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HomeMy WebLinkAbout35204_NC DOT_200309264" 1 CAMA / ❑ DREDGE & FILL GENERAL RAL PERMIT Previous permit # ❑❑New Modification ❑Complete Reissue ❑Partial Reissue Date previous permit issued As authorized by the State of North Carolina, Department of Environment and Natural Resources and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC ❑ Rules attached. Applicant Name ; w Project Location: County Address ,i :- i_i j Street Address/ State Road/ Lot #(s) City State ZIP Phone # Fax # ( ) Subdivision Authorized Agent � ; "14 C , City _ ZIP Affected CW NEW ❑ PTA ❑ ES ❑ PTS Phone # ( ) - River Basin OEA ElHHF ElIH ElUBA El N/A AEC(s): Adj. Wtr. Body _ (nat /man /unkn) C PWS: ❑FC: ORW: yes / no PNA yes / no Crit. Hab. yes / no Closest Maj. Wtr. Body Type of Project/ Activity (Scale: ) Pier (dock) length Platform(s) Finger pier(s) Groin length number Bulkhead/ Riprap length avg distance offshore max distance offshore Basin, channel cubic yards Boat ramp Boathouse/ Boatlift Beach Bulldozing i Others 1.�,� �,u�,•''!.d;� Shoreline Length SAM not sure yes no Sandbags: not sure yes no Moratorium: n/a es i no Photos: yes J no Waiver Attached: yes no A building permit may be required by: Notes/ Special Conditions Agent or Applicant Printed Name Signature "Please read compliance statement on back of permit" Application Fee(s) Check # See note on back regarding River Basin rules. Permit Officer's Signature Issuing Date 'Expiration Date 5W Local Plan ningJurisdiction Rover File Name L- Statement of Compliance and Consistency This permit is subject to compliance with this application, site drawing and attached general and specific conditions. Any violation of these terms may subject the permittee to a fine or criminal or civil action; and may cause the permit to become null and void. This permit must be on the project site and accessible to the permit officer when the project is inspected for compliance. The applicant certifies by signing this permit that 1) prior to undertaking any activities authorized by this permit, the applicant will confer with appropriate local authorities to confirm that this project is consistent with the local land use plan and all local ordinances, and 2) a written statement or certified mail return receipt has been obtained from the adjacent riparian Iandowner(s) . The State of North Carolina and the Division of Coastal Management, in issuing this permit under the best available information and belief, certifythatthis project is consistentwith the North Carolina Coastal Management Program. River Basin Rules Applicable To Your Project: ❑ Tar- Pamlico River Basin Buffer Rules ❑ Other: ❑ Neuse River Basin Buffer Rules If indicated on front of permit, your project is subject to the Environmental Management Commission's Buffer Rules for the River Basin checked above due to its location within that River Basin. These buffer rules are enforced by the NC Division of Water Quality. Contact the Division of Water Quality at the Washington Regional Office (252-946-6481) or the Wilmington Regional Office (910-395-3900) for more information on how to comply with thesebuffer rules. Division of Coastal Management Offices Central Office Elizabeth City District Mailing Address: 1367 U.S. 17 South 1638 Mail Service Center Elizabeth City, NC 27909 Raleigh, NC 27699-1638 252-264-3901 Location: Fax: 252-264-3723 Parker -Lincoln Building 2728 Capital Blvd. Raleigh, NC 27604 919-733-2293 / 1-888ARCOAST