20000420 Ver 1_COMPLETE FILE_20000329

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
LT!3'A
NC ENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
April 7, 2000
Craven County
DWQ Project # 000420
APPROVAL of 401 Water Quality Certification and Neuse Buffer Rules
S&T Land, LLC
PO Box 1575
New Bern, NC 28563
Dear Sirs:
You have our approval, in accordance with the attached conditions and those listed below, to fill 0.07 acres of wetlands
in Craven County for the purpose of residential construction, as you described in your application received by the Division of
Water Quality on March 17, 2000. After reviewing your application, we have decided that this action is covered by General
Water Quality Certification Number 3103. This certification allows you to use Nationwide Permit Number 14 when the
Corps of Engineers issues it. This approval is also valid for the Neuse River Buffer Rules (15A NCAC 2B .0233). 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 Water shed regulations.
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 you may be required to 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) (6) and (7). For this approval to be valid, you must follow the conditions listed in the attached
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 Dorney at 919-733-9646.
Rc
Stevens
Attachment
cc: Corps of Engineers Washington Field Office
Washington DWQ Regional Office
Joseph Avolis, Avolis Engineering, PO Box 15564, New Bern, NC 28561
File Copy
Central Files 000420
Division of Water Quality • Non-Discharge Branch
1621 Mail Service Center, Raleigh, NC 27699-1621 Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer • 50 recycled/10% post consumer paper
http://h2o.en r. state. nc.us/wetlandc. htmi
zl::]:,
March 15, 2000
AVOLIS ENGINEERING, P.A.
P.O. Box 15564 • New Bern, North Carolina 28561 • [phone]
Mr. John Dorney
NC Division of Water Quality
1621 Mail Service Center
Raleigh, NC 27699-1621
r?? 2G00
M-..

