.): N/A Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond, local storrnwater requirement, etc.): N/A Current land use in the vicinity of the pond: N/A Size of watershed draining to pond: N/A Expected pond surface area: N/A 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. All wetlands and surface waters not affected by construction will be protected from unnecessary encroachment during construction. Strict enforcement of Best Management Practices for the protection of wetlands and surface waters will be enforced during construction. Only the smallest amount of fill necessary to complete the project will be placed in waters of the United States. 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. USAGE - In accordance with the Final Notice of Issuance and Modification of Nationwide Permits, published in the Federal Register on January 15, 2002, 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 Page 5 of 8 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 USAGE or DWQ to consider the application complete for processing. Any application lacking a required mitigation plan or NCEEP 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. All compensatory mitigation requirements will be left to the discretion of the re ulatory review a encies. 2. Mitigation may also be made by payment into the North Carolina Ecosystem Enhancement Program (NCEEP). Please note it is the applicant's responsibility to contact the NCEEP at (919) 715-0476 to determine availability, and written approval from the NCEEP indicating that they are will to accept payment for the mitigation must be attached to this form. For additional information regarding the application process for the NCEEP, check the NCEEP website at http://h2o.enr.state.nc.us/wrp/index.htm. If use of the NCEEP is proposed, please check the appropriate box on page five and provide the following information: Amount of stream mitigation requested (linear feet): N/A Amount of buffer mitigation requested (square feet): N/A Amount of Riparian wetland mitigation requested (acres): N/A Amount ofNon-riparian wetland mitigation requested (acres): N/A Amount of Coastal wetland mitigation requested (acres): N/A IX. Environmental Documentation (required by DWQ) 1. Does the project involve an expenditure of public (federal/state/local) funds or the use of public (federal/state) land? Yes ® No ^ 2. 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 aNEPA/SEPA document is required, call the SEPA coordinator at (919) 733-5083 to review current thresholds for environmental documentation. Yes ^ No Page 6 of 8 3. If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a copy of the NEPA or SEPA final approval letter. Yes ^ No ^ X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ) It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to required state and local buffers associated with the project. The applicant must also provide justification for these impacts in Section VII above. All proposed impacts must be listed herein, and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ Regional Office may be included as appropriate. Photographs may also be included at the applicant's discretion. I. Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233 (Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 02B .0243 (Catawba) 15A NCAC 2B .0250 (Randleman Rules and Water Supply Buffer Requirements), or other (please identify )? Yes ® No ^ 2. If "yes", 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. Site 1 Zone* Impact (square feet) Multiplier Required Mitigation 1 1,725 3 (2 for Catawba) N/A 2 1,136 1.5 N/A Total 2,861 N/A * Zone I extends out 30 feet perpendicular from the top of the near bank of channel; Zone 2 extends an additional 20 feet from the edge of Zone 1. 3. If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation of Property, Riparian Buffer Restoration /Enhancement, or Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as identified within I SA NCAC 2B .0242 or .0244, or .0260. N/A XI. Stormwater (required by DWQ) Describe impervious acreage (existing and proposed) versus total acreage on the site. Discuss stortnwater controls proposed in order to protect surface waters and wetlands downstream from the property. If percent impervious surface exceeds 20%, please provide calculations demonstrating total proposed impervious level. No additional impervious surface is proposed with this maintenance nroiect. Erosion and sediment control devices at this site are comprised of temporary dewaterin and rip rap armoring. Page 7 of 8 XII. Sewage Disposal (required by DWQ) 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. This project will not generate wastewater. XIII. Violations (required by DWQ) Is this site in violation of DWQ Wetland Rules (15A NCAC 2H .0500} or any Buffer Rules? Yes ^ No Is this an after-the-fact permit application? Yes ^ No XIV. Cumulative Impacts (required by DWQ) Will this project (based on past and reasonably anticipated future impacts) result in additional development, which could impact nearby downstream water quality? Yes ^ No If yes, please submit a qualitative or quantitative cumulative impact analysis in accordance with the most recent North Carolina Division of Water Quality policy posted on our website at http://h2o.enr.state.nc.us/ncwetlands. If no, please provide a short narrative description: This maintenance project will not result in additional development. XV. 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). ~-Applicant/Agent's Signature Date (Agent's signature is valid only if an authorization letter from the applicant is provided.) Page 8 of 8