Fax: 919-733-1495 (Serves: Camden, Chowan, Currituck, Dare, Gates, Pasquotank and Perquimans Counties) Morehead City District 151-13 Hwy. 24 Hestron Plaza II Morehead City, NC 28557 202-808-2808 Fax: 252-247-3330 (Serves: Carteret, Craven, Onslow -above New River Inlet- and Pamlico Counties) Washington District 943 Washington Square Mall Washington, NC 27889 252-946-6481 Fax: 252-948-0478 (Serves: Beaufort, Bertie, Hertford, Hyde, Tyrrell and Washington Counties) Wilmington District 127 Cardinal Drive Ext. Wilmington, NC 28405-3845 910-395-3900 Fax: 910-350-2004 (Serves: Brunswick, New Hanover, Onslow -below New River Inlet- and Pender Counties) www.nccoastalmanagement.net Revised 10/05/01 A —EXA GOB NCDENR North Carolina Department of Environment and Natural Resources Division of Coastal Management Michael F. Easley, Governor Donna D. Moffitt, Director William G. Ross Jr., Secretary September 26, 2003 NC Department of Transportation ATTN: Mr. Mason Herndon 124 Division Drive Wilmington, NC 28401 Dear Mr. Herndon: Attached is General Permit #C-35204 to replace culverts in New Hanover County adjacent to Pages Creek at SR 1403 (Middle Sound Loop Road) at the crossing of the tributary to Pages Creek. In order to validate this permit, please sign all three (3) copies as indicated. Retain the white copy for your files and return the signed yellow and pink copies to us in the enclosed, self- addressed envelope. If the signed permit copies are not returned to this office before the initiation of development, you will be working without authorization and will be subject to a Notice of Violation and subsequent civil penalties. We appreciate your early attention to this matter. Sincerely, Bill Arrington D.O.T. Field Representative BA/srk Enclosures 151-B Hwy. 24, Hestron Plaza II, Morehead City, North Carolina 28557 Phone: 252-808-28081 FAX: 252-247-33301 Internet: www.nccoastalmanagement.net An Equal Opportunity 1 Affirmative Action Employer— 50% Recycled 110% Post Consumer Paper XCAMA / }DREDGE & FILL Y 3J O GENERAL PERMIT Previous permit # / 114 XNew DModification ❑Complete Reissue ❑Partial Reissue Date previous permit i ued /'A As authorized by the State of North Carolina, Department of Environment and Natural Resources and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC C+ % f f ^^'' nn ❑Rules attached. Applicant Name At h 0- Project Location: County n.'� �;� Rules attached. e _ Address / bh Ut^i VP-- Street Address/ State Road/ Lot #(s) S ft City State ZIP�Gn- Phone # (�) Z 5 % 3%& Fax # ( ) Subdivision Plc .fe Cue k /) Authorized Agent C h C, �- _ - _ City C2 c. ZIP XCW XEW El PTA XES PTS Phone# ( -_) River Basin Gct T�4 Affected OEA ❑ HHF 7— IH UBA N/A AEC(s): Adj. Wtr. Body A'6-C' 5 Cre-e ate/man /unkn) PWS: - FC: I II ^_ ORW: yes / no PNA yes no Crit. Hab. yes / no Closest Maj. Wtr. Body } l i -tom r C' e c,-. Type of Project/ Activity C tr_, �-o� /� F � �n c e? ttu 10 (Scale: CA tiro ci Pier (dock) length_ _, Platforms) _ __ Finger pier(s) — — -- (� ( f \ lei[ . // �XI J r I �711 Groin length li�l number Bulkhead/ Riprap length avg distance offshore max distance offshore y t `7 7/ Cc r. t jf ✓ �� �/ �'`� S Basin, channel " " cubic yards_ C(C � [� Boat ramp - - - - - - - Ct • 1� ✓`4 L-. t t' >v� S 5 f_ t U 111-t' Boathouse/ Boatlift "4e A (�/Vc 3 Beach Bulldozing Otherc'—C.