Re: Nationwide #14 for Driveway Crossings, The Oaks Subdivision.
Old Cherry Point Road, Craven County
Dear John:
Enclosed please find seven copies of the above-referenced permit application. Your assistance
with this project is appreciated.
Should you have any questions or need any additional information, please do not hesitate to call.
Sincerely,
Jos ph C. Avolis, P.E.
Pr sid nt
?N` 01
RECEIVED
()00420
PIR 9 2000
i
t u
IET ii"
0 0 42a
D C-RpS ACT ON ID:
E:ID:
NATICMri,DE PEP-MIT REQUESTED (PROVIDE N:-.T10 -DE PERMIT 4) .
14
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE: r
1) NOTIs ICATION TO T-- CORPS OF r iGM-M-y-RS r:
2) APPLICATION FOR SECTION 401 C?RTZ='ZC?,TIONy v,? t e 09 2000 ? 3r2
3) COORDINATION WITH TEZ NC DIVISION OF COASTAL Z0,NAGE4=VT
?'?D ^'??E ORSGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APE rCr'
S cT
_E?.•L OF F:= OF THE CORPS OF rNZ GINEERS (SEZ AGCY ADDRESSES S^..
(7) C021ES SHOULD BE SENT TO THE N.C. D="viS.ON Or
(SEE AGENCY ADDRESSES SHEET) PLEASE PRINT. h
f iU
f ;20010
? . OWNERS NAME: S & T LAND LLC nr , 2„ ? ? ?r "
"LITY SECTION
Mme,- LNG ADDRESS: P.O. BOX 1575 _T
SUB07IISION NAME :
CITY : New Bern STATE: NC ZIP CODE: 28563
°ROu CT LOCATION ADDRESS, INCLUD"=NG SUBD=JISION NAMIE (_= DT_?'?".:: =may'-" =xcm
Y?_LING ADDRESS ABOVE) , The Oaks Subdivision, Old Cherry Point Road (NCSR 1113)
TELEPHONE NUMBER (HOME) . [phone] (WORK) : [phone]
A?DT_C ,.,_. CORPORATE OS'_ICIAL, ADDRESS,
s, IF ?BLE: AGENT'S NA?`?SE OR RESPONSIBLE
PHONE .NUMBER: Jose h C. Avol is P.E.
Avolis Engineering, P.A. P.O. Box 15564 New Bern, NC 28561
[phone]
-i
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS:TOPOGRAPhZC
MAP OR AERIAL PHOTOGRAPHY WITH SCALE) : New RPrn
COUNTY: Craven NE A REST TOWN OR CITY
Please see enclosed USGS Quad
1
PAYMENT
REOFI,,!'_ n
SPECIFIC LOCATION (INCLUDE ROAD
NUMB ERs , LANDMIARKS, ETC.) : The Oaks Subdivision is located 500 feet south of the
intersection of Thurman Road (NCSR 1116) and Old Cherry Point Road (NCSR 1113)
along Old Cherry Point
i . --V-PACTED OR NEAREST STRZA,\f/RIVER: Unnamed tributary to the Neuse River
RIVER BASIN: Neuse.
7a. TS ?RO,LCT LOCATED NEAR r7ATER CLASSIFIED AS TROUT, TIDA?, SALT-',4-AT-.R
(SA), HIGH QUALITY WATERS (HQW), OUTSTANDING RESOURCE WATERS (ORW), riATER
SU?OLY ("nS-I OR ,;S-,I) ? YES [ 1 NO [XX1 IF YES, EXPLAIN:
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COAST
HANAGE1MEiT AREA OF ENVIRONI-F.NTA?., CCNCERN (AEC)? YES [ J NO [XX]
7c. IF THE PROJECT IS LOCATED WIT;IN A COASTAL COUNTY (SEE PAGE 7 OR
LIST OF COASTAL COUNTIES-),, irH] T IS THE L;UND USE PL?V (LUP) DESIGNATICN?
Rural
8a. rA'v? INY SECTION 4-04 P RMITS BEEN PREVIOUSLY REQUESTED FOR USE ON
THIS PROPERTY? YES [XXl NO [ ] IF YES, PROVIDE ACTION I.D. N m1BER OF
2REVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION): Acti on I D ??199810397 401 Water Qual i U certification was not reoui rPrl
8b. AR ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN 'THE
FUTURE? YES [ ] NO V ] IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND : 16.95 Acres
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
1.5 Acres
2

10a. NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROTECT BY:
FILLING : 0.0598 Acres
FLOODING: 0
T-,?-kINAGE :
0
EXCAVATION: 0
OTHER : ( Previ ousl y Permitted Filling = 0.234 Acres)

TOTAL ACRES TO BE IMPACTED : 0.304
1.0b. (1) STREAM CHANNEL TO BE I-VIPACTED BY THE PROPOSED PROS CT (rF
RELOCATED, PROVIDE DISTANCE BOTH 3EFORE AND AF TER RELOCATION
LZNGTH BEFOR:., : Not a stream -.T A FTER : N/A T T
: --
WI TH BEFORE (based on normal high water contours) N/A TT
.m
WIDT? AFTER: N/A - -
AV---RAGE DE'T=- BEFORE: - --? --
-i = m<"-??,{ T1.(D]C"_'C 'N'_IL =,??_: ._. "_' C (C HECK ALL T:_:T -22LY)
-
C2 E- C:1?TNEL ?T ATICr+. N/A PLACEu-.NT c_ P-_ 7N c?NN_:;. XX
?LCc
..13L NNE? ^ AV -TION. N/A. CONSTRUCT=ON OF A D='M/FLOODING. N/A
=x-
OTHER : N/A
11. IF CONSTRUCTION OF A POND IS PRCPOSED, -.3T IS THE SIZE OF THE
WATERSHED DRAINING TO THE POND? No Pond
WFAT IS THE EXPECTED POND SURFACE AREA? NA
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICAL. EQUIPMENT TO BE USED (ATTACH PLa.NS : 8 1/2" X !I,' DRAWINGS
ONLY) : Work includes tfi---construction of approximately 900 feet of residential driveway.
The p roject requires crossing three wetland areas 30' 30' and 35' in length. The

total wetland impact from the three crossings is 0.0698 Ac res Eouioment will consist
of a track hoe and a tractor and box blade.
13. PURPOSE OF PROPOSED WORK: Access two residential building lots with a
single driveway. Building lots are located across narrow ravines.

