19980335 Ver 1_COMPLETE FILE_19980415

9'903 3 5
THIS PACKET OF INFORMATION
IS PROVIDED TO ASSIST YOU
IN COMPLETING THE PRE-
(PCN) FORM THAT IS REQUIRED
BY THE U.S. ARMY CORPS OF
ENGINEERS AND THE NORTH
CAROLINA DIVISION OF
ENVIRONMENTAL MANAGEMENT.
WHEN APPLYING FOR CERTAIN
NATIONWIDE PERMITS
AUTHORIZED BY THE U.S.
ARMY CORPS OF ENGINEERS
APR ? 5 ?
DEM "ID : CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #)
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM T THE APPROPRIATE FIELD OFFICE
OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET).VJSEVEN (7) COPIES SHOULD BE
SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT (SEE AGENCY ADDRESSES SHEET).
PLEASE PRINT.
1. OWNERS NAME:
2. MAILING ADDRE
5
7a.
SUBDIVISION NAME:
CITY STATE: flJ C. ZIP CODE: (5iWaS
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER
4. IF APPLICABLE
(HOME) aS? ?Rrl (WORK)
AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL,
ADDRESS, PHONE NUMBER:
6. IMPACTED OR NEAREST STREAWRIVER: rn 'i 1) lz moo' V l1
RIVER BASIN:

IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (.HQW), OUTSTANDING RESOURCE WATERS
(WS-I OR WS-II)? YES [ ] NO Jx] IF YES, EXPLAIN:
(ORW), WATER SUPPLY
LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP OR
AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: 2"4.1r NEAREST TOWN OR CITY: Q+K`
CncrTCTr T.nramrnN (TNCLUDE ROAD NUMBERS, LANDMARKS, ETC.) M m c,
1 .
e
7b.'IF THE PROJECT IS LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT
ARE OF ENVIRONMENTAL CONCERN (AEC)? YES [V/3 NO [ I
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF COASTAL
COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION: V-P-5. - C.l.Ay-' -Q,- 10.-,rl uso.IS
- 26 Y m 101-1d C hEA-n Ar -1- i 1 ?? -2.
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROPERTY?
YES [ ) NO [V 11 IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND ANY
ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE? 1
YES [%.--I NO [ ] IF YES, DESCR1IBE ANTICIPATED WORK: !C-[ V1SR. C?-?xr, +.T
9A. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND:
9B. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: S
10A. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: • S EXCAVATION:
FLOODING: OTHER:
DRAINAGE: TOTAL ACRES TO BE IMPACTED:
10B. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED, PROVIDE
DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: FT AFTER: FT
WIDTH BEFORE (based on normal high water contours): FT
WIDTH AFTER: FT
AVERAGE DEPTH BEFORE: FT AFTER: FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY) /
OPEN CHANNEL RELOCATION: ? PLACEMENT OF PIPE IN CHANNEL:
CHANNEL ELEVATION: CONSTRUCTION OF A DAM/FLOODING:
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED DRAINING
TO THE POND? S 0.CX--e-S
WHAT IS THE EXPECTED POND SURFACE AREA? I ± QCX?S
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL EQUIPMENT
TO BE USED (ATTACH PLANS : 84" x 11" DRAWINGS ONLY) ? au nq 3 - `dad ? ?- 36" (e?7tQ.vyrr
Sp,IILUCL'?J) in branch -4o be c0yeyed hoc -%1) rng r"al.j?0'nurQQb o-?c???sl,..?+;,•,o ,road_ men+
? t'' ?-ed is 3an.??rAaK?rno e; ?-? rr?G?'y?}r(y_ m;?a?; ors use i 1 e a?-ri 2d o?, ?- a?e,r ne.? r? i?
e4rli ab) i b -4c? J-c - QS-?y?l ish 54?; c io r, a 5 i C.o J ?.u, l
b-e. ? i s -v,Yo ?? h s i t -C-9. 't C-kuc.K darns .
13. PURPOSE OF PROPOSED T+7ORK:
-rpT iirk OUMS r-Ond -b 42d>a( 9e4 A 1-s , V S, CC (fin
?t
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS) : LDCa-4ic>, of mid
?L44T1" 4A viei I a r, S mini o l" s i ? N cj-cx ?IA?, o,? ?7va YOM CD--Arx 44s (IU t, m.)-l cly-A ? l Iyyl )It
ayle vet Cxu -?ca?c? -Q E Ali n? pipe Co d ke A0 3 b rd, c? reS ?n ?Qrg i n4 0? i,rPcA- l s"j i
W; I)
btt IOco 4Lbe 441.4 Y-ri in 1-> mrxP) , -41 us tj RY')d Ii wQ?cr low .
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLE SERVICE (USFWS) AND/OR
NATIONAL MARINE'FISHERIES SERVICE (NMFS) (SEE AGENCY ADDRESSES SHEET) REGARDING
THE PRESENCE OF ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED OR
THREATENED SPECIES OR CIRTICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY
THE PROPOSED PROJECT.
DATE CONTACTED: " slhe (ATTACH RESPONSES FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) (SEE
AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE
PERMIT AREA WHICH-MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: 3/3/ I42 C' OJ d ?Sp(DKe w4h fkcap r7On /JCAC J
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF PUBLIC
(STATE) LAND? YES ( ] NO (V-? (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL DOCUMENT
PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT?
YES [ ] NO ( ]
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA DEPARTMENT
OF ADMINISTRATION STATE CLEARINGHOUSE? YES ( ] NO [ ]
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING COMPLIANCE WITH THE
NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE DIRECTED TO MS.
CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH CAROLINA DEPARTMENT OF
ADMINISTRATION, 116 WEST JONES STREET, RALEIGH, NORTH CAROLINA 27603-8003, TELEPHONE
[phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED ACTIVITY
INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES AND PONDS ON THE
PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, AND 38). ALL
STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON THE MAP.
MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1 INCH EQUALS 100 FEET OR THEIR
EQUIVALENT.
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. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY? 4) nbR,6, 4-6atanjo-nd
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? All/14
g. SIGNED AND DATED BY AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT, AND
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF ENVIRONMENTAL MANAGEMENT
(WATER QUALITY) CERTIFICATION..

