General Permits (4068)

1 0 CERTIFICATION OF EXEMPTION
FROM REQUIRING A CAMA PERMIT
as authorized by the State of North Carolina,
Department of Environment, Health, and Natural Resources and the Coastal Resources Commission
in an area of environmental concern pursuant to 15 NCAC Subchapter 7K .0203.
Applicant Name .Phone Number
Address
City ( State
Project Location (County, State Road, Water Body, etc.)
Type and Dimensions of Project
The proposed project to be located and constructed as described
above is hereby certified as exempt from the CAMA permit re-
quirement pursuant to 15 NCAC 7K .0203. This exemption to
CAMA permit requirements does not alleviate the necessity of
your obtaining any other State, Federal, or Local authorization.
Zip
This certification of exemption from requiring a CAMA permit is
valid for 90 days from the date of issuance. Following expiration,
a re-examination of the project and project site may be necessary
to continue this certification.
I SKETCH (SCALE: ) I
Any person who proceeds with a development without the con-
sent of a CAMA official under the mistaken assumption that the
development is exempted, will be in violation of the CAMA if there
is a subsequent determination that a permit was required for the
development.
The applicant certifies by signing this exemption that (1) the ap-
plicant has read and will abide by the conditions of this exemp-
tion, and (2) a written statement has been obtained from adjacent
landowners certifying that they have no objections to the
proposed work.
to
Applicant's signature
i
CAMA Off iciaFs signature
J I �U
Issuing date
j 1 11 'Z v
Expiration date
Attachment: 15 North Carolina Administrative Code 7K .0203

Tocdt-tion:
Phone
Description of Project:
�1
ld Rep.
Date cf Report:
Date Project Reportedly Comp-fftte:
(1)' Do the *measured dimensions of the developmen "iffer from those
indicated in the permit .and rkplat?, Yes / No Have all pernit
conditions been satisfied? es / No
CO2P=NT :
(2)
(3)
Sedinenta-icn an(i Fresicn Control: Has Sc= eft
or c'ther"wlse sta'Zi1iZed all disturhed arca5: c Na
COMr IN
1
crassad,
Future Mcn1tcring and Qnforcement P_ n: Is' furl^er in`estlQat? cr.
or enforcement- action needed? Yes
COUNT:

cA 41
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U.S. ARMY CORPS OF ENGINEERS
Action ID: I q - } -� () ?_' \ t
Wilmington District
County:
Notification of Jurisdictional Determination
Property owner/Authorized Agent
tl �QV�CS C /6 �csV J �v tamer
Address -A•o/�r.br
., DJ (�t`/ 4
Telephone Number 0.S`` �� t�{ 3 �� •��� i
Size and Location of Property(waterbody, Highway
Indicate Which of the following apply:
ber, town, etc.) V?- S�v.,J L Mc r m\ 4 , S\(—
• There are wetlands on the above described property which we strongly suggest should be delineated and
surveyed. The surveyed wetland lines must be verified by our staff before the Corps will make a final
jurisdictional determination on your property.
�� • Because of the size of your property and our present workload, our identification and delineation of your
wetlands cannot be accomplished in a timely manner. You may wish to employ a consultant to obtain a
�U t more timely delineation of the wetlands. Once your consultant has flagged a wetland line on the property,
�-v CeZ-�.Corps staff will review it, and, if it is accurate, we strongly recommend that you have the line surveyed for
2` C e° 4final approval by the Corps. The Corps will not make a final jurisdictional determination on your property
without an approved survey.
• e wetlands on your lot have been delineated, and the limits of Corps jurisdiction have been explained
to you. Unless there is a change in the law or our published regulations, this determination may be relied
upon for a period not to exceed three years from the date of this notification.
• There are no wetlands present on the above described property which are subject to the permit
requirements of Section 404 of the Clean Water Act (33 USC 1344). Unless there is a change in the law
or our published regulations, this determination may be relied upon for a period not to exceed three years
from the date of this notification.
• The project is located in one of the 20 Coastal Counties. You should contact the nearest State Office of
Coastal Management to determine their requirements.
Placement of dredged or fill material in wetlands on this property without a Department of the Army
permit is in most cases a violation of Section 301 of the Clean Water Act (33 USC 1311). A permit is
not required for work on the property restricted entirely to existing high ground. If you have any
questions regarding the C of Engineers regulatory rogram, please contact
at 1O 1-4 G3(o
Property owner/Authorized Agent Signature
Project Manager Signature
Date u �OL)JExpiration Date
SURVEY PLAT OR FIELD SKETCH OF DESCRIBED PROPERTY AND THE WETLAND
DELINEATION FORM MUST BE ATTACHED TO THE YELLOW (FILE) COPY OF THIS FORM.
CESAW Form 566
1 OCT 92