3
A
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CrRRIED
OUT IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS) : The two upland building lots are isolated by narrow wetland ravines. The
crossings occur at the narrowed and most accessible wetland locations.
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND W-ZLDLIF- SERVICE
(USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) (SEE AGENC'_'
ADDRESSES SHEET) REGARDING THE PRESENCE OF ANY FEDERALLY LISTED OR
PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL H13 ITAT
IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PRO??CT DATE
CONTACTED: March 15, 2000 (ATTACH RESPONSES
FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION O-=ICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
PROPERTIES IN THE PERMIT AREA rvr.IC H MAY BE AF TCTED BY THE PROPOSED
PROJECT. DATE CONTACTED: March 15, 2000
17. DOES THE PROjr.CT INVOLVE AN EXPENDI-TURE OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES C l NO M (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 [ ] N/A
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YEs [ ] No [ ] N/A
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCIIMENTATION 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].
4.
IS. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS A?PLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISC'.-A GE OF EXCAVATED OR FILL MATERIAL
INTO WETLANDS
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, LASS
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMB ERS 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 WETLAUNDS TO BE
IMPACTED BY PROJECT.
a. 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 STORM-WATER MANAGEMENT PLAN =F REQUIRED.
e. WHAT IS LAND USE OF SURROUNDING PROPERTY? Residential wooded
i. TT AP2LICA3LE, WHAT IS PROPOSED METHOD OF SEWAGE DISPGSAL?
Private septic tanks
N 77 g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, A?PI.•ICAIBLE.

NOTE,': WETLANDS OR WATERS OF THE U.S. 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 DIVISICN OF
EN4iRONb,lENT_A,L MANAGEMENT (WATER QUALITY) CZERTIF ICATION, AND
3) (IN THE TWEYTY COASTAL COUNT"S ONLY) , A LETTER FROM THE
NORTH CARCLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM. 1 .1.11
Z'S/AGENT'S SIGNATURE
tT H. SMITH, PARTNER
3? ? 5 - d a
DATE
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18g.))
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MAR 7 2000
Vy r„JD5 GROUP
`r?' ,?;'"!_ITY SECTION
.volis Engineering, PA Date: ?OLOO
)stOffice Box 15564 • New Bern, NC 28563-15564 • [phone] Project: TH-S OAK 5u6.WVI5jv?
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Approves Cy

` 000420
DE:? ID: CORPS ACTION 7D:
NAT-TOW47DE p7,LMIT REQUESTED (PROVIDE N SIONGi DE PERM= 4)
14
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERMITS THAT REQUIRE:
MAR
1) NOTIrICATICN TO Tar CORPS OF ZNG=q' S
2) APPLICATION 3'CR SECTION 401 RTZ='ICATION WETI-ANDS ? Gk j,
COORDIN2,TICN WITH THr NC DIVISION OF COASTAL 20-MG21 It SLl )`?l1„
Sc"''.ND ORIGINAL AND (1) COPY OF THIS COMPLET= FORM TO THE A PROZ-BUZA
-IEID OFFICZ OF T CORPS OF Z NGINEE.RS (SaE AG"r..`NCY ADDRESSZS SiME'T') SE??' `N
(?) COPIES SHOULD BE SENT TO THE N . C . DT_'v SION OF ENVIRON`t41Z.`" 4L Y- ; + G
(SEE AGENCY ADDRESSES SCILLT) . PLEASE PRINT 1r .j b s
OWNERS NAME :
S & T LAND, LLC
d=-
,?- ING ADDRESS P.O. BOX 1575
2.
SUB0=7ISICN NAIME :
CITY: New Bern STATE: NC ZI? CODE: 28563
PRO?TUCT LOCATION ADDRr'.SS, INCLUDING SUED=7=SION NAME _ DIF-_r=.?i_ FRO -
ADDRESS ROVE) ; The Oaks Subdivision, Old Cherry Point Road (NCSR 1113)
3 TELEPHONE NUMBER 252) 637-5724 (WORK) : [phone]
. (HOME) . (
1. _ APPLICABLE : AGENT ' S NA CORPORATE OF=ICIAL, ?DRESS,
g ??.?.?`?L OR RES?ONSIBLE
?HONE NUM-BER: Joseph C. Avolis P.E.
Avolis Engineering, P.A. P.O. Box 15564 New Bern, NC 28561
[phone]
5. LOCATION OF WORK (PROVIDE A MAP, PREFER?-BLY A COPY OF QSGS TCPCGRA2H!C
MAP OR ?s.RIAL PHOTOGRAPHY WITH SCALE) NEAREST TOWN OR CITY: "i°'^' R°rn
COUNTY : Craven
Please see enclosed USGS Quad
PAYMENT
RECEIVED