OWNER'S/AGENT'S SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18G.))
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78007'30" 765 2270 000 FEET 767 51 768
?0 Mapped, edited, and published by the Geological Survey

?OpS Control by USGS, NOS/NOAA, and State of North Carolina agencies
\ * 1
Topography by photogrammetric methods from aerial photographs tnN
GN loot

taken 1979. Field checked 1981. Map edited 1984 1 E
Projection and 1000-meter grid, zone 17: Universal 7°

Transverse Mercator 124 MILS 1°40'
30 MILS
10,000-foot grid ticks based on North Carolina coordinate system
1927 North American Datum
To place on the predicted North American Datum 1983
move the projection lines.14.meters south and LITM GRID AND 1984 MAGNETIC NORTH
25 meters west as shown by dashed corner ticks DECLINATION AT CENTER OF SHEET
A FOI
s -
n r? R
THIS PACKET OF INFORMATION
IS PROVIDED TO ASSIST YOU
IN COMPLETING THE PRE-
(PCN? FORM THAT IS REQUIRED
BY THE U.S. ARMY CORPS OF
ENGINEERS AND THE NORTH
CAROLINA DIVISION OF
ENVIRONMENTAL MANAGEMENT
WHEN APPLYING FOR CERTAIN
NATIONWIDE PERMITS
AUTHORIZED BY THE U.S.
ARMY CORPS OF ENGINEERS
` t
DEM "ID
CORPS ACTION ID:
. NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM T THE APPROPRIATE FIELD OFFICE
OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET).IJSEVEN (7) COPIES SHOULD BE
SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT (SEE AGENCY ADDRESSES SHEET).
PLEASE PRINT.
1. OWNERS NAME:
2. MAILING ADDRE
SUBDIVISION NAME:
CITY ???g4w STATE: tJ C ZIP CODE: cZ8aS
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER (HOME) : q l? aS? OF"I I (WORK)
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL,
ADDRESS, PHONE NUMBER:
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP OR
AERIAL PHOTOGRAPHY WITH SCALE):
Q+1? 1 1 15 d r
COUNTY : 0Qj-"i4'y-- NEAREST TOWN OR CITY:
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.) N C &I-CL-2-rnoj
1-12. l bR l- ?'? r? rl O? d d -e s? 54-0 -k lnoj'o_ I g 95 D 1) ?- w 11 i e rv-?
'R pad
6. IMPACTED OR NEAREST STREAM/RIVER: I?Y? ? ( l ?}?C'L??l
RIVER BASIN:
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER SUPPLY
(WS-I OR WS-II)? YES [ ] NO IF YES, EXPLAIN:
r
7b.-IF THE PROJECT IS LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT
ARE OF ENVIRONMENTAL CONCERN (AEC)? YES [V/3 NO [ ]
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF COASTAL
COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION: Ve-5, Cla??? IQrr) uspjs.
-E0Ym QriA Srirr,l2QY ,'f?O?S? N naC?- 1 i ?-2.
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROPERTY?
YES [ ] NO [V f" IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND ANY
ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES [V.-I NO [ ] IF YES, DESCRIBE ANTICIPATED WORK: 'S?C-;
-T J
1L
9A. ESTIMATED TOTAL NUMBER OF _
•
ACRES IN TRACT OF LAND:
9B. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: S
10A. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT B Y:
FILLING: -J EXCAVATION:
FLOODING: OTHER:

DRAINAGE: TOTAL ACRES TO BE IMPACTED:
10B. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED, PROVIDE
DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: FT AFTER: FT
WIDTH BEFORE (based on normal high water contours): FT
WIDTH AFTER: FT
AVERAGE DEPTH BEFORE: FT AFTER: FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
/
OPEN CHANNEL RELOCATION: ? PLACEMENT OF PIPE IN CHANNEL:
CHANNEL ELEVATION: CONSTRUCTION OF A DAM/FLOODING:
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED DRAINING
TO THE POND? S 0.CX S
r?
+ C?
r
WHAT IS THE EXPECTED POND lG1
?S
SURFACE AREA? I
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL EQUIPMENT
TO BE USED (ATTACH PLANS: 8&1" x 11" DRAWINGS ONLY) Tlauna 3 - ' 4a" 4- ape
SPi?1Lu4y? ire hrQnc}, -S0 lie cov ILved h? -ill -32 -'iaSQeg2urQQE& O?cflv kS?v?i?}ir?cz r?cxd. ?i?r712t?
-to e d vs ;-San' ""W=e 1-
b 'p AS mG;y[1e b(v. YYl i ai a 0.? ion l).s? 11 i'r i d o-C-4 v n P?? ?OcK? i s
-
e4 oblish? ??.orAty -6 ?-p-es}- oblishs4 ;e<ID abtrZkl-Q Set?iYYW- orsurid4v s,Cnr, c.0
s ,
b-4L i s -vv-%Yo? V 1 .2. c GhicrK darns .
13. C
PURPOSE OF PROPOSED RK:
f; eA.Q C c y55 C00
-TO A -b D d cG 1-1-c VA - S i CC p( )r,
T

e
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS):Lo-s or, of od
r-t-J-Alma As wed I cy , a m i a i a jxjoS N glu- .?I o, .? + o,r Q?tva reed cro'irxiz 40 1 1C.oh cx J Cw/(a nt
biakrr-IOv3 ?r-lc J' --jin't o?e& cua'C 4 due A0 3 bray-.cj-ies c-c*lyergi'25 a?ify-A- e4s'ji
pr h mcQno kjf%o.--ouVp.%AA.J(4e n?loviQkfr' ? A 29YQrf4ke-, Ytsr,n nQ?tTIril ?ELLST I?Qd. n-f %A%?no.? W;)
bt, 10CAAkd 4+.A J Y? u?p m 0- 1 n t:) mmll) -41 us and l i 4Lc r Ion J.
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLE SERVICEw (USFWS) AND/OR
NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY ADDRESSES SHEET) REGARDING
THE PRESENCE OF ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED OR
THREATENED SPECIES OR CIRTICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY
THE PROPOSED PROJECT.
DATE CONTACTED: (ATTACH RESPONSES FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) (SEE
AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE
PERMIT AREA WHICH-MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED : 3/ 31 /98 COW i 5 2QK4 W i % 1?cre?ion+?' /Sect ?'y
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF PUBLIC
(STATE) LAND? YES [ ) NO [vl? (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL DOCUMENT
PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT?
YES [ ) NO [ )
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA DEPARTMENT
OF ADMINISTRATION STATE CLEARINGHOUSE? YES [ ) NO [ )
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING COMPLIANCE WITH THE
NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE DIRECTED TO MS.
CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH CAROLINA DEPARTMENT OF
ADMINISTRATION, 116 WEST JONES STREET, RALEIGH, NORTH CAROLINA 27603-8003, TELEPHONE
[phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED ACTIVITY
INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES AND PONDS ON THE
PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, AND 38). ALL
STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON THE MAP.
MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1 INCH EQUALS 100 FEET OR THEIR
EQUIVALENT.
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. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
w
I e. WHAT IS LAND USE OF SURROUNDING PROPERTY? I rnbR,6, -?0.rml0.nc?
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? Al/lq
g. SIGNED AND DATED BY AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT, AND
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF ENVIRONMENTAL MANAGEMENT
(WATER QUALITY) CERTIFICATION..
cam. -a - Ze
OWNER'S/AGENT'S SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18G.))
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Mapped, edited, and published by the Geological Survey
Opya? Control by USGS, NOS/NOAA, and State of North Carolina agencies
tAt4
Topography by photogrammetric methods from aerial photographs GN 1001
' E
taken 1979. Field checked 1981. Map edited 1984
Projection and 1000-meter grid, zone 17: Universal 7-
124 MILS 1°40
Transverse Mercator 30 MILS
10,000-foot grid ticks based on North Carolina coordinate system
1927 North American Datum
To place on the predicted North American Datum 1983
move the projection lines .14`meters south and UTM GRID AND 1984 MAGNETIC NORTH
25 meters west as shown by dashed corner ticks DECLINATION AT CENTER OF SHEET
A FO
v
g ,

