20010248 Ver 1_COMPLETE FILE_20010217

Michael F. Easley
Governor
Sherri Evans-Stanton, Acting Secretary
Department of Environment and Natural Resources
Kerr T. Stevens
Division of Water Quality
March 13, 2001
Alexander County
DWQ Project # 010248
APPROVAL of 401 Water Quality Certification
Mr. Dennis Harrow
Post Office Box 2361
Hickory, NC 28603
Dear Mr. Harrow:
You have our approval, in accordance with the attached conditions, to place fill material in 0.0275
acres of waters for the purpose of constructing a rock wall on your property on Lake Hickory, as you
described in your application dated February 17, 2001. After reviewing your application, we have decided
that this fill is covered by General Water Quality Certification Number 3280. This Certification allows you
to use Regional 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 Domey at 919-733-1786.
Sincerely,
Stevens
Attachment
cc: Corps of Engineers Asheville Field Office
Mooresville DWQ Regional Office
File Copy
Central Files
Wlw.
NCDENR
Division of Water Quality 1650 Mail Service Center Raleigh, NC 27699-1650
Wetlands/401 Unit: [phone]
Fax: [phone]
i
Att. Todd St, JohA
Mere is thot information you, rtgidre. Thkok you for your izhtnediate attention to this
matter it truly is appreciated-
1. We want to build a tock- wall around our point on lake Hickory, It will be
approx1mately 350 to 400 feet long.
a. My wife and I arc buildi!dg our hdrpe !Dn this site,
3. 1 hove enclosed a pI4t stjowink thi .area that'will touch the water of lake Hickory.
4. There are no ponds Or streams on the site.
5. There will be approxiWi ely 2,5 tai 3 feet c ff stone undet the water.
Again thank you for your attention and anderstattding'ofour situation. Any help in
expediting this request will be apprediated.
Denals Harrow
829-324-5900 phone
82$-324-9712 Fax
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RICHARD Q.
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State of Noah Carina
Department of EnvkDnnvent
and Natural Resources
Division of Water Quality
James B_ Hunt- Jr_. Governor
Bill Holman, Secretary
Kerr T_ Steverts_ Di ec or
dlr. Dennis Harrow
Post Oific-- Box 2361
Hickory _ tiC 286
Dear tir. harrow=
NZA
NCDENR
t-IC J '1 CL-.OC-T elA 0EPAR-rM`oTT OF
ENVIRC*4ME'
R?tLL ?NAT JRAL rt?DUFc'==
Februaxy 27_ 2001
D`WQ 010= 48
Alexander Comity
On Febn2ar_•- 1-7-21001 the Division of 'Water Quality (DX'Q'a u-2s notified by receipt of
your application- your plan to fill aetlands or %-criers for an im Alexander County.
Approval from DWQ is re-quh-ed to dis:rurb thes` areas- In particular ms des"-n-bed in 15A LCAC
213 .0=02__ we -%-W re`se «u W locate all strz=is and pond on the eroperny_ Please show these
on maps of suitable `?-.le (fir iastance 1- = 100 feet) so a e can bed w deters i your projects-
compliance with 15 A !CAC 2H -0500-
1. a descrip cm of the activiryyou plan to conduct and the purpose of this activity,
2 _ a site plan shov its the location of the impact and
3- a dsescrip&n of the arcaof the impact t o wetlands or Raters.
Please call T-oW Sa John at (919) 73=-1786 if }sou have any questions CM- would esquire
copies of our rule= or pra e`wal materials- This project will remaiffi on hold as incomp+aete in
accordance -%ith 15A NC-AC 2H _0-50-(c). The processing time for this application will begin
ashen this infformaik-vi rec:ei«i If Re do not hear from you by wrix7in4 within three (3) -weeks
we sill assume you no loner vmnt to pursue the project and w it corder it withalrawm.
Cc= i\iooresV7ile DWQ Regional Offices
Ashe%Ue Corps of Erin r
File Copy
Cezmral Files
R fem.= 3 Emrz • 4401 R Cry Road • Rakiz!'b `worth CmmEma 2760 ;.
