74103_NCWRC Frying Pan BAA_20191104

►'dCAMA/ ❑DREDGE & FILL . -/D 6W/
No. 74103 C D
U NERAL PERMIT Previous permit# VA��— 1 ENERAL
❑Complete Reissue ❑Partial Reissue Date previous permit issued Al/A
As authorized by the State of North Carolina,Department of Environmental Quality
and the Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC 0 7 II, 12 0 0 Ei Rules attaAed.
Applicant Name /•C(Ai 1< t K y//)6' IAAe )3A/ Project Location: County 1VR 1?< I ��d U NT Y
Address g I J2 D MAIL S IZ V IL r K I) Street Address/State Road/Lot#(s) SSTS O
City RAL1=1G14 State ZIP 7-14)07 rRYIA)G r'4/.) IZj)
Phone# 0) 9 )707 COg3 E-Mail Subdivision r1?Y//VG FA"1
Authorized Agent Ili( jj AU t I G 6L Tr City CO L u M.13I ZIP '779 77 0 J
❑CW OW 1/PTA ❑ES ❑PTS Phone# ( ) River asin PASQ VOTAlvt(
Affected ❑OEA ❑HHF ❑IH ❑USA ❑N/A
AEC(s): Adj.Wtr. Body r iey /Ak j'a Canan /unkn) "i
Pws: ALCIGgTUR I'l tlE R,
Closest Maj.Wtr. Body
ORW: dr no PNA yes /C
Type of Project/Activity A U T1(c,IZ 1?1 0 &) 6 'X?0 ' rt a 1 Ai 6 PECe P/CR
(Scale: )
Pier(dock)length
T
Fixed Platform(s) I
- i
Floating Platform(s) ` X If) < <,
1
Finger pier(s) r I ( f
Groin length - n
number I .SC�C I it 19 K '12AW4 ')(-1) '5. '
Bulkhead/Riprap length
avg distance offshore
max distance offshore �, (7 I 1 I .
I
i
Basin,channel - .
f 4
cubic yards - u
Boat ramp . f
I
Boathouse/Boatlift - f ' I
- i ...--
j - --j
Beach Bulldozing
} l
Other
I ! 6
1
I
- - ~REC - -
Shoreline Length 2�0 ; ,
i
����/ A qr
SAV: otsure.) yes no 4- — nfV7 fi..2 Lb19 - --
I
Moratorium: n/a yes (nsD
Photos: yes no F DC '
M Y A R O
Waiver Attached: yes no i
A building permit may be required by: ! I c'c/L C C IA A)T/ . I See note on back regarding River Basin rules.
(Note Local Planning Jurisdiction)
Notes/Special Conditions S L C O ? II . 1 Zoo
kl,„i //tprl4,
rG,.l Le �# Ncw,C KEVIJ OAR I
Agen, orAlicant rinted Name PermitOfficer's Printed Name
J � ,
Signature !l lease read compliance statement on back of permit** Signature
ttOO. (DO E-TttnNSKI2 t/ nloV Zoi 9 . Ll MARU E1 2020
. Application Fee(s) Check# Issuing Date Expiration Date
KC I' 1,f 0000U 11614

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own property adjacent to NC Wildlife Resources Commission 's
(Name of Property Owner)
property located at 5550 Frying Pan Road,Columbia,NC
(Address, Lot, Block, Road, etc.)
on Frying Pan , in Tyrrell County , N.C.
(Waterbody) (City/Town and/or County)
The applicant has described to me, as shown below, the development proposed at the above
location.
I have no objection to this proposal.
I have objections to this proposal.
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
Proposed replacement of the existing fixed docks on-site with two 6'wide floating docks in existing footprint.
Work will involve demolition, grading, construction of two 6'x8'concrete abutments, installation of rip rap,and
seeding &mulching to disturbed areas.
No additional construction activities are proposed. Please see attached preliminary plans for additional
information.
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me. (If you wish to waive the setback,you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement.
I do not wish to waive the 15'setback requirement.
(Prove v Owner Information) (Adj en Pr a Owner Inr ion)
Signature Signature*
Michael Leggett/NCWRC Steve Trowell agent for NC Dept. of Transportation
Print or Type Name Print or Type Name
1720 Mail Service Center 113 Airport Drive Suite 100
Mailing Address Mailing Address
Raleigh,NC Edenton,North Carolina 27932
City/State/Zip City/State/Zip
919 707 0083/michael.leggett(a?netvildlife.org [phone]
Telephone Number/email address Telephone Number/email address
_ 10L2912Q14 October 29 2019
Date Date*
(Revised Aug. 2014)
*Valid for one calendar year after signature*