80335.-
THIS PACKET 0P4TMlGjBpJATION
IS PROVIDED TO ASSIST YOU
IN COMPLETING THE PRE
ENGINEERS AND THE NORTH
CAROLINA DIVISION OF
ENVIRONMENTAL MANAGEMENT
WHEN APPLYING FOR CERTAIN
-(PM) FORM THAT IS REQUIRED
BY THE U . S . ARMY CORPS OF
NATIONWIDE PERMITS
AUTHORIZED BY THE U.S.
ARMY CORPS OF ENGINEERS
t ?
DEM-ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TT_HE APPROPRIATE FIELD OFFICE
OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). ,EVEN (7) COPIES SHOULD BE
SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT (SEE AGENCY ADDRESSES SHEET).
PLEASE PRINT. -,???
1. OWNERS NAME: P11'1o1P?1-10 Q-en A :'?'?'? _Y+ -• 0,a-1s c
2. MAILING ADDRESS: I I? 95 -EPA 1 Q' C 1J?II i anc?& 2n0.?
SUBDIVISION NAME: _
CITY STATE: K_ ZIP CODE: oZ8a5
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER (HOME) rl (WORK) :
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL,
ADDRESS, PHONE NUMBER:
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP OR
AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY : P l-va_o? NEAREST TOWN OR CITY: Q K, `z
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.) m c,
1 i 2, l '? n? Ol d y-.e s? S?-a- (-e ms 2 I $ 95 011 w? 11 i e? ?
-R
6. IMPACTED OR NEAREST STREAM/RIVER: Iy ? I?1?C??'lC
RIVER BASIN:
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER SUPPLY
(WS-I OR WS-II)? YES [ ] NO Pr l IF YES, EXPLAIN:
f
7b.-IF THE PROJECT IS LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT
ARE OF ENVIRONMENTAL CONCERN (AEC)? YES [" J NO [ I
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF COASTAL
COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION: q-e-5., Clay?-e. 4 loj-,rj use, is
1 c+Z-,cl -4;.r,l??r 'no?s? kC? CnK? n lr - ?Q? ,^ -1'ti2 ?c??-c a 1?-e_
-?r,cty 13:j
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROPERTY?
YES [ J NO [V J, IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND ANY
ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION)
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES [?J NO [ ] IF YES, DESCRIBE ANTICIPATED WORK: ?-?C-i J <?Ssz -2-xr?+I
SOY A 1 o G:.? ,? l Q C- 9 C-) v c 4
9A. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: 1LI•
9B. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: B
10A. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: • 5 EXCAVATION:
FLOODING: OTHER:
DRAINAGE: TOTAL ACRES TO BE IMPACTED:
10B. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED, PROVIDE
DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: FT AFTER: FT
WIDTH BEFORE (based on normal high water contours): FT
WIDTH AFTER: FT
AVERAGE DEPTH BEFORE: FT AFTER: FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY) /
OPEN CHANNEL RELOCATION: ? PLACEMENT OF PIPE IN CHANNEL:
CHANNEL ELEVATION: CONSTRUCTION OF A DAM/FLOODING:
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED DRAINING
TO THE POND? S 0.C-v4-S
WHAT IS THE EXPECTED POND SURFACE AREA?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL EQUIPMENT
TO BE USED (ATTACH PLANS : 8';e" x 11" DRAWINGS ONLY) : Q,-i ?-??i 3 3 to' Oi ov I QYpQV?P/}
s?Mlv4yD I, hranch AD be covg-vec) by -P, 11 n-,Ql??. ol.v nom; o? c onsl-hu+i ,o row -?merr{
,? ? us-e d i s 3 an •!? R?1 ramp ?,,,, 1 "'? rnG .1-,.(Lr 1,(y IrYI i? ors w i 11 ?+rri d +Ckl a- 0??14 ?? r?P??J' r^•O? i ?
n?rApv -4c? ?-0 Q .e? IS? fr' ?e ,. f t??Jv ('1e. t 5?1 YY r?YTTti'?l ?1') QYt? J VAS 1 L?1^? ?-0 ?73'YC1f W I

b-e. 1'vt4 U v
13. PURPOSE OF PROPOSEDIiJORK:
r

? a
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS): Loua,io" c)-(r' sad
r-luej-4hru As vief ct,,a mini n, 17-PS{,%Qjg -- 44a-,,4or4jh?lra roM C.Q irAAQ 1401 c'A,,4 LLjjy lent
a(evetous ?zc05.>Z4k- 02 0iM CoaloZc l,. due 3 bm C t-q conyerg o$ !Qsjc?x , a!div'gj- 1"'ji
L,;,
uL,;,
I ) I-KA
10 15. YOU ACRE REQUIRED _ TO CON AT CT THE U.S.1FISLis ND WILDLE SERVICE US1FWS) AND/OR
NATIONAL MARINE%FISHERIES SERVICE (NMFS) (SEE AGENCY ADDRESSES SHEET) REGARDING
THE PRESENCE OF ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED OR
THREATENED SPECIES OR CIRTICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY
t
THE PROPOSED PROJECT.
DATE CONTACTED: alzi he (ATTACH RESPONSES FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) (SEE
AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE
PERMIT AREA WHICH-MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: 3/31/92 l.aW ?SpCKe w- % f4gCeebori
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF PUBLIC
(STATE) LAND? YES [ ) NO [Vl( (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL DOCUMENT
PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT?
YES [ I NO [ ]
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA DEPARTMENT
OF ADMINISTRATION STATE CLEARINGHOUSE? YES [ ) NO [ I
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING COMPLIANCE WITH THE
NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE DIRECTED TO MS.
CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH CAROLINA DEPARTMENT OF
ADMINISTRATION, 116 WEST JONES STREET, RALEIGH, NORTH CAROLINA 27603-8003, TELEPHONE
[phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED ACTIVITY
INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES AND PONDS ON THE
PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, AND 38). ALL
STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON THE MAP.
MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1 INCH EQUALS 100 FEET OR THEIR
EQUIVALENT.
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. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
a e
4
w
' • e. WHAT IS LAND USE OF SURROUNDING PROPERTY? 4) r :j)? /-aa-tr-n i o-Yld
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? Al.lliq
g. SIGNED AND DATED BY AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT, AND
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF ENVIRONMENTAL MANAGEMENT
(WATER QUALITY) CERTIFICATION..
'-R? I f e?' 7?
OWNER'S/AGENT'S SIGNATURE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18G.))
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78o 04' 30" 765 2 270 000 FEET 767 5' 768
Mapped, edited, and published by the Geological Survey
?Gpy Control by USGS, NOS/NOAA, and State of North Carolina agencies * 1
MN
Topography by photogrammetric methods from aerial photographs GN 1000
taken 1979. Field checked 1981. Map edited 1984 13
Projection and 1000-meter grid, zone 17: Universal 7°
Transverse Mercator 124 MILS 1°40'
10,000-foot grid ticks based on North Carolina coordinate system 30 MILS
1927 North American Datum
To place on the predicted North American Datum 1983
move the projection lines 14 meters south and
UTM GRID AND 1984 MAGNETIC NORTH
25 meters W2St as ShOWR by dashed corner ticks DECLINATION AT CENTER OF SHEET
A FOLD

1 Aj
y
A'SR' 9803 35
THIS PACKET OF INFORMATION
IS PROVIDED TO ASSIST YOU
IN COMPLETING THE PRE-
(PCN) FORM THAT IS REQUIRED
BY THE U . S . ARMY CORPS OF
ENGINEERS AND THE NORTH
CAROLINA DIVISION OF
ENVIRONMENTAL MANAGEMENT
WHEN APPLYING FOR CERTAIN
NATIONWIDE PERMITS
AUTHORIZED BY THE U.S.
ARMY CORPS OF ENGINEERS

DEM "ID : CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):
PRE-CONSTRUCTION NOTIFICATION APPLICATION
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM T?T_HE APPROPRIATE FIELD OFFICE
OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). EVEN (7) COPIES SHOULD BE
SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT (SEE AGENCY ADDRESSES SHEET).
PLEASE PRINT.
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
1. OWNERS NAME:
2. MAILING ADDRE
3.
4.
FOR NATIONWIDE PERMITS THAT REQUIRE:
SUBDIVISION NAME:
CITY STATE: N C _ ZIP CODE: aB?aS
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
TELEPHONE NUMBER (HOME) : q 10 a8--3 rl9'1 (WORK)
IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL,
ADDRESS, PHONE NUMBER:
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP OR
AERIAL PHOTOGRAPHY WITH SCALE):
Q"F" I? 1 Y7S d
COUNTY : P ,l_)l-eor^ NEAREST TOWN OR CITY:
e+nc. l.T L+T el Tnram T nAT /TNrT.TTnp.. ROAD NUMBERS, LANDMARKS, ETC.) ? NC -o_
6.
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER SUPPLY
(WS-I OR WS-II)? YES [ ] NO J??] IF YES, EXPLAIN:
IMPACTED OR NEAREST STREAM/RIVER: rn ? ?V1?C.???l
RIVER BASIN:
7b.-IF THE PROJECT IS LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT
ARE OF ENVIRONMENTAL CONCERN (AEC)? YES ["/3 NO [ ]
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF COASTAL
COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION: q-P-5 cxxv k 4 14r,r'J uSo.IS
-?--n y rr; l Rr,c? -4; .? ,h p?+r ?i t ?DOS? _CQ?t?1n if - -W?_ ? -e-
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROPERTY?
YES [ ] NO [V J; IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND ANY
ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES ['?] NO [ ] IF YES, DESCRIBE ANTICIPATED WORK:'. C,I V?Sst_ l? 2Xr?-+?
-VnY r,Q 4. 9C-)y'd
9A. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: 14-
9B. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: g
10A. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: - 5 EXCAVATION:
FLOODING: OTHER:
DRAINAGE: TOTAL ACRES TO BE IMPACTED:
10B. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED, PROVIDE
DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: FT AFTER: FT
WIDTH BEFORE (based on normal high water contours): FT
WIDTH AFTER: FT
AVERAGE DEPTH BEFORE: FT AFTER: FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY) /
OPEN CHANNEL RELOCATION: ? PLACEMENT OF PIPE IN CHANNEL: V
CHANNEL ELEVATION: CONSTRUCTION OF A DAM/FLOODING:
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED DRAINING
TO THE POND? 5 0.c-V--us
WHAT IS THE EXPECTED POND SURFACE AREA? ± 0.C 1r?S
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL EQUIPMENT
TO BE USED (ATTACH PLANS : 81-1" x 11" DRAWINGS ONLY ) --? ad nq 3 - y a i1 1- 3 tj o, pe Lernw?err
SpillwaQi n bYanc}, Ao be coveted by -rill 1n41fy-'-LSC j2UrQUS.e o? c?rksl?.u l;,•,s o_W1Qmer1+
be used .s Aan"KwwrnP f? f nng 1,4 ky MIAAa0. ion ill ri d r?i?- r?eu? rD?
ishA tr% Qr[d2x -ln (P-!e 1 ish Su4pi Ap-,A. ?q x Clo,a -Seth morr?a?i 00 and o vnSCnr, C.on42of m',i l
lae. 1 s -N-%r0U s 11 nc-e. It U-%Ac-K dcLer s .
13. PURPOSE OF PROPOSED IORK:
I i
Y
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS):LozA?iln of?ld
r-tg-J 4hru Ys uje;fiQr,c?C mmiC ,7-PSc-,NQle.--440,,-? ,4h_orASbrn ?roM CZ,, ;nuosd0?(Lwv?? c? CUyNo>jt
WaAt*'f-tOv3 -- XAA& -Q-ljing p;m Canor_i4 due {0 3 bro--C -hes ?n?Qrgi? iae ar . a!difw-A- ks,-Jt
L';
b- i OCA-Vt4 4+NAe LA 4+,b m i n r -41 us o nd l i wo 44 e liozJ .
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLE SERVICE (USFWS) AND/OR
NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENCY ADDRESSES SHEET) REGARDING
THE PRESENCE OF ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED OR
THREATENED SPECIES OR CIRTICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY
THE PROPOSED PROJECT. !
DATE CONTACTED: (ATTACH RESPONSES FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) (SEE
AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE
PERMIT AREA WHICH-MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: 3/3/ I92 CWlpd ispat wrlh 1pGe?hOn?? *LWA-Y'y
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF PUBLIC
(STATE) LAND? YES [ ] NO [V?'(IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL DOCUMENT
PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT?
YES [ ] NO ( ]
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA DEPARTMENT
OF ADMINISTRATION STATE CLEARINGHOUSE? YES [ ] NO [ ]
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING COMPLIANCE WITH THE
NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE DIRECTED TO MS.
CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH CAROLINA DEPARTMENT OF
ADMINISTRATION, 116 WEST JONES STREET, RALEIGH, NORTH CAROLINA 27603-8003, TELEPHONE
[phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED ACTIVITY
INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES AND PONDS ON THE
PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, AND 38). ALL
STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON THE MAP.
MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1 INCH EQUALS 100 FEET OR THEIR
EQUIVALENT.
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. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
r a
• e. WHAT IS LAND USE OF SURROUNDING PROPERTY? 4,1
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? Adiq
g. SIGNED AND DATED BY AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT, AND
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF ENVIRONMENTAL MANAGEMENT
(WATER QUALITY) CERTIFICATION.
q,
OWNER'S/AGENT'S SIGNATURE DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18G.))
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78° 07' 30" 265 2270000 FEET 267 5 268
V Mapped, edited, and published by the Geological Survey
CAS Control by USGS, NOS/NOAA, and State of North Carolina agencies * 1
? MN.... ?
A`'1 Topography by photogrammetric methods from aerial photographs GN 1000
taken 1979. Field checked 1981. Map edited 1984 E3
Projection and 1000-meter grid, zone 17: Universal
124 MILS 1°40'
Transverse Mercator 3o MILS
10,000-foot grid ticks based on North Carolina coordinate system
1927 North American Datum
To place on the predicted North American Datum 1983
move the projection lines 14 meters south and uTM GRID AND 1984 MAGNETIC NORTH
25 meters west as shown by dashed corner ticks DECLINATION AT CENTER OF SHEET
'f; A FOLD

i? APR ? 5 ? ? 980335
THIS PACKET OF INFORMATION
IS PROVIDED TO ASSIST YOU
IN COMPLETING THE PRE
(Paz) FORM THAT IS REQUIRED
BY THE U . S . ARMY CORPS OF
ENGINEERS AND THE NORTH
CAROLINA DIVISION OF
ENVIRONMENTAL MANAGEMENT.
WHEN APPLYING FOR CERTAIN
NATIONWIDE PERMITS
AUTHORIZED BY THE U.S.
ARMY CORPS OF ENGINEERS
t
DEM'ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM T THE APPROPRIATE FIELD OFFICE
OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET).l/SEVEN (7) COPIES SHOULD BE
SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT (SEE AGENCY ADDRESSES SHEET).
PLEASE PRINT.
1. OWNERS NAME : ?TYI t'? t P ?`rn2?12 Q YIn?1?? [ ?Q 1 S ?'?
2. MAILING ADDRESS: ??9?J ?7P?? E' ???I?1C1??5 1CC?0.
SUBDIVISION NAME:
CITY STATE: ICI C_ _ ZIP CODE: aggaS
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER (HOME) : 9IQ a2_3 f)97 (WORK)
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL,
ADDRESS, PHONE NUMBER:
5.
6. IMPACTED OR NEAREST STREAM/RIVER: rn
RIVER BASIN:
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER SUPPLY
(WS-I OR WS-II)? YES [ ] NO P l IF YES, EXPLAIN:
LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP OR
AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY : plx Yd _Ql)r' NEAREST TOWN OR CITY: Q
n ., cnrcT lT.nramTnN rTMr T.TTT)F. ROAD NUMBERS, LANDMARKS, ETC.) M NC ?'?2-

i a A 1? rte Q 0- ?;u^ ' -
I
7b.-IF THE PROJECT IS LOCATED WITHIN A NORTH CAROLINA ? DIVISION OF COASTAL MANAGEMENT
ARE OF ENVIRONMENTAL CONCERN (AEC)? YES ["'1 NO [ ]
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF COASTAL
COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION: 10.1-j uso.is
--?r1QYrn 1Qnc? ? -?;?-,l?,r ?,-not?sc k? cr?K?ar?- 4?nd ? ? ?.ti-? ?-?-?.?.???
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROPERTY?
YES [ ] NO [VII, IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND ANY
ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
ter,-,
YES [?] NO [ ] IF YES, DESCRIBE ANTICIPATED WORK: .C-;-9j ?-X-JL PA
9A. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND:
9B. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: S
10A. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: - 5 EXCAVATION:
FLOODING: OTHER:
DRAINAGE: TOTAL ACRES TO BE IMPACTED:
lOB. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED, PROVIDE
DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: FT AFTER: FT
WIDTH BEFORE (based on normal high water contours): FT
WIDTH AFTER: FT
AVERAGE DEPTH BEFORE: FT AFTER: FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY) /
OPEN CHANNEL RELOCATION: ? PLACEMENT OF PIPE IN CHANNEL: V
CHANNEL ELEVATION: CONSTRUCTION OF A DAM/FLOODING:
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED DRAINING
TO THE POND? 5 0.CX-C-S
WHAT IS THE EXPECTED POND SURFACE AREA? I + QCX-?S
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL EQUIPMENT
TO BE USED (ATTACH PLANS: 84" x 11" DRAWINGS ONLY) aclnW 3 - yai? 4 ?- 36" O?ro (errlQy
Se'IILU in ?rancl, -4o 6e covP,ved by -i11 mQA*rraSaeg2u p s o?c?v?5?,???ti,-,Q ,roc?d kipT'vrr+
dp `v2 . ,? d i? ??n ??:-kr-?rino e ice. ,r,G •4•„n? l,cv m`?a?; o,-? use 11 Yri d ?1 ?. n ?.e,v ne?a rid is
P?o,},I : aL,,.,1 :.. r....to,. .1.. Jam. Pf?-e1•?? iS}? Su-??i?SAt?i' u?a?tx-?•b.,??5?.i morr?e.?i ors a?,cl ? yAS i c?r? C•orr?-rUf ut,I ?
k
l 3se.
rnc. e. ? C4-K d0.rns .

e
0
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS. '1 (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS) : LCCA?io', of 'la
r-t'-J -4h r-L 4 +a wei I Qr, ?i S m i n i rr, j7 n S i- N a ca- 440. -? 04h m/ d !ya YTW zovi?co t,?(Lnh [,,L-A C!&yllo)'7t
WQky'f-iQ-13 -1'4? i02 0 iM e-Uaci-l-., due -ko 3 bray-C -W5 "-onyeig,%?., oslfrec?- laS'Ji
_u? ??gg tJ;I) t:) m 15. YOU P?,RE REQUIRED TO CONTACTiTHE U.S. FISH AND WILDLrEE SERVICE (USIFWS) AND/OR
NATIONAL MARINE' FISHERIES SERVICE (NMFS) (SEE AGENCY ADDRESSES SHEET) REGARDING
THE PRESENCE OF ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED OR
THREATENED SPECIES OR CIRTICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY
THE PROPOSED PROJECT.
DATE CONTACTED: "fsiltig (ATTACH RESPONSES FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) (SEE
AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE
PERMIT AREA WHICH- MAY BE AFF/ECT'E_Dt BY THE PROPOSED PROJECT.
DATE CONTACTED: 3/31I9g Called t? SpC'e (.Ji?7 l?cRphon /52c
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF PUBLIC
(STATE) LAND? YES [ ] NO [vl? (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL DOCUMENT
PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT?
YES [ ] NO [ ]
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA DEPARTMENT
OF ADMINISTRATION STATE CLEARINGHOUSE? YES [ ] NO [ ]
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING COMPLIANCE WITH THE
NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
i
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE DIRECTED TO MS.
CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH CAROLINA DEPARTMENT OF
ADMINISTRATION, 116 WEST JONES STREET, RALEIGH, NORTH CAROLINA 27603-8003, TELEPHONE
[phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED ACTIVITY
INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES AND PONDS ON THE
PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, AND 38). ALL
STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON THE MAP.
MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1 INCH EQUALS 100 FEET OR THEIR
EQUIVALENT.
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. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
r'
e
, e. WHAT IS LAND USE OF SURROUNDING PROPERTY? 4'l r4LR,6, /"'t"(IY r maid
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? -At/iq
g. SIGNED AND DATED BY AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT, AND
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF ENVIRONMENTAL MANAGEMENT
(WATER QUALITY) CERTIFICATION.
k)wcj ? - C-
OWNER'S/AGENT'S SIGNATURE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18G.))
4-9-gs
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780 07' 30" 765 2270 000 FEET 767 51 768
Mapped, edited, and published by the Geological Surrey
?p5a? Control by USGS, NOS/NOAA, and State of North Carolina agencies * 1
\
Topography by photogrammetric methods from aerial photographs
Mry.... GN E? ?
1000

taken 1979. Field checked 1981. Map edited 1984 E3
Projection and 1000-meter grid, zone 17: Universal 7°

Transverse Mercator 124 MILS 1°40'
30 MILS
10,000-foot grid ticks based on North Carolina coordinate system ?
1927 North American Datum
s To place on the predicted North American Datum 1983
move the projection lines 14 meters south and UTM GRID AND 1984 MAGNETIC NORTH
25 meters west as shown by dashed corner ticks DECLINATION AT CENTER OF SHEET
A FOLD

98p335
THIS PACKET OF-T I ON
IS PROVIDED TO ASSIST YOU
IN COMPLETING THE PRE-
ENVIRONMENTAL MANAGEMENT.
WHEN APPLYING FOR CERTAIN
NATIONWIDE PERMITS
AUTHORIZED BY THE U.S.
(PC-N) FORM THAT IS REQUIRED
BY THE U.S. ARMY CORPS OF.
ENGINEERS AND THE NORTH
CAROLINA DIVISION OF
ARMY CORPS OF ENGINEERS
,
DEM -ID:
NATIONWIDE PERMIT REQUESTED
CORPS ACTION ID:
(PROVIDE NATIONWIDE PERMIT #):
PRE-CONSTRUCTION NOTIFICATION APPLICATION
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM T THE APPROPRIATE FIELD OFFICE
OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET).LJSEVEN (7) COPIES SHOULD BE
SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT (SEE AGENCY ADDRESSES SHEET).
PLEASE PRINT.
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
1. OWNERS NAME:
2. MAILING ADDRE
3.
4.
FOR NATIONWIDE PERMITS THAT REQUIRE:
SUBDIVISION NAME:
CITY STATE: ZIP CODE: aB?Fas
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
TELEPHONE NUMBER (HOME) : 9 10 aB _; 0 SO 1 (WORK) :
IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL,
ADDRESS, PHONE NUMBER:
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP OR
AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: DO -,A-vr NEAREST TOWN OR CITY:
anv? Tv7tP T.nr'MMTnN ITNrT,T1DE ROAD NUMBERS,. LANDMARKS, ETC ) m NC '?-
6.
7a. IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), WATER SUPPLY
(WS-I OR WS-II)? YES [ ] NO J] IF YES, EXPLAIN:
IMPACTED OR NEAREST STREAM/RIVER: ryl ?_rCk Md-?
RIVER BASIN:
f
ti
ARE OF ENVIRONMENTAL CONCERN (AEC)?
7c.-IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF COASTAL
COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION: \?5 CUyy-ek4 10.k-Y-1 use, is
--s n r m Qnd ?-i amlw i f JOSt_ kQ WK ar UA i v1 ?c? ?-La
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROPERTY?
YES [ ] NO [V 1, IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND ANY
ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION):

7b.-IF THE PROJECT IS LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT
NO [ ]
YES [ V/3
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES [y/J NO [ ] IF YES, DESCRIBE ANTICIPATED WORK: l?C-1 4? V-ks L
S6y- d c C, o- o ?- CJ
9A. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: 1L4.4.2.
9B. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: g
10A. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: - 5 EXCAVATION:
FLOODING: OTHER:
DRAINAGE : '1'U'1'AL Al;AL,.5 -1 U na hire-M-.L rjiJ. _
10B. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT
DISTANCE BOTH BEFORE AND AFTER RELOCATION):
(IF RELOCATED, PROVIDE
LENGTH BEFORE: FT AFTER: FT
WIDTH BEFORE (based on normal high water contours): FT
WIDTH AFTER: FT
AVERAGE DEPTH BEFORE: FT AFTER: FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
/
OPEN CHANNEL RELOCATION: ? PLACEMENT OF PIPE IN CHANNEL:
CHANNEL ELEVATION: CONSTRUCTION OF A DAM/FLOODING:
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED DRAINING
TO THE POND? S 0'rX-C-s
r
± Q
CX-<?S
WHAT IS THE EXPECTED POND SURFACE AREA? 1
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL EQUIPMENT
TO BE USED (ATTACH PLANS: 81.1" x 11" DRAWINGS ONLY) ?QCIng 3-140," 4 L 36 Oise ? QrpQ-V?Prr
SpillLus-D i n y-o-ri h 40 be ma-yed hu -i 1) ngA-ex t al Cv cnurnC?L o? cc?vkSl?.? 1;,,o road % &prmr +
IO s e d i S :S ark AJ ame S m? ?' ?.cy YYl i ?i a 0. i ?r? w i 11 ern d ?i ;. ?? n2UJ f0? i s
eh-4
JP - ? 11 isF? 54 ;c?Qr,? ? ? ? o.?tx ?k? ?? Se?i morr?a i or, arcl p vas i nr? CAn?
al71 I
s ?r1 QV-Aex AIN
rQJ w; l ?
bc. '
i s ?k?,n??y1? 1 r,c,0. t c ruCK dctrr?s .
13. PURPOSE OF PROPOSED -WORK:

. S
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS):LoLa,in, of, sNd
"-4hn4 Nor: u,e+ictr,a", mini0r;17nS c-.,?a,ex 44a-o+-4u"jq??/a rDM 67!,l irxoSdoLAlk- cad 0,L4L ?Qrjt
?volev?tOvs cis a46Ji,3 pipe C.Uoti-nj due AD 3 bra,- CJ-lRS QonVQr_Ring jQS?. It
-?_1??_?'?r?+_c __r__o ?YLW ) ?P Li sQa/Q p" vi Qk lSlU by-Qrgk oc Y A mrl i p 'in" l Q?Li S rnci I 1 Q 1 ?? ? pj W) i
bt, i ocA.+t-dw-J r?.wr u? m i r us and I ir? !-rw?? er to ?.1 .
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WIT-n- E SERVICE (USFWS) AND/OR
NATIONAL MARINE' FISHERIES SERVICE (NMFS) (SEE AGENCY ADDRESSES SHEET) REGARDING
THE PRESENCE OF ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED OR
THREATENED SPECIES OR CIRTICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY
THE PROPOSED PROJECT. !
DATE CONTACTED: (ATTACH RESPONSES FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) (SEE
AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE
PERMIT AREA WHICH-MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: 3/3//92 COJW ?Sy&t Lo (% fvuplion?/ser?
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF PUBLIC
(STATE) LAND? YES [ ] NO [V-? (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL DOCUMENT
PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT?
YES [ ] NO [ ]
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA DEPARTMENT
OF ADMINISTRATION STATE CLEARINGHOUSE? YES [ ] NO [ ]
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING COMPLIANCE WITH THE
NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE DIRECTED TO MS.
CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH CAROLINA DEPARTMENT OF
ADMINISTRATION, 116 WEST JONES STREET, RALEIGH, NORTH CAROLINA 27603-8003, TELEPHONE
[phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED ACTIVITY
INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES AND PONDS ON THE
PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, AND 38). ALL
STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON THE MAP.
MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1 INCH EQUALS 100 FEET OR THEIR
EQUIVALENT.
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. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
•
p e. WHAT IS LAND USE OF SURROUNDING PROPERTY? 4 ? m Le& 4762irr o rij
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? Adlq
g. SIGNED AND DATED BY AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT, AND
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF ENVIRONMENTAL MANAGEMENT
(WATER QUALITY) CERTIFICATION.
u r Cts?ttti
OWNER'S/AG NT'S SIGNATURE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18G.))
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76° 09' 30" 765 2 270 000 FEET 767 / 768
5
Mapped, edited, and, published by the Geological Survey

??pM1a? Control by USGS, NOS/NOAA, and State of North Carolina agencies * -
\?
Topography by photogrammetric methods from aerial photographs MH GN 1000

taken 1979. Field checked 1981. Map edited 1984 F=r-
Projection and 1000-meter grid, zone 17: Universal

Transverse Mercator 124 MILS 1°40'
30 MILS
10,000-foot grid ticks based on North Carolina coordinate system 1
1927 North American Datum
To place on the predicted North American Datum 1983
move the projection lines14 meters south and LITM GRID AND 1984 MAGNETIC NORTH
25 meters west as shown by dashed corner ticks DECLINATION AT CENTER OF SHEET
A FOLD

?sosss
,.10803 ?i j
THIS'-,"- OF INFORMATION
IS PROVIDED TO ASSIST YOU
IN COMPLETING THE PRE-
(PCN) FORM THAT IS REQUIRED
BY THE U.S. ARMY CORPS OF
ENGINEERS AND THE NORTH
CAROLINA DIVISION OF
ENVIRONMENTAL MANAGEMENT
WHEN APPLYING FOR CERTAIN
NATIONWIDE PERMITS
AUTHORIZED BY THE U.S.
ARMY CORPS OF ENGINEERS

DEM -ID:
CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #):
1) NOTIFICATION TO THE CORPS OF ENGINEERS
2) APPLICATION FOR SECTION 401 CERTIFICATION
3) COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM T?THE APPROPRIATE FIELD OFFICE
OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET).l%SEVEN (7) COPIES SHOULD BE
SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT (SEE AGENCY ADDRESSES SHEET).
PLEASE PRINT. n
1. OWNERS NAME : ?l 1'1 f"?1 P J7?VY,YJ? a.,m? r l 'a 1 ?? r
d7?? ?? ? ??1?? ?n0.?
2. MAILING ADDRESS: I EC
SUBDIVISION NAME:
CITY STATE: N C _ ZIP CODE: ?8 aS
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
3. TELEPHONE NUMBER (HOME) L (WORK)
4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL,
ADDRESS, PHONE NUMBER:
5.
6. IMPACTED OR NEAREST STREAWRIVER: ry-) ? ?1?Q?'1CI?
7a.
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
RIVER BASIN:

IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS
(WS-I OR WS-II)? YES [ ] NO Pr l IF YES, EXPLAIN:
(ORW), WATER SUPPLY
LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP OR
AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY : NEAREST TOWN OR CITY: Q+K i r,,s n t=?
onvl-rVTI? T_nrnmTnW (TNCT.t1nF. ROAD NUMBERS, LANDMARKS, ETC-)m Nc,
r
d
7b.-IF THE PROJECT IS LOCATED WITHIN A NORTH CAROLINA D-IVISION OF COASTAL MANAGEMENT
ARE OF ENVIRONMENTAL CONCERN (AEC)? YES [" ] NO [ ]
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF COASTAL
COUNTIES), WHAT IS THE LAND USE PLAN (LUP) DESIGNATION: ,&5- , CU ZZ1,4 10,tr'l USe. ice
Y m 1 Qnc? -4? .r,la??r ?r (70SR ?c? Kin ?c- 1 ?? ?e .
8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROPERTY?
YES [ ] NO (VII IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND ANY
ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION):
8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES CV-1 NO [ ] IF YES, DESCRIBE ANTICIPATED WORK: 'S ° C-( 4? U?SJt- G?arr?-, T
?14?1f1Q O.. .-,rte, r?-
9A. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: 14.
9B. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: S
10A. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: - S EXCAVATION:
FLOODING: OTHER:
DRAINAGE: TOTAL ACRES TO BE IMPACTED:
10B. (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED, PROVID
DISTANCE BOTH BEFORE AND AFTER RELOCATION):
LENGTH BEFORE: FT AFTER: FT
WIDTH BEFORE (based on normal high water contours): FT
WIDTH AFTER: FT
AVERAGE DEPTH BEFORE: FT AFTER: FT
(2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY) /
OPEN CHANNEL RELOCATION: ? PLACEMENT OF PIPE IN CHANNEL:
CHANNEL ELEVATION: CONSTRUCTION OF A DAM/FLOODING:
E
OTHER:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED DRAINING
TO THE POND? 5 QCX-t-s r?
WHAT IS THE EXPECTED POND SURFACE AREA? I ± 0.CXZS
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OOF? TYPE OF MECHANICAL EQUIPMENT
TO BE USED (ATTACH PLANS: 8W' x 11" DRAWINGS ONLY) : 11 Ina 3' `-Ic7?? Z 1- 36 I ape (err ,y
SPi l lli a-a i n 6-o vid , -4o be c c?v y d by ??11 r? ?Q? ev a.S n?1 r; Qb o cnvksl,r. err o - ? ?Qmerr{be uS e d i S :sar- ." Ag ame I n mG M i 8 a 0. i Ors Will rr1 d ??- 4 ? n?,J ?? i s
ej640b1 i,,1,nA nv-Aer (n ?D-2S?ral?lisll S4?Ficin..1 r ?eL?S?. ?j2diwarTi?a'iOr? and 4+-ocinr, COr4rpl WJj
b-'L i s " ,yyh s i 1 K ??-?c-?. { C4--IC K d0.rr's .
13. PURPOSE OF PROPOSED26ORK: ;
M?,pa-murk GUMS rQ&d -b D ? A 1-14 ?2 511- CC nn
0
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS):LoLA-+in' O-cr sad
rOmJ-thru Ag weiI0u,dSminio?17-PS c?1n tr-f10..E??Iltc,r2&?a rood e??-r?;rx?ps?U?.lao}? clod ?uy?'2nt
WQd?CL.3 -%-+ca.Q dS Jds!-i n 2 O i m CAy OX-; 4 due AD 3 bra.- C -t e5 ????Qrg i na daae? r o i,?et - ?? s?,.l t
_ u?p _ w; I
15 . YOU ARE REQUIRED TO CONTACT THE U.S. tFISH AND WILDLIFE I-M SERVICE USlFWS ) AND/OR
NATIONAL MARINE' FISHERIES SERVICE (NMFS) (SEE AGENCY ADDRESSES SHEET) REGARDING
THE PRESENCE OF ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED OR
THREATENED SPECIES OR CIRTICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY
THE PROPOSED PROJECT.
DATE CONTACTED: (ATTACH RESPONSES FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) (SEE
AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE
PERMIT AREA WHICH-MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: '3/31 /9'R CQJ" ?Soat w4h fQckpkont-q-/sk'Lp4 "
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OR THE USE OF PUBLIC
(STATE) LAND? YES [ ) NO [V? (IF NO, GO TO 18)
a. IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL DOCUMENT
PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT?
YES [ ] NO [
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA DEPARTMENT
OF ADMINISTRATION STATE CLEARINGHOUSE? YES [ ) NO [ I
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGEMENT REGARDING COMPLIANCE WITH THE
NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUESTIONS REGARDING THE STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE DIRECTED TO MS.
CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH CAROLINA DEPARTMENT OF
ADMINISTRATION, 116 WEST JONES STREET, RALEIGH, NORTH CAROLINA 27603-8003, TELEPHONE
[phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED ACTIVITY
INVOLVES THE DISCHARGE OF EXCAVATED OR FILL MATERIAL INTO WETLANDS:
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LAKES AND PONDS ON THE
PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, AND 38). ALL
STREAMS (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON THE MAP.
MAP SCALES SHOULD BE 1 INCH EQUALS 50 FEET OR 1 INCH EQUALS 100 FEET OR THEIR
EQUIVALENT.
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. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIRED.
w d x
19 1
e. WHAT IS LAND USE OF SURROUNDING PROPERTY? r l)? 4-atrriiorij
f. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
g. SIGNED AND DATED BY AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT, AND
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF ENVIRONMENTAL MANAGEMENT
(WATER QUALITY) CERTIFICATION..
OWNS 'S/AGENT'S SIGNATURE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18G.))
q-g-qv
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Mapped, edited, and published by the Geological Survey
?p Control by USGS, NOS/NOAA, and State of North Carolina agencies * 1
Topography by photogrammetric methods from aerial photographs GN 1000
I?
taken 1979. Field checked 1981. Map edited 1984 I
Projection and 1000-meter grid, zone 17: Universal 7°
124 MILS 1°40'
Transverse Mercator 30 MILS
10,000-foot grid ticks based on North Carolina coordinate system
1927 North American Datum
To place on the predicted North American Datum 1983
move the projection lines 14 meters south and uTM GRID AND 1984 MAGNETIC NORTH
25 meters west as shown by dashed corner ticks DECLINATION AT CENTER OF SHEET
A FOLD