(I Shoreline Length SAM not sure yes too Sandbags: not sure yes Moratorium: n/a Fye2 no Photos: no Waiver Attached: es no A building permit may be required by: See note on back regarding River Basin rules. Notes/ Special Conditions es tat f U PY I r\ V� r`r iV1 �t �� 6� �+ f cti S / �Z U2 �� �c' c�`��i%cC ftii ►✓ p�C 1`1aSOOL H-,�rtte&'A- --- Agent or Applicant Printed Name P rmit Office 9/;?u /o Signature ** Please read compliance stajte�ment on back of permit * Issuing D2(te ' Expira iion Date / Application Fee(s) Check # Local Planning Jurisdiction Rover File Name NC DOT project No. 36762 Subject: NC DOT project No. 36762 Date: Fri, 26 Sep 2003 10:31:50 -0400 From: Bill Arrington <Bill.Arrington@ncmail.net> Organization: NC DENR DCM To: "Poole, Jaye" <Jaye.Poole@ncmail.net> Hi Jaye, I hope this note finds you back to work and feeling well. Could you debit DOT for $100.00 for GP 35204, DOT project No. 36762. I'm sorry to hear about your illness. I hope you take time to rest and recover fully. Bill 1 of 1 9/26/03 10:33 A j I ra STATE OF NORTH CAROLINA DEPARTMENT OF TRANSPORTATION MICHAEL F. EASLEY DIVISION OF HIGHWAYS LYNDO TIPPETT GOVERNOR SECRETARY September 15, 2003 Bill Arrington, Field Representative Division of Coastal Management North Carolina Department of Environment and Natural Resources 151 — B Highway 24 Hestron Plaza Morehead City, North Carolina 28557 SUBJECT: Pipe replacement on Middle Sound Loop Rd (SR 1403), at Pages Creek, New Hanover County. Project # 36762, CAMA GP application fee of $100.00 will apply. Dear Mr. Arrington: Please find enclosed a CAMA General Permit Application for a pipe replacement on Middle Sound Loop Rd. (SR 1403), 0.2 miles west of SR 1814 (Anaca Point Rd) in New Hanover County. The existing pipe is a 54" x 54-ft corrugated metal pipe (CMP) and will be replaced with a 54" X 47-ft corrugated aluminum pipe (CAP). Headwalls and wingwalls will be placed on both the upstream and downstream ends of the pipes to stabilize the shoulder. Replacement of this pipe is necessary due to its poor and deteriorating condition. Furthermore, it is proposed to resurface and widen this road to 28 ft to create safer travel lanes and add a bicycle lane to this roadway as part of the Moving Ahead program. Pipe size was recommended in order to accommodate for the drainage area and to allow for 1 ft of the pipe diameter to be set below normal bed elevation. The scope of the work will impact 0.002 acres of waters to an unnamed tributary to Pages Creek, which is classified SA HQW by the Division of Water Quality. A courtesy notification for this pipe as well as an application to extend two additional pipes in 404 jurisdictional areas on this project has been sent to the Army Corp of Engineers, Wilmington District Office. If you have any question or concerns, please feel free to contact me at (910) 251-5724. Enclosures Sincerely, ;;11 l Mason Herndon, Division Environmental Officer Division 3 124 Division Drive, Wilmington, NC 28401 PHONE: (910) 251-5724 FAX: (910) 251-5727 Form DCM-MP-5 BRIDGES AND CULVERTS Attach this form to Joint Application for CAMA Major Permit, Form DCM-MP-1. Be sure to complete all other sections of the Joint Application that relate to this proposed project. 