ADJACENT RIPARIAN PROPERTY OWNER STATEMENT
I hereby certify that I own properly adjacent to
(Name of Property Owner)
property located at R, L
(Address,Lot, Block, Road,etc.)
on N C
(Waterbody) (City/Town and/or County)
The applicant has tiescubed to me_ as shown below, the development proposed at the above
location
i have no objection to this proposal.
have objections to this proposal
DESCRIPTION AND/OR DRAWING OF PROPOSED DEVELOPMENT
(Individual proposing development must fill in description below or attach a site drawing)
Propos k,l ,th acL'ln°t`----1 ut (Ili'cA on-sitc with 1wi h' wide tloattn�_' di)ckJ in cvi LI li! footprint,
wih ,t1\(Ike Wrtitolition, latlnl',.eonstructIon of two h'XK'concrete abutment , IrNa;l ttion of rip rap,and
��'�u3tla? .A (lilt lCh iJ1+:� .tJ d1'tuihed dreati_
\<< .,ids ina1 :on•strueton acti ales are propos d. Plca,e see attached preliminary plans for additional
int��tttlatilar..
WAIVER SECTION
I understand that a pier, dock, mooring pilings, boat ramp, breakwater, boathouse, lift, or groin
must be set back a minimum distance of 15' from my area of riparian access unless waived by
me (If you wish to waive the setback, you must initial the appropriate blank below.)
I do wish to waive the 15' setback requirement
I do not wish to waive the 15' setback requirement
(Property Owner Information) (Adjacent Property Owner Information)
)(JO
J`iputltu2' Mr tin Stluchen
1110
Print or Typo Name
Pratt or 1 ype Name
5125 Faisor?Ridge Lane
Marling Address
Mailing Address Knigrtdaie_NC 2 545
k�i � h \t
—�" City/State/Zip
(4y/St,3te/Zrp _9�g 332�8 1
rl ) i (KI 4'rm haul. rnrt+illlt 1-!
Telephone:Number/emrrit address
Telephone Number%email addre tis '1»O 112Q 19
i1r2'i=1j`1
)ate)
(Revised Aug 2014)
'Valid for one calendar year after signature'

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Hart, Kevin
From: Phillips, Howard <[e-mail]>
Sent: Thursday, October 31, 2019 3:41 PM
To: Hart, Kevin
Subject: [External] NCWRC Frying Pan Boating Access Area
ee
Hi Kevin,
Per our earlier conversation, I have issued a Special Use Permit (SUP) to the NC Wildlife Resources
Commission to rehab the subject boat ramp facilities and I have no issue/concern with them getting required
CAMA or other permits for the work authorized. Let me know if you need a copy of the SUP.
Howard
Howard Phillips, Refuge Manager
Pocosin Lakes NWR; PO Box 329; Columbia, NC 27925
252/796-3004 x226 (office) 252/796-7517 (mobile)
www.fws.gov,/pocosinlakes/
NOTE: email correspondence and any attachments to and from this sender are subject to the Freedom of
Information Act (FOIA) and may be disclosed to third parties.
1