Terre 919-ems 2-1796 FAX = 3-9959
Am F si G!pora?g s ire 9 =-
S0-- rczyc1--'IGf1.:pos% cCV S n Mc
FEB-07-2001 WED 12:50 AM FAX NO,
710 -v

010
24 C rn
DWQ ID; ----- CORPS, 1 CTION ID:
NATIONWIDE PIERMTT RFQi1I+-ST1?D (PROVIDE NATIONWIDE PERMIT
PRF.-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE 11F.RMITS THAT REQUIRE:
I. NOTIFICATION TO THE CORPS OF ENGINEERS
2. APPLICATION FOR SEC!'ION 401 CERTIFICATION
3. COORDINATION WITH THE NC DIVISION OF COASTAL MANAOL•'MEN°('
SENT '1111" ORICTNAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE FIELD
OFFICE-_ OF T1il` CORPS OF ENGINEERS (SEL- AGENCY ADDRESSES SIImn.). SEVEN (7)
COPIES MUST BE SENT TO THE NC DIVISION Or WATER QUALITY,
A'I'TN-. JOHN DORNFY, 4401 REEDY _CUEK ROAD, RALEIGH NC
27607. PLEASE PRINT OR TYPE.
v`1
i. OWNER'S NAME: ?[?nn ? S I"rc?- r r o
2. MAIL1N0ADDIUZSS:
SUBDW]IS10N NAME
"LIP CODE: o; ? o3
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADORLSS ABOVE): C -+T j_oanel
{ 0'ylorsvi (lei ??
3. TF,.1,F,PHONL NUMBS-R: (HOME) (WORK) 31 _Sgpp
$X-3 ag-
4. IF APPLI('AQLL*: AGENT'S NAMF. OR RESPONSIBLE CORPORA'TI' ()FFICIAL, ADDRESS,
PHONE 111"U\113L"R.
P. 01
s. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USCIS TOPOGRAPHIC MAP
OR ATRIAL PHOTOGRAPHY WITH SCALE)-
COUN'fY:fq(:?-4. II ARES'r'TOWN: FGy IorS w, le-? N6
SPLiCI1'IC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) R nk
LGl C°i- / A ile_ on 1^%?U QGt0SS -PIOM GK4jC.WIC* d011N D&-v `
6. IMPACTED OR NFARFS"r STRLAM/RIVER: RIVER BASIN: LQ o- Gk0 r Y
7, (a) IS PRc)1GC:T I.OCATED NEAR WA'('f:R CLASSIFIED AS'I'ROUT,'r1r)AL SAL1'WATE'R, (SA),
HIGH QUALITY WATERS (HQW). OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-I1)'? YES ? NO'p IF YES, EXPLAIN:
(b) IS'I RE PROJECT LOCATFD WITHIN A NORTH CAROLINA DIVISION OF C ASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCHMN (AEC)? YF.S ? NO
(c) IF T1113 PROKiCI' IS LOCATED WITHIN A COASTAL COUNTY (SEEPAGE 7 FOR LIST OI,
? J?
COASTAI- COUNTIES), WHAT IS Tic: LAND USE. PLAN (L'UP) DESIGNATION?
FEB-07-2001 WED 12:50 AM FAX NO. P, 02
b. (a) ID-\V ANY SFC'TION 404 PSRMITS BEEN PRF,VIOUSI,Y RF,QUFSTFD FOR USE ON THIS
PROJI?C'1"? YLS 0 NO IF YES, PROVIDE; ACTION I.U. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL IN -ORMATION ( INCIAJDF. PHOTOCOPY OF 401 CFRTIFICATION):
(b) ARE ADDITIONAL PERMIT REQUESTS 1-XPECTED FOR THIS PROPERTY IN THE FUTURE?
YES U NO . II-' YES, DESCRIBE? ANTICIPATED WORK:
9, (a) F.STIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND:
(b) 1;SI'IMA'1'L.D 'I'O'I'AL NUMLICR OF ACRES OF WFTI."ANDS LOCATED ON PROJECT SITF:
IU. (a) NUM I3LR 01" NACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY: V
FILLING: __._ EXCAVATION:
FLOODING: ___ OTHER :
DRAINAGE:_ ,,TOT'AL. ACRES TO BE IMPACTED:
(b) (1) STRLAM C EIANNEL. TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATOn,
/7
PROVIDE DISTANCE BOTH BEI"ORL' AND AEI'ER RELOCATION: /VLL:NG I'Ii BEFORE. F'I' Ar rLR: __,,,._„„ Fr /4
WIDTH BEFORE thascd on normal ht,h water contours): FT
AVF;RACi1? LPL"P"I"I1 F.;I FURr:: „m.,?.. F 1' AFTER: 1• r
(b) (2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY) `(//X
OPEN CHANNEL RELOCATION: I'i.ACFMFNT OF PIPE IN CHANNEL:
CHANNEL EXCAVATION: WNSTRUCTION OF A DAM/FLOODING:
OTHER:
1 I. IF CONSTRUCTION OVA POND IS PROPOSED, WHAT IS TJ42 SIL.L• OF TfIE WATI:RSHFD
DRAINING TO THE POND'? WHAT IS TIM EXPECTED POND SURFACE AREA'?
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE. OF MECHANICAL
EQUIPMENT TO BE USED? (AT ,",CH PLANS; 81/2 BY I I DRAWINGS ONLY)
F r O A4- l-DaA
13. PURIIOSL Or•'})120POSFD WORK. paS+u,rc m?s?{?
14. STATE R[ ASONS WHY IT IS 131liLICVED THAT THIS ACTIVITY MUST BE, CARRIED OUT IN
WETLANDS ( INCLUDE ANY MFASURE;S TAKL'N TO MINIMIZE WETLAND IMPACTS) /A//)q
15. YOU ART. R.F.QUIRL,D ,ro CON I'ACT THF" US FISH AND WILDLIFE SERVICE ANFVOR
NATIONAL. MARINE FISHERIES SERVICE REGARDING THE PRESENCE OFANY I-'LDf RAI,I,,Y
LIS'11:1.) OR NZOPOSED FOR LISTING ENDANGFRF:D OR THREATENED SPECIL'S OR CRITICAL
HAT MAY BC AFFECTED BY THE PROPOSE:D PROJEC'r.
\T
14AB1'1'A'1' 1N "I'IIF PERMwl
DATE CONTACTLD:
16. YOU ARE RE.;QUIRED TO C ON'I'AC" 1" I'IIE STATE EISTORIC PRI SFRVATION OFFICER
(Slll'U) REGARDING THE PRESENCE OF HISTORIC PROPI,RTIES IN THE PERMIT AREA
WIIIC'H MAY IIL: AI7r1;C'rFn RY'rHE PROPOSr I PROJECT. DA'rE CON'I'AC'rr_D _,_-. A/R
FES-07-2001 WED 12:51 AM FAX NO. P. 03
17. DOES TIME PRO.1I:C T INVOL AN EXPENDITURE OF PUBLIC FUNDS O'1" HE USE OF PUBLIC
(STATF,) LAND? YES ? NO (11' NO. CIO TO 10)
(a) It:DOES TILL PROJECT REQUIRE'. PREPARATION OP AN LNV1Ro NMEN'1'AL
DOCUMI?NT PURSUANT TO TI-12 RLQUIRIEMENfS OF THE NORTH CAROIINA
ENVIRONME'N'TAL POLICY ACT? YES ? NO ?
(h) 1F YES, lTr\S THE DOCUMENT I31:F;N 1.E;VILiWL I?'1'IIROUGTI'1'T1L NORTH CAROLINA
DI'P,\RTMFNT OF ADMINIS'1'RATfON STATE CLEARINGHOUSE YES ? NO ?
11' ANSWE'R 171) IS YES, THL;N SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
C:1.1"ARINC;HOUSE WITH THE NORTH CAROLINA ENVIRONMEN'T'AL POLICY ACT,
QUESTIONS REGARDING THE: STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
D1RL.CTE'D "1'O MS. CIIRYS BAGGE"IT. DIRECTOR STATE CLI-iARINC;HOUSE, NORTH
CAROT.fNA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, " E'LL FRONE [phone].
18. TI IF' F01,1,OWINC1 ITEMS SHOULD 13F INCLUDED WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVE-$ THE DISCHARGE, OF 1-:XC:AVATED OF FILL MA'T'ERIAL INTO
W L"1'l-ANDS v /A
(a) WL'T'LAND DEIANGATION NIAP SHOWING ALL. WETLANDS, STREAMS. LAKES, AND
P(ENI)S ON'ri-IE''. PROPERTY I FOR NA'T'IONWIDE, PERMIT NUMBFiRS 14, 18, 21, 26, 29, AND 38).
ALL S"FREAM (INTERMITTENT AND PLERMANGNI') ON THE PROPERTY MUST 132 SHOWN ON
THE MAP. MAP SCALES SHOULD BF 1 INCH EQUALS 50 FEF,T OF I INCH EQUALS 100 FERT
01:'111E[R EOUfVALENT.
(b) IF AVAII,AFit.I;, RT;PRF.,SI-.NTATIVE PHOTOGRAPH OF WFTI,ANDS TO 13F. IMPACTED 13Y