1. BRIDGES i. Height of proposed bridge above wetlands j. Will the proposed bridge affect existing water flow? Yes F] No If yes, explain a. Public ] Private [l k. Navigation clearance underneath proposed bridge b. Type of bridge (construction material) 1. Will the proposed bridge affect navigation by c. Water body to be crossed by bridge reducing or increasing the existing navigable opening? n Yes ❑No If yes, explain d. Water depth at the proposed crossing at MLW or NWL e. Will proposed bridge replace an existing bridge? m. Will the proposed bridge cross wetlands containing nYes -ONo no navigable waters? ElYes -ONo If yes, If yes, explain (1) Length of existing bridge (2) Width of existing bridge (3) Navigation clearance underneath existing n. Have you contacted the U.S. Coast Guard bridge concerning their approval? (4) Will all, or a part of, the existing bridge be C1 Yes _0No removed? (Explain) If yes, please provide record of their action. f. Will proposed bridge replace an existing culvert(s)? 2. CULVERTS Yes F] No If yes, a. Water body in which culvert is to be placed (1) Length of existing culvert Pages Creek (2) Width of existing culvert (3) Height of the top of the existing culvert above b. Number of culverts proposed 1 the MHW or NWL (4) Will all, or a part of, the existing culvert be c. Type of culvert (construction material, style) removed? (Explain) Corrugated Metal Pipe (CMP) d. Will proposed culvert replace an existing bridge? n Yes -ENo g. Length of proposed bridge If yes, (1) Length of existing bridge h. Width of proposed bridge (2) Width of existing bridge Revised 03/95 Form DCM-MP-5 (3) Navigation clearance underneath existing (2) Width of area to be excavated 2 ft bridge (3) Amount of material to be excavated in cubic (4) Will all, or a part of, the existing bridge be yards 1_3 removed? (Explain) c. Will the placement of the proposed bridge or culvert e. Will proposed culvert replace an existing culvert? require any highground excavation? IR Yes R No IR Yes ELNo If yes, If yes, (1) Length of existing culvert 54 ft (1) Length of area to be excavated 47 ft (2) Width of existing culvert 54 in (2) Width of area to be excavated 32 ft (3) Height of the top of the existing culvert above (3) Amount of material to be excavated in cubic the MHW or NWL 2.6 ft MHW yards 278 (4) Will all, or a part of, the existing culvert be removed? (Explain) Due to the poor d. If the placement of the bridge or culvert involves any condition of existing pipe all will be excavation, please complete the following: removed (1) Location of the spoil disposal area NCDOT New Hanover County waste site f. Length of proposed culvert 47 ft (2) Dimensions of spoil disposal area g. Width of proposed culvert 54 in N/A (3) Do you claim title to the disposal area? h. Height of the top of the proposed culvert above the E Yes ❑ No MHW or NWL 2.0 ft MHW If no, attach a letter granting permission from the owner. i. Will the proposed culvert affect existing water flow? (4) Will the disposal area be available for future M Yes -2 No maintenance? R Yes EL No If yes, explain (5) Does the disposal area include any coastal wetlands (marsh), SAVs, or other wetlands? R Yes E No j. Will the proposed culvert affect existing navigation If yes, give dimensions if different from (2) potential? R Yes -ENo above. If yes, explain (6) Does the disposal area include any area below the MHW or NWL? R Yes E No If yes, give dimension if different from No. 2 3. EXCAVATION AND FILL above. e. Will the placement of the proposed bridge or culvert a. Will the placement of the proposed bridge or culvert result in any fill (other than excavated material require any excavation below the MHW or NWL? described in Item d. above) to be placed below MHW E Yes 0-No or NWL? E Yes Q No If yes, If yes, (1) Length of area to be excavated 8 ft (1) Length of area to be filled 47 ft (2) Width of area to be excavated 10 ft (2) Width