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0 North Carolina Wildlife Resources Commission :_
Gordon Myers, Executive Director
October 14,2019
Mr. Kevin Hart—Compliance and Enforcement
NCDEQ-CAMA
943 Washington Square Mall
Washington,NC 27889
RE: Frying Pan BAA Dock Replacement—General CAMA Permit Application
Mr. Hart:
The North Carolina Wildlife Resources Commission (NCWRC) is submitting a General CAMA application package for
replacement of the existing docks at the Frying Pan Boat Access Area(BAA)located in Tyrell County. The existing docks
are in a deteriorated state due to age. NCWRC is seeking approval to replace both existing fixed docks with 6' wide
floating docks and concrete abutments. A small section of ADA accessible sidewalk will also be added to connect the
existing ADA sidewalk to a proposed abutment/dock.
Proposed work will involve replacing the fixed docks with 6' wide floating docks, construction of two 6' x 8' concrete
abutments, minor grading work, installation of riprap armor around the abutments and seeding and mulching to disturbed
areas. Note that this project is located on property owned by the USFW.
Please find 2 attached copies of the project plans, a copy of the special use permit approved by USFW, and information
related to the CAMA application fee. Please let me know if you have any questions related to this project. I can be reached
at(919)707-0083 or via email at michael.leeeett ct ncwildlife.org.
Sincerely,
ilesileit
Michael Leggett, PE
Engineer
enclosures
Mailing Address: N.C. Wildlife Resources Commission • 1701 Mail Service Center • Raleigh NC 27699-1701
Telephone: [phone]

General Activities 1
Special Use Permit
Station #: FFO4RNPLOO (For Official Use Only) Permit #: 19-010
Permit Term: From 10/8/19 To 9/30/20
1) Permittee Name/Business: NC Wildlife Resources Commission (Michael Leggett, PE)
2) Permit Status: a)Approved: • If approved, provide special conditions (if any) in the text box below.
b) Denied: 0 If denied, provide justification in the text box below.
[Type in additional Special Conditions or Justification for Denied Permit in the space provided]
At the NCWRC's Frying Pan Boating Access Area (BAA), 5550 Frying Pan Rd, Columbia, NC - the
permittee is authorized to demolish the existing fixed docks and install two floating docks in the
same footprint as described in the attached SUP application. In addition, the Service has no
objection to the maintenance dredge on the canal as described in the application, but disposal of
any dredge material is NOT authorized on any refuge lands.
The attached "Conditions for Special Use Permits & Authorized Activities" apply. All appropriate
signs are authorized; necessary machinery, equipment, supplies, and materials to do the work may
be placed/stored in the BAA parking area; cutting torches and like tools are authorized as needed
when appropriate measures are taken to prevent wildfire. Contact the Refuge Manager if other
authorizations are needed.
3)Are there additional special conditions attached to the permit? Yes 0 No 0
4)Are other licenses/permits required, and have they been verified? Yes O No 0 N/A 0
5)Are Insurance and/or Certification(s) required, and have they been verified? Yes 0 No 0 N/A 0
6) Record of Payments: Full°Partial°Exempt :.0
Amount of full payment: Record of partial payments:
7) Is a surety bond or security deposit required? Yes O No 0 N/A 0
This permit is issued by the U.S.Fish and Wildlife Service and accepted by the applicant signed below,subject to the terms,covenants,
obligations,and reservations,expressed or implied herein,and to the notice,conditions,and requirements included or attached.A
copy of this permit should be kept on-hand so that it may be shown at any time to any refuge staff.
8) Permit approved/issued by:(Signature and title) 9) Permit accepte by:(Signature of permittee)
HOWARD PHILLIPS Dateal2o19.1008Y10O1806 oaoHPS 411
Re
Date: Date: IC`$IK