SPECIFIC LOCATION (INCLUDE ROAD
\IUM-BERS, LANDM.A.RKS, ETC.) :
The Oaks Subdivision is located 500 feet south of the
intersection of Thurman Road (NCSR 1116) and Old Cherry Point Road (NCSR 1113)
along Old Cherry Point IMPACTED OR NEAREST STREAM/RIVER: Unnamed tributary to the Neuse River
RIVER BASIN: Neuse
7a. 71Z pRO,;-7CT LOCATED NEAR WATER, C??.SSIFIED AS TROUT, TIDAL S?T.T'N?T
(SA) , HIGH QUALITY WATERS (HQW) , OUTSTANDING. RESOURCE WATERS (ORW) WAT ? a? + iL ?Ct1vN
Si-L'_ (v+S-I OR WS---) ? Y'S [ j NO [XXl I= YES, EXPLAIN.
7b. IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTZ?L
` 2 NAGM4-ENT AREA_ OF ENVIROUM-E ITAL CONCERN (ARC) ? YES [ j NO [XX]
7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR
LIST OF COASTAL 000NTIES-) ,\ W`HAT IS THE 11 1'% I`7D USE PLAN (LU?) DESIGNATION?
Rural
ga. HAVE ANY SECTION 404 PE.UMITS BEEN PREVIOUSLY REQUESTED FOR USE ON
T:iIS PROPERTY? YES (XX] NO [ j I YES, PROLiDE ACTION I.D. NUmBEI OF
PREVIOUS PERMIT AND ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401
CERTIFICATION): Acti on I D ??199810397 • 401 Water Oual i tv certification was not reoui red -
8b. ARE ADD=TIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE
FUTURE? YES [ j NO ?Xj IF YES, DESCRIBE ANTICIPATED WORK:
9a. ESTIMATED TOTAL NUMBER OF ACRES IN TRACT OF LAND: 16.95 Acres
9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
1.5 Acres
2
10a. NUMBER OF ACRES OF WETLANDS IupaCTE'D BY THE PROPOSED PROjICT BY:
FILLING: 0.0698. Acres EXCAVATION : 0
LoODING : 0 OT::ER : (Previ ousl y Permi tted Fi 11 i n4 = 0.234 Acres)
ima-TNAGE : 0 TOTAL ACRES TO BE IMPACTEM : 0.304
lOb. (1) STREAM CHANNEL TO BE T ACTED BY THE PROPOSED PROS CT (I?
RELOCr?TED, ?ROVrDE D rSTANCF. BOTH BEFORE AND Ar iER RELOCATION
L?iGTH BEFcR" Not a stream FT =mER: N/A FT
,4 _a BEFORE (based on no=al high grater contours) : N/A FT
TdIDTH AFTER: N/A ^m
AVwMAGE DEPTH BEFORE: 0 'T AVER: 0 ;Yr*
L
CTT ..?.M '?]\ r'? IMPACTS WILL R_SUJT FRCM: (C^.:C{ cZ ?''._? ?? PLY)
OPE.T CF y,,.gEI, RELCCAT=cN. N/A 2L•AC=7 N^_ CF PI"E ;N C?_NNE_. XX
C 3.L"N,.= N/A. CCNSTRUC'_=ON 0-7 -'A- DAIM/FlCOCING: N/A
OTHER : N/A
11. IF CONSTRUCTICN OF A POND IS PRCPCSED, -RHAT IS THE SIZE OF THE
WATERSHED DRAINING TO THE POND? No Pond
gHAT IS THE EXPECTED POND SURFACE AREA? N/A
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF
MECHANICP.L EQUIPM-vT. TO BE USED (ATTACH PLP.NS: 8 1/2" X 11" DRAWINGS
ONLY) : Work includes tfeconstruction of approximately 900 feet of residential driveway.
The project requires crossing three wetland areas 30' 30' and 35' in length. The
total wetland impact from the three crossings is 0.0698 Acres Eguioment will consi?t_
of a track hoe and a tractor and box blade.
13. PURPOSE OF PROPOSED WORK: Access two residential building lots with a
single driveway. Building lots are located across narrow ravines.