of area to be filled 18 ft (3) Depth of area to be excavated 2.0 ft (3) Purpose of fill Stone bedding and backfill (4) Amount of material to be excavated in cubic around pipe yards 5_9 f. Will the placement of the proposed bridge or culvert b. Will the placement of the proposed bridge or culvert result in any fill (other than excavated material require any excavation within: described in Item d. above) to be placed within: R Coastal Wetlands R SAVs E Other Wetlands ____ Coastal Wetlands _ SAVs _ Other Wetlands If yes, If yes, (1) Length of area to be excavated 9 ft (1) Length of area to be filled N/A (2) Width of area. to he filled N/A Form DCM-MP-5 (3) Purpose of fill N/A g. Will the placement of the proposed bridge or culvert result in any fill (other than excavated material described in Item d. above) to be placed on highground? F1 Yes 0 No If yes, (1) Length of area to be filled (2) Width of area to be filled (3) Purpose of fill 4. GENERAL h. Will the placement of the proposed bridge or culvert require any shoreline stabilization? Yes Fj No If yes, explain in detail Headwalls and win,y; walls will be placed on both inlet and outlet ends of pipe NCDOT-Middle Sound Loop Rd - New Hanover Applicant or Project Name � � Signature September 10, 2003 ��. Date a. Will the proposed project involve any mitigation? Q Yes 0 No If yes, explain in detail b. Will the proposed project require the relocation of any existing utility lines? ❑ Yes R No If yes, explain in detail c. Will the proposed project require the construction of any temporary detour structures? M Yes 0 No If yes, explain in detail d. Will the proposed project require any work channels? Q Yes ® No If yes, complete Form DCM-MP-2 e. How will excavated or fill material be kept on site and erosion controlled? silt fence f. What type of construction equipment will be used (for example, dragline, backhoe or hydraulic dredge)? backhoe, crane g. Will wetlands be crossed in transporting equipment to project site? ❑ Yes 0 No If yes, explain steps that will be taken to lessen environmental impacts. -- -- _-- um ---- ---, e — — — — — — — — — — ,� ¢ 1894 1822 ^ro 8371834 \ o � 1939 .� � 1407 ,D 403 R � .� �+ 1828 ae o d• 140 404 •� 182 � 1918 1403 1. .a 1925 r4 9 035 �1831 1846 S=? 1 1838 1830 \8 .y it 1918 1848 8 01 ,� 2 1908 1927'a 1404 $ t9t 40.E 1815 .rr 1844 36'' B 'r 8 7 mg S 182 •- _ q, a 192 °j 192 ' e 1403 1408 1825 POil 841 .1910 1947 'e2 1843 16 1948 m'� 945 4 � 1948 1941 1944 � 1940 Omk ,' 7e �• fv � wrightsv,116 14 1 WS / ' 0 / , / f / / WRIG POP.3119988EACH 3 \ O � I ese \ QD ' r0 81 , 1l ' 1\ / 7e / / / / / / / / / AV V SR 1403 PIPE REPLACEMENT - OUTLET �•, ` rr. V^� � ♦ Ilr 4 Iti i l I •I �1 ���* 1 +��• 1_ i.. � / _ '��"e S. ati 1:�� • � rt ' ,,• t n [' � ., Ertl ♦ � r N Ar �.. �/ 'r�t ��• 'y (�)�� y�j "l +` .fie-�.- ., 4 p Ali i} \ ) �`11� ; •y 1 ) - ,Cr •`r vx. 41 • L r-G rr �� � t J i �• ��� ,�. i 7,� w' .t'r ' 1 I . � ��� _ r�_,�;- �': ;.t �� 1��� �r�i�l•,,. 41, � , r .