General Conditions and Requirements
1) Responsibility of Permittee: The permittee, by operating on the premises, shall be considered to have accepted these premises with
all facilities, fixtures, or improvements in their existing condition as of the date of this permit.At the end of the period specified or upon
earlier termination, the permittee shall give up the premises in as good order and condition as when received except for reasonable
wear,tear, or damage occurring without fault or negligence. The permittee will fully repay the Service for any and all damage directly or
indirectly resulting from negligence or failure on his/her part, and/or the part of anyone of his/her associates,to use reasonable care.
2)Operating Rules and Laws: The permittee shall keep the premises in a neat and orderly condition at all times, and shall comply with
all municipal county, and State laws applicable to the operations under the permit as well as all Federal laws, rules, and regulations
governing national wildlife refuges and the area described in this permit. The permittee shall comply with all instructions applicable to
this permit issued by the refuge official in charge. The permittee shall take all reasonable precautions to prevent the escape of fires and
to suppress fires and shall render all reasonable assistance in the suppression of refuge fires.
3) Use Limitations: The permittee's use of the described premises is limited to the purposes herein specified and does not, unless
provided for in this permit, allow him/her to restrict other authorized entry onto his/her area; and allows the U.S. Fish and Wildlife
Service to carry on whatever activities are necessary for: (1)protection and maintenance of the premises and adjacent lands
administered by the U.S. Fish and Wildlife Service; and(2)the management of wildlife and fish using the premises and other U.S. Fish
and Wildlife Service lands.
4)Transfer of Privileges: This permit is not transferable, and no privileges herein mentioned may be sublet or made available to any
person or interest not mentioned in this permit. No interest hereunder may accrue through lien or be transferred to a third party without
the approval of the Regional Director of the U.S. Fish and Wildlife Service and the permit shall not be used for speculative purposes.
5)Compliance: The U.S. Fish and Wildlife Service's failure to require strict compliance with any of this permit's terms, conditions, and
requirements shall not constitute a waiver or be considered as a giving up of the U.S. Fish and Wildlife Service's right to thereafter
enforce any of the permit's terms or conditions.
6) Conditions of Permit not Fulfilled: If the permittee fails to fulfill any of the conditions and requirements set forth herein,the U.S. Fish
and Wildlife Service shall retain all money paid under this permit to be used to satisfy as much of the permittee's obligation as possible.
7) Payments:All payment shall be made on or before the due date to the local representative of the U.S. Fish and Wildlife Service by a
postal money order or check made payable to the U.S. Fish and Wildlife Service.
8)Termination Policy:At the termination of this permit the permittee shall immediately give up possession to the U.S. Fish and Wildlife
Service representative, reserving, however, the rights specified in paragraph 11 below. If he/she fails to do so, he/she will pay the U.S.
Fish and Wildlife Service, as liquidated damages, an amount double the rate specified in this permit for the entire time possession is
withheld. Upon yielding possession, the permittee will still be allowed to reenter as needed to remove his/her property as stated in
paragraph 11 below. The acceptance of any fee for the liquidated damages or any other act of administration relating to the continued
tenancy is not to be considered as an affirmation of the permittee's action nor shall it operate as a waiver of the U.S. Fish and Wildlife
Service's right to terminate or cancel the permit for the breach of any specified condition or requirement.
9) Revocation Policy: The Regional Director of the U.S. Fish and Wildlife Service may revoke this permit without notice for
noncompliance with the terms hereof, or for violation of general and/or specific laws or regulations governing national wildlife refuges,
or for nonuse. It is at all times subject to discretionary revocation by the Director of the Service. Upon such revocation the U.S. Fish and
Wildlife Service, by and through any authorized representative, may take possession of said premises for its own and sole use, and/or
may enter and possess the premises as the agent of the permittee and for his/her account.
10) Damages: The U.S. Fish and Wildlife Service shall not be responsible for: any loss or damage to property including but not limited
to crops, animals, and machinery; injury to the permittee or his/her relatives or to the officers, agents, employees,or any other(s)who
are on the premises from instructions; the sufferance from wildlife or employees or representatives of the U.S. Fish and Wildlife Service
carrying out their official responsibilities. The permittee agrees to hold the U.S. Fish and Wildlife Service harmless from any and all
claims for damages or losses that may arise to be incident to the flooding of the premises resulting from any associated government
river and harbor, flood control, reclamation, or Tennessee Valley Authority activity.
11)Removal of Permittee's Property: Upon the expiration or termination of this permit, if all rental charges and/or damage claims due to
the U.S. Fish and Wildlife Service have been paid,the permittee may,within a reasonable period as stated in the permit or as
determined by the U.S. Fish and Wildlife Service official in charge, but not to exceed 60 days, remove all structures, machinery, and/or
equipment, etc.,from the premises for which he/she is responsible.Within this period the permittee also must remove any other of
his/her property including his/her acknowledged share of products or crops grown, cut, harvested, stored, or stacked on the premises.
Upon failure to remove any of the above items within the aforesaid period, they shall become the property of the U.S. Fish and Wildlife
Service.