3
14. STATE REASONS W'HY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED
OUT IN WETLANDS. (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND
IMPACTS) : The two upland building lots are isolated b narrow wetland ravines. The
crossings occur at the narrowed and most accessible wetland locations.
15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE 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 CRITICAL H.3--TAT
IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE
CONTACTED: March 15, 2000 (ATTACH R ES20NSES
FROM THESE AGENCIES.)
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) (SEE AGENCY ADDRESSES SHEET) REGARDING THE PRESENCE OF HISTORIC
Rr.IC: M.?Y BE A7--'TCMED BY THE PROPOSE=
PROPERTIES IN THE, PERMIT AREA '
PROJECT. DATE CONTACTED: March 15, 2000
17. DOES THE PRO,-CT INVOLVE AN =XPENDITURS OF PUBLIC FUNDS OR THE USE OF
PUBLIC (STATE) LAND?
YES [ ] NO (77 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 [ ] N/A
b. IF YES, HAS THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE?
YES [I NO [I N/A
IF ANSWER TO 17b IS YES, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE
STATE CLEARINGHOUSE TO DIVISION OF ENVIRONMENTAL MANAGMjENT 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].
4

18. THE FOLLOWING IT7"MS SHOULD BE INCLUDED WITH THIS APPLICATION IF
PROPOSED ACTIVITY INVOLVES THE DISCH; RGE OF EXCAVATED OR FILL M.ATER_TA..L
INTO WETLANDS
a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREA?MLS, LAEiS
AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUM3ERS 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
INCH EQUALS 100 FEET OR THEIR EQUIVALENT.
b. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE
IMPACTED BY PROJECT.
a. 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. WrL,T IS LAND USE OF SURROUNDING PROPERTY? Residential vended
DIS?OSAL?
II AP2LIC23LE, WHAT IS PROPOSED METHOD OF SEWAGE
Private septic tanks
g. SIGNED AND DATED AGENT AUTHORIZATION LETTER, I= A?PL=k-3LE.
NOTE: WETLANDS OR WATERS OF THE U.S. MAY NOT BE IMPACTED PRIOR TO:
1) ISSUANCE OF P_ SECTION 404 CORPS OF ENGINEERS PERMIT,
2) EITHER THE ISSUANCE OR WAIVER OF A 401 DIVLSICN OF
ENVIRONMENTAL MANAGE,`vfENT (WATER QUALITY) CZERTIFICATION, AND
3) (SN T;0 TWMVTY COASTAL COUNTS ONLY) , A LETTER FROM THE
NORTH CAROLINA DIVISION OF COASTAL MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH THE NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM.
S/AGENT'S SIGNATURE
H. SMITH, PARTNER
DATE
1
5
(AGENT'S SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED (18g.))
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