���1''�'�•,U7Y: �(, rr• r jj���' Iy��� j� 4 1,t� rlrrG F 4� � 14� �,� � � Y, J , Pi o ject Road County L)I_Ii�d I� Katherine V Devane PO Bc,x -"- 8 W11mingtr,n, N1- 28402-�12`18 P11_)e Exten,_,ir-�,n SR 1403 Middle New Hanover Scott:Hill Wachovia Mortgage Co. PO Box 3196 15th Floor Winton Salem, NC 27102-3196 EXISTING Fi4" X 54 ft CMP 20 DEGREE `=,kEW go ound =F- Rd PROPOSED 54" X 47 ft CAP CI New Hanover County Water/Sewer C/O Depi-ALI Finance Dir ectnr 414 Chestnut St. Wilmington, NC 28401 Katherine V Devane PO Box 2q8 Wilmington, NC 28402-0298 --- ------ WETLAND BOUNDARY .................. _.........._____...._._..... EDGE OF PAVEMENT FILL AREA - — - — EDGE OF SHOULDERS ------------ TOE OF SLOPE - — - - — - - — INTERMITTENT STREAM \Templates\Pipe X2_section.dgn 09/10/03 12:36:35 PM STATE OF NORTH CAROLINA DEPARTMENT OF TRANSPORTATION MICHAEL F. EASLEY DIVISION OF HIGHWAYS LYNDO TIPPETT GOVERNOR SECRETARY CERTIFIED MAIL RETURN RECEIPT REQUESTED September 10, 2003 Katherine V. Devane PO Box 298 Wilmington, NC 28402-0298 Dear Ms. Devane: This correspondence is to notify you as an adjacent riparian landowner that the North Carolina Department of Transportation plans to replace the existing 54" x 54 ft metal pipe with a 54" x 47 ft aluminum pipe with head and wing walls, onsite of his/her property located on SR 1403 (Middle Sound Loop Rd) in New Hanover County. The sketch attached accurately depicts the proposed construction. Should you have objections to the proposed construction, please check the appropriate statement below, sign, date, and return as soon as possible to: Mr. Bill Arrington N.C. Dept. of Environment and Natural Resources Morehead City District Division of Coastal Management 151-B Hwy 24 Hestron Plaza II Morehead City, N.C. 28557 Written comments must be received by the Division of Coastal Management within 10 days of receipt of this notice. NO RESPONSE WITHIN 10 DAYS of receipt of the correspondence will be INTERPRETED AS NO OBJECTION. Sincerely, I have no objection to the proposed project as described in this correspondence. I have objection to the project as presently proposed and have enclosed comments. (Signature) (Date) 124 Division Drive, Wilmington, NC 28401 PHONE: (910) 251-5724 FAX: (910) 251-5727 46- STATE OF NORTH CAROLINA DEPARTMENT OF TRANSPORTATION MICHAEL F. EASLEY DIVISION OF HIGHWAYS LYNDO TIPPETT GOVERNOR SECRETARY CERTIFIED MAIL RETURN RECEIPT REQUESTED September 10, 2003 Wachovia Mortgage Company PO Box 3196, 15th Floor Winston Salem, NC 27102-3196 To Whom it May Concern: This correspondence is to notify you as an adjacent riparian landowner that the North Carolina Department of Transportation plans to replace the existing 54" x 54 ft metal pipe with a 54" x 47 ft aluminum pipe with head and wing walls, onsite of his/her property located on SR 1403 (Middle Sound Loop Rd) in New Hanover County. The sketch attached accurately depicts the proposed construction. Should you have objections to the proposed construction, please check the appropriate statement below, sign, date, and return as soon as possible to: Mr. Bill Arrington N.C. Dept. of Environment and Natural Resources Morehead City District Division of Coastal Management 151-B Hwy 24 Hestron Plaza II Morehead City, N.C. 28557 Written comments must be received by the Division of Coastal Management within 10 days of receipt of this notice. NO RESPONSE WITHIN 10 DAYS of receipt of the correspondence will be INTERPRETED AS NO OBJECTION. Sincerely, I have no objection to the proposed project as described in this correspondence. I have objection to the project as presently proposed and have enclosed comments. (Signature) (Date) 124 Division Drive, Wilmington, NC 28401 PHONE: (910) 251-5724 FAX: (910) 251-5727 STATE OF NORTH CAROLINA DEPARTMENT OF TRANSPORTATION MICHAEL F. EASLEY DIVISION OF HIGHWAYS LYNDO TIPPETT GOVERNOR SECRETARY CERTIFIED MAIL RETURN RECEIPT REQUESTED September 10, 2003 New Hanover County Water/Sewer C/O Deputy Finance Director 414 Chestnut St. Wilmington, NC 28401 To Whom it May Concern: This correspondence is to notify you as an adjacent riparian landowner that the North Carolina Department of Transportation plans to replace the existing 54" x 54 ft metal pipe with a 54" x 47 ft aluminum pipe with head and wing walls, onsite of his/her property located on SR 1403 (Middle Sound Loop Rd) in New Hanover County. The sketch attached accurately depicts the proposed construction. Should you have objections to the proposed construction, please check the appropriate statement below, sign, date, and return as soon as possible to: Mr. Bill Arrington N.C. Dept of Environment and Natural Resources Morehead City District Division of Coastal Management 151-B Hwy 24 Hestron Plaza II Morehead City, N.C. 28557 Written comments must be received by the Division of Coastal Management within 10 days of receipt of this notice. NO RESPONSE WITHIN 10 DAYS of receipt of the correspondence will be INTERPRETED AS NO OBJECTION. Sincerely, I have no objection to the proposed project as described in this correspondence. I have objection to the project as presently proposed and have enclosed comments. (Signature) (Date) 124 Division Drive, Wilmington, NC 28401 PHONE: (910) 251-5724 FAX: (910) 251-5727 SEP-19-2003 16:56 DIU 3 OFFICE ■ Complete items 1, 2, and 3. AIW oomplete A i Item 4 If Restricted Delivery Is desired. X ■ Print.your name and address bn the reverse So that we can return the card to you, g, • Attach this card to the back of the mailplece, or on the front If space permits. 1. Article Addressed to: 9102515727 P.02 0 Ag M ReceWed bd Pilnted Nerve) C. Date of Delivery J 0, lardoll rmbedaerwItfromhOM17VMES, e address below: ❑ No 11 2D43 PO r—D-01K, 2q g 3. SMVIc6TYPO XcGartlfied Mail ❑ uprass Mall r I r /� 2 �7 4D 2 _ 0 Registered �etum Receipt for Merchandise f \v�v! + v (—, b ❑Insured Mall CI C.O.D. ®2(q 4. 86Btrlctsd DApveryr Prhm r'ee) ❑ Yea 2. !uttGle tJuunbar 7 0 0 2 2 410 0 0 0 6 9367 1031 F9 i grin, 3$11, August 2001 i ; s 17omestic Return Kaoelpt ,u2sssoz•r+> ,sac ■ Complete Items , 2, aplete A SI ure nd 3. Also Com' Item 4 If Restricted Delivery Is desired. V❑ Age 0 Print your name and address On the rev&U X ❑Addresses So that we can return the card to you, ■ Attach this card to the back of the mallplece, ved by (FW ES ate of Delivery or on the front If space permits. Mlcle Addressed to: D. 19 dellvery d }feramt from hem 1? H YES, a or ry address below: N W a.dhwJ 8. Service 19-Certm ❑ Ek m= Mall I .Jr i n M1 11v 1 ❑ Reg. Q n,m Rec M dlee `����.lP.�►'12 [3 lrs.rad Mal W � I 4. Restricted Delivery! ❑ yes 2. umber WOOr MAvrm aeNlOe label 7002 2410 0006 9367 1024 (TiensJlar PS Fob 381 1.'Au 2001 ; P borrrestic Ream Receipt •,'r ;�'•f;` 1 o, ,025eb-OY•M ,SW ■ Complete [ferns 1, 2, and 3. Also complete A. re item 4 if Restricted Delivery Is desired. ❑ Agent ■ Print your name and address X on the reverse 0 pddrga so that we can return the carts to you. a by prrpd Name) C. of De ■ Attach this card to the back of the mslipieoa, er or on the front if space permits. C d ,. Article Addressed to: D. 1e delivery address dMerent son ham 1 El ea It YES, enter delivery address below: ❑ No N+� 0-4 Y 3, Service Type XCertlfled Ma ❑ eorpress Mall + L� ❑ Registered $11Ret mn Receipt for Merchandise lint � I rr� I�JC � g 1 O i Cl inured Mai ❑ C.O-D, 4.. Restricted Delivery (prtre Fee) ❑ Yes z Article Number Y7002 2410 0006 9367 1062 (nanstAr rrom servke letaefj ... 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