Pocosin Lakes National Wildlife Refuge
CONDITIONS FOR SPECIAL USE PERMITS&AUTHORIZED ACTIVITIES
1. The Permittee or authorized person, and all officers, agents, employees, representatives, and
clients of the Permittee or authorized person, shall comply with all Refuge, Federal, State, and
local regulations and conditions that apply to the special use activity. Failure to comply with any
applicable regulation or condition, and all Federal laws, rules, and regulations governing National
Wildlife Refuges and the area described in the Special Use Permit(Permit) or authorizing
documents may result in revocation of the Permit or authorized activity and/or criminal
prosecution.The Permit is non-transferable.
2. While engaged in a special use activity on the Refuge,the Permittee or authorized person, and
his/her officers, agents, employees, or representatives,shall be in possession of a copy of the
Permit or authorizing documents (including all attachments that contain conditions) and shall,
upon request by an authorized Refuge official or by any authorized local,state,or federal law
enforcement officer, display the copy authorizing their presence and activity on the Refuge and
shall furnish any other licenses and identification documents as may berequested.
3. Any accident that results in a personal injury(i.e., an accident that requires professional medical
treatment) shall be reported to the Refuge Manager within 24 hours of the accident.
4. Entryon the Refuge during nighttime hours (i.e.,%2-hour after sunset to%-hour before
sunrise) is prohibited, unless authorized in writing by the Refuge Manager. Access to areas
closed to the public is not allowed, unless authorized in writing by the Refuge Manager.
5. Vehicle travel shall only be on designated roads or routes of travel, unless authorized in writing
by the Refuge Manager. Vehicles, boats,trailers, and other equipment shall be parked in such a
manner that roads and trails,including canoe trails and navigable waters, are not to be
blocked. Roads and trails need to be accessible to other Refuge visitors and to Refuge staff,
cooperative farmers,fire trucks,emergency vehicles, maintenance equipment, and law
enforcement patrols.
6. Vehicles with catalytic converters shall be restricted to paved roads, recently maintained gravel or
dirt roads,or bare soil areas because of the high fire potential. Vehicles with catalytic converters
shall not be parked over high vegetation or other fire hazardous materials.
7. All locked Refuge gates shall be closed and locked upon entering and leaving Refuge property.
1 RF-001 (Revised 05/08/2018)

Refuge gates should be left the way they are found (i.e.,open, closed, either locked or
unlocked as the case may be). All signs describing authorized and unauthorized entry through
a gate shall be followed unless entry is allowed by this permit.
8. Refuge gate or building keys shall not be loaned to other agencies, companies, or persons. If
there is a need for access by other persons, please have them contact the Refuge Manager. All
Refuge keys shall be returned to the Refuge Manager, or a designated staff member, within 10
calendar days, after expiration or termination of the Permit or authorizedactivity.
9. All dogs (or any other pet) must be confined or on a leash while on the Refuge, unless authorized
in writing by the Refuge Manager. Leashed pets must be under the immediate control of the
Permittee or authorized person, or the leash must be secured to a stationary object.The leash
shall not be in excess of 10 feet in length. Dogs are not allowed in areas where dogs are
prohibited, unless authorized in writing by the Refuge Manager.
10. Possession or use of firearms, air guns, bows and arrows, cross bows, spears, or gigs; or illegal
knives,weapons, or devices;or explosives of any type is prohibited on the Refuge when engaged
in a special use activity, unless authorized in writing by the Refuge Manager.
11. Littering is prohibited. All materials brought into the Refuge shall be removed and properly
disposed. Drink cans, bottles, candy wrappers,toilet paper, and other garbage and refuse shall
not be left on the Refuge.
12. The Refuge Manager shall be contacted before any surface work is done.This includes
mowing, road or trail improvements, digging, clearing or trimming of brush or vegetation,
installation of structures,etc.
13. The use of herbicides and pesticides on Refuge property is prohibited, unless authorized in
writing by the Refuge Manager. Unrestricted, over-the-counter-type, insect repellents may be
used on or near the body and clothing to repel biting or stinging insects.
14. No permanent or semi-permanent markings shall be made on any Refuge building, structure,
gate, post, sign,fence,tree,vegetation, or soil by either marking, painting, cutting, scratching,
blazing, mowing, digging, or other destructive method, unless authorized in writing by the
Refuge Manager. When needed, only temporary, removable markers (e.g.,flagging tape, survey
stakes, metal/paper/plastic tags, etc.) shall be used to mark site locations, plots, etc. Safety signs,
informational signs, and any other signs required by law or regulation for the special use activity
being conducted,shall be posted as required, but only with prior authorization by the Refuge
Manager. All markers and signs shall be removed upon conclusion of the special use activity or
upon expiration or termination of the Permit.
2 RF-001 (Revised 05/08/2018)

15. No permanent or semi-permanent fences, buildings, shelters, docks, piers, or other structures or
facilities may be erected, built, or placed on the Refuge, unless authorized in writing by the
Refuge Manager. No machinery, equipment,supplies, or materials may be placed or stored on
the refuge, unless authorized in writing by the Refuge Manager.
16. All open fires are prohibited, unless authorized in writing by the Refuge Manager. Leaving an
authorized open fire unattended or not completely extinguished is prohibited. Setting on fire or
causing to be set on fire any timber, brush,grass, or other inflammable material, including camp
or cooking fires, is prohibited, unless authorized in writing by the Refuge Manager. The use of
cutting torches, arc welders, or any other open flame/sparking devices (which are required to
conduct the special use activity) shall be exercised with caution and only with prior authorization
from the Refuge Manager or Refuge Fire Management Officer. When use of these devices is
necessary,the operator(s)shall have immediate access to appropriate fire control equipment
(e.g., fire extinguishers,shovels, etc.) and immediate communication access to local emergency
services (e.g., cellular telephone,two-way radio, etc.).Tobacco smokers shall practice caution
when smoking; shall completely extinguish all matches, cigars, cigarettes, and pipes; and shall
dispose of same in a proper container(e.g., a vehicle ashtray).
17. The Refuge Manager should be contacted immediately at(252) 796-3004 upon discovery of any
wildfire,or any leak,spill, or break in a pipeline, power line,canal, or dike, or any other accident
or incident that has the potential to have an adverse impact on the soil,wildlife, or plants in the
area. Any unusual wildlife sightings or suspected illegal activities should be reported to the
Refuge Manager.
18. It is unlawful to disturb, destroy, injure, collect, or take any wildlife, plant, natural object, mineral,
cultural or historical feature, or public property on the Refuge, unless authorized in writing by
the Refuge Manager. State and federal collections or scientific use permit regulations and
conditions also apply.
19. Wildlife shall not be harmed or harassed and disturbance shall be kept to a minimum,this
includes all snakes (poisonous and non-poisonous snakes), unless authorized in writing by the
Refuge Manager. State and federal collections or scientific use permit regulations and conditions
also apply.
20. Any research or monitoring activities involving ground disturbance may require historic
preservation consultation with the Regional Office and/or State Historic Preservation Office.
Researchers must obtain an Archeological Resource Protection Act permit from the Regional
Office prior to obtaining a special use permit from the refuge.
21. All researchers will be required to obtain appropriate State and Federal permits for the capture
3 RF-001 (Revised 05/08/2018)

and possession of protected species,for conducting regulated activities in wetlands, and for
other regulated activities. Researchers may also need to provide an assurance of animal care
form or an institutional animal approval form, if applicable.
22. Research collection activities must adhere to the Service's policy regarding disposition of biotic
specimens:
i. You may use specimens collected under this permit, any components of any specimens
(including natural organisms, enzymes,genetic materials or seeds), and research results
derived from collected specimens for scientific or educational purposes only, and not
for commercial purposes unless you have entered into a Cooperative Research and
Development Agreement (CRADA)with us. We prohibit the sale of collected research
specimens or transfers to third parties for commercial purposes. Breach of any of the
terms of this permit will be grounds for revocation of this permit and denial of future
permits. Furthermore, if you sell or otherwise transfer for commercial purposes
collected specimens, any components thereof, or any products or research results
developed from such specimens or their components without a CRADA,you will pay us
a royalty rate of 20 percent of gross revenue from such sales. In addition to such royalty,
we may seek other damages and injunctive relief against you (USFWS 2016). U.S. Fish
and Wildlife Service. 2016. Director's Order No. 109,Amendment 11: Use of Specimens
Collected on Fish and Wildlife Lands. March 31, 2016.
23. The use or possession of traps, snares, or other passive (i.e., unattended) collection devices,
which are used to collect wildlife, is prohibited, unless authorized in writing by the Refuge
Manager. Each individual trap, snare, or passive collection device shall have a weather-resistant,
permanent tag attached with the Permittee's, authorized person's, and/or organization's name
legibly marked on the tag or shall have the Permittee's, authorized person's, and/or
organization's name legibly marked, imprinted, or engraved on the trap,snare, ordevice.
24. For protection of threatened, endangered, rare, sensitive or commercially desirable species,
publication of specific collection locations (latitude/longitude) is prohibited.The Refuge Manager
(or designee) must approve the release of this information. Photographic materials
(photographs, digital images and videos)that document activities involving threatened and
endangered species permitted by this Permit (e.g., handling wildlife, entering refuge during
closed hours, collecting of any kind, entering a closed area, disturbing habitat, etc.) may not be
posted in any public forum (Internet, Facebook, HerpNation, etc.) unless authorized in writing by
the Refuge Manager and will result in the revocation of this Permit.
25. Permittee may use photographic materials in official (University/public agency) publications,
including the Internet but must include a statement that the activity was conducted under the
4 RF-001 (Revised 05/08/2018)

provision of a Special Use Permit.All data collected on refuge lands will be shared with the U.S.
Fish and Wildlife Service.
26. Recreational and commercial uses of unmanned aerial vehicles (drones) are prohibited on the
refuge. Permitted research projects using UAS technology will be considered using Federal
Aviation Administration (FAA), Office of Aviation Services (OAS), and Department of Interior(DOI)
Aviation Policy guidelines.
27. All researchers are required to submit a final report to the refuge upon completion of their work.
If the study is long-term, an interim progress report will be required. Failure to provide progress
reports and/or final reports could result in the revocation of the current permit or jeopardize the
issuance of future permits.
28. Researchers who publish the work in peer-reviewed publications are to provide copies to the
refuge. All reports, presentations, posters, articles or other publications will acknowledge the
Refuge System and appropriate refuges as partners in the research, provided that the Service
does not otherwise deem it appropriate to issue a disclaimer.The acknowledgement recognizes
that the research could not have been conducted without the existence of the refuge and its
support and cooperation. The research organization/agency or personnel in conjunction with the
Service will retain the use and ownership of all data/reports.
5 RF-001 (Revised 05/08/2018)

Applicant:
NCI ,iZC_ r zyl,^) C IA/J i7' /A
Date: 7 ,)o d 2 tr)I �(
General Permit#: 74-1 165 3
Describe below the HABITAT disturbances for the application. All values should snatch the name,and units of measurement
found in your Habitat code sheet
TOTAL Sq. Ft. FINAL Sq.Ft. I TOTAL Feet I FINAL Feet
(Applied for (Anticipated final (Applied for. (Anticipated finat
DISTURB TYPE Disturbance total disturbance. Disturbance disturbance.
Choose One includes any Excludes any total includes Excludes any
anticipated restoration any anticipated restoration and/or
restoration or and/or temp restoration or temp impact
temp impacts) impact amount) temp impacts) amount)
G 1 0v LJAr-in Dredge❑ Fill ElBoth ❑ Other (ZG,j— 1 1 Z 0, / "Z
Dredge❑ Fill❑ Both 0 Other ❑
Dredge❑ Fill❑ Both 0 Other ❑
Dredge 0 Fill❑ Both ❑ Other El
Dredge❑ Fill❑ Both El Other El
Dredge❑ Fill 0 Both El Other ❑
Dredge❑ Fill El Both 0 Other 0
Dredge El Fill❑ Both ❑ Other 0
Dredge El Fill❑ Both 0 Other ❑
Dredge 0 Fill❑ Both El Other ❑
Dredge❑ Fill❑ Both ❑ Other El
Dredge El Fill❑ Both ❑ Other 0
Dredge❑ Fill❑ Both ❑ Other ❑
Dredge❑ Fill❑ Both ❑ Other El