19990359 Ver 1_COMPLETE FILE_19990419

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Kerr T. Stevens, Director
A; lk
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
April 23, 1999
Stanley County
DWQ Project # 990359
APPROVAL of 401 Water Quality Certification
Mr. Daniel Adams
P.O. Box 3086
Pinehurst N.C. 28374
Dear Mr. Adams:
You have our approval, in accordance with the attached conditions, to place fill material in 89 feet of shoreline of
for the purpose of stabilizing the shoreline at your lot (lot 4, Tillery Shores), as you described in your application dated
April 20, 1999. After reviewing your application, we have decided that this fill is covered by General Water Quality
Certification Number 3099. This Certification allows you to use General Permit Number 030 when the Corps of
Engineers issues it. In addition, you should get any other federal, state or local permits before you go ahead with your
project including (but not limited to) Sediment and Erosion Control, Coastal Stormwater, Non-Discharge and Water
Supply Watershed regulations. Also this approval will expire when the accompanying 404 or CAMA permit expires
unless otherwise specified in the General Certification.
This approval is only valid for the purpose and design that you described in your application. If you change your
project, you must notify us and send us a new application. If the property is sold, the new owner must be given a copy of
this Certification and approval letter and is thereby responsible for complying with all conditions. If total wetland fills for
this project (now or in the future) exceed one acre, compensatory mitigation may be required as described in 15A NCAC
2H .0506 (h). For this approval to be valid, you must follow the conditions listed in the attached certification. This
approval shall expire when the corresponding Nationwide Permit expires or as otherwise provided in the General
Certification.
If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearing. You must
act within 60 days of the date that you receive this letter. To ask for a hearing, send a written petition which conforms to
Chapter 150B of the North Carolina General Statutes to the Office of Administrative Hearings, P.O. Box 27447, Raleigh,
N.C. 27611-7447. This certification and its conditions are final and binding unless you ask for a hearing.
This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If you
have any questions, please telephone John Dorsey at 919-733-1786.
Sincerely,
T. tevens
Attachment
cc: Wilmington District Corps of Engineers
Corps of Engineers Asheville Field Office
Mooresville DWQ Regional Office
Mr. John Dorsey
Central Files 990359.1tr
Division of Water Quality - Environmental Sciences Branch
Environmental Sciences Branch, 4401 Reedy Creek Rd, Raleigh, NC 27607 Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer - 50% recycled/10% post consumer paper
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DWQ 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 TO NC DIV. OF WATER QUALTTY FOR SECTION 401 CERTIFICATION
3. COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE FIELD
OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7) COPIES
MUST BE SENT TO THE NC DIVISION OF WATER QUALITY, ATTN: JOHN DORNEY, 4401 REEDY
CREEK ROAD, RALEIGH, NC 27607. PLEASE PRINT OR 'H'YPE.
1. OWNER'S NAME: Dan l o F_ . AM s
2. MAILING ADDRESS: Ft. &K 306(,o PP nc_hu rs + N c -qg 3 q y
SUBDIVISION NAME : i (Ierq Share S
CITY: A (?, emar I e- STATE: N L ZIP CODE: 00
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
L of 4 Tarh-ee_1 ,ri'v-e- C FIM Qoe S , Pa3e b0?
o1Wvnov-le Nc. a?00l r
3. TELEPHONE NUMBER: (HONE)( 000)((I a - a -1-7 (WORK)\011 ?) 5 ' 0
4
IF APPLICABLE: AGENTS 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: h I NI NEAREST TOWN: At be IYIck r I
'+C
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.)
rrovrn 7y()?q KIC- got,-\q -a4- a"1 Wes-} ,
VQt" 2y -a I
1 r • 6 g g, , ' fa L e v ? l r f ? od h 4, 11 15 7-o c-
J
/0's d own
?o lOUSe AI'1f
(9 r\ I-he Wes+ tounv- c) Lo-6
6. IMPACTED OR NEAREST STREAMMVER:_
RIVER BASIN:
i
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTST ING RESOURCE WATERS (ORW), WATER
' SUPPLY (WS-I OR WS-II)? YES NO IF YES, EXPLAIN: -7 (b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL„
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES NO (/
(c) 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?
8. (a) HAVE ANY SECTION 4 4 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES NO IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT AND ANY AD ITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
(b) ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES NO_4-L-IF YES, DESCRIBE ANTICIPATED WORK:
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: ?Z
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
10. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: N I A EXCAVATION: N 1/1
FLOODING: I I?_ OTHER : NI A
DRAINAGE: N TOTAL ACRES TO BE IMPACTED:
(b) (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: FT AFTER: FT IV/
WIDTH BEFORE (based on normal high water contours): FT /" AVERAGE DEPTH BEFORE: FT AFTER: FT /' -1 A
(b) (2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODING:
OTHER.
rY {F

11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAWING TO THE POND? _
WHAT IS THE EXPECTED POND SURFACE AREA? N I A-
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 81/2 BY I 1 DRAWINGS ONLY)
6LAU) A Su#w,4Lt- (?Vhj-(460SIr d StaP-46 F=RDM
PRE-SS v 12 F T'e A- rc o W r) oD /jY ff+1Qp
Scr E'x?glr- 11 Z
13. PURPOSE OF PROPOSED WORK: S+d r e o--, U Oaf, 2 e I Ski s
+ +cknn(oa dec-K.
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO NUND [ZB WETLAND IMPACTS)
$ 1L i r- ? /i c?"'j c-
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR NlA-
NATIONAL MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY
FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED
-SFLQ S OR CRITICAL HAB AT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE
PROPOSED PROJECT. DATE CONTACTED:
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA Nll+
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED:
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF fglA-
PUBLIC (STATE) LAND? YES ( ) NO ( ) (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 ADMIMSTRATION STATE CLEARINGHOUSE? YES ( ) NO ( )
IF ANSWER 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE 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].

a
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF 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 STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST
BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS SO FEET OF 1
INCH EQUALS 100 FEET OF THEIR EQUIVALENT.
(b) IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY
PRODUCT.
(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?
?`?'sil.fi•c?11(i l
(I) IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
(g) SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
1. ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2. EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF WATER QUALITY
CERTIFICATION, AND
3. (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM.
2NVWVN /A E S S ATURE DATE
(AGENT'S SIGNATURE VALID ONLY IF AUTHORIZATION LETTER FROM THE OWNER IS
PROVIDED).

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Number of Pages
To:
Fax No. _
Attention:
Prom:
01 iSIS EL
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FAX COVER SHEET
P. O. Sox 3090
Pinehurst, NC 28374
2001
TEL [phone]
FAX [phone]
Post Office Box 090 . Pinehurst, NC 28374
O e Location Hwy. 211 West
TEL No. 910-295-6055
FAX No.t 910-295-p3103
Date Tl Q 7
(Do not include this cover.
Di y f S1,
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PA Y111 L
RECEIVED
PAYMENT
ECEIVED
If you did not receive the specified number of pages or this
transmission is not clear, please contact us at 910-295'6055.
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PO Box 568
Mt. Gilead, NC 27306
April 0. 1999
Mr. & Mrs. Daniel E. Adams
Daniel Adams Construction Company
PO Box 3090
Pinehurst, NC 28374
Dear Mr. Adams:
/6 .?
Subject: Seawall, Boathouse, Deck Area and Walkway (Waterward Side of Seawall)
Tillery Shores Subdivision Lot 4 (Plat Book 5, Page 60)
1 have received your information regarding the seawall, boathouse and walkway (waterward side of
seawall). Listed below are items needed before I can forward the facilities approval from used to
secure a building permit, from Stanly County:
1. Letter from NCDENIZ and COE authorizing placement of seawall in the water of Lake Tillery
(required form to send to both agencies enclosed).
2. Width, length and height of seawall. Will seawall be made of pressure treated wood (creosote
not allowed)? Will seawall run from one allocation line all the way to the other allocation line?
3. Length and width of handicap ramp on Carolina Power & Light Company property.
4. Is boathouse 35 feet, as one drawing shows or is it 35 feet 6 inches long as the other shows?
5. Length and width of overhang at, entrance to boathouse (please note the difference items 5 and
6 will make concerning the 1200 square foot limit of water coverage).
6. Size of steps over deck (please note that steps located over land are not allowed, this includes
steps from a handicap ramp).
7. Are there steps over water to top of boathouse? If there are. what is their size?
8. Payment of x;100.00 to secure facilities approval form.
If there are questions or we need to meet, on the site., give me a call at. [phone] and we will set.
up an appointment..
Sincerely
YN
mmy (;. Chisholm
U
Senior Support, Specialist J 'jP
C: Mr. Les Pearce
(p) - o` 1 ??

??C1y? 11.4.^??l Ye+."?1.? 411 (I .. I I .
I ; 4 1.. .. I >,1 1
DWQ ID: CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #)
PRE-CONSTRUCTION NOTIFICATION APPLICATI`
FOR NATIONWIDE PERMITS THAT REQUIRE:
1. NOTIFICATION TO THE CORPS OF ENGINEERS
2. APPLICATION TO NC DIV. OF WATER QUALTIY FOR SECTION 441 CERTIFICATION
3. COORDINATION WITH THE NC DMSION OF COASTAL MANAGEMENT
SEND THE ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE FIELD
OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7) COPIES
MUST BE SENT TO THE NC DIVISION OF WATER QUALITY, ATTN: JOHN DORNEY, 4401 REEDY
CREEK ROAD, RALEIGH, NC 27607. PLEASE PRINT OR TYPE.
OWNERS NAME: Dan i eI F • /adam S
2. MAILING ADDRESS: P• b • !B- O K 30 'i?(o f ? ne"hu Irs t N C a? 3 `' `I
:?t??er?i Shares
SUBDIVISION NAME
CITY: A16e mar 1 e- STATE: N G ZIP CODE: 00
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE):
L of LA Tcvrh?e-t bri'v'-e- Pi?+ Qeo S Pa9? ???
ar
3. TELEPHONE NUMBER: (HOME)Cq 1 U) C(l A- -7-1 (WORK)( ?? o?S ' b D 5-S
IF APPLICABLE: AGENTS 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): A
COUNTY: S+Gh I ?l NEAREST TOWN: A I be Inca r I e-
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.)
rr0vv-? Iyo? NL. qQi%-\ q a4- ), -1 fivesj , Cip C. 1 rise, lmI e' - l1,
nrjc ?1 l9ltS? ?? h
((G h4 . T+
s /Os
)tf -a 1
L-L
d ow v)
core t-h W e s - ViC-4 ny- i) Lo
6. IMPACTED OR NEAREST STREAM/RIVER:
RIVER BASIN:
It I
7. (a) IS PROJECT LOCATED NEAR WATER CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW), OUTST 7 ING RESOURCE WATERS (ORW), WATER
' SUPPLY (WS-I OR WS-In? YES NO IF YES, EXPLAIN:
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTALl
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES NO
(c) 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?
8. (a) HAVE ANY SECTION 44 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES NO IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS
PERMIT AND ANY AD ITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION):
(b) ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES NO-.6.,/-IF YES, DESCRIBE ANTICIPATED WORK:
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND:
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
10. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: N
EXCAVATION: N -LA
FLOODING: OTHER : N j A"
DRAINAGE: TOTAL ACRES TO BE IN[PACTED:
(b) (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
AVERAGE DEPTH BEFORE: FT AFTER: FT
(b) (2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY)
OPEN CHANNEL RELOCATION: PLACEMENT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODING:
OTHER.
L
11er,i , ti
t
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? '
WHAT IS THE EXPECTED POND SURFACE AREA? N I A-
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 81/2 BY 11 DRAWINGS ONLY)
BLAILu A- sc- wAu_ dch-rtf,00SC * St-VP461F ?RdM
PIRt sSvR-F TR A-reo WOOD /jY ffl-A D -
Sir EX191r 14 2
13. PURPOSE OF PROPOSED WORK: S+o r e CL- b oa± 2 ?k 15
+cknn(vv del:K .
14
STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MQNINUZE WETLAND IMPACTS)
Slei FL ri ci,0 (r -
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR NIA
NATIONAL MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY
FEDERALLY LISTED OR PROPOSED FOR LISTING END GERED OR THREATENED
-SPF, S OR CRITICAL HAB AT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE
PROPOSED PROJECT. DATE CONTACTED:
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA N/,I-
WIECH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED:
17. DOES THE PROJECT INVOLVE AN EXPENDITURE OF PUBLIC FUNDS OT THE USE OF fI/p-
PUBLIC (STATE) LAND? YES ( ) NO ( ) (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 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE 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 'T'HIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF 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 STREAM (INTERMITTENT AND PERMANENT) ON THE PROPERTY MUST
BE SHOWN ON THE MAP. MAP SCALES SHOULD BE I INCH EQUALS SO FEET OF 1
INCH EQUALS 100 FEET OF THEIR EQUIVALENT.
(b) IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY
PRODUCT.
(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?
i i;' Iw"kjI(( ?
(fl IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
(g) SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTE: WETLANDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO:
1. ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2. EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF WATER QUALITY
CERTIFICATION, AND
3. (IN THE TWENTY COASTAL COUNTIES ONLY), A LETTER FROM THE NORTH
CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM.
--- - -----------
OWNER' /A E S S ATURE D
(AGENT'S SIGNATURE VALID ONLY IF AUTHORIZATION LETTER FROM THE OWNER IS
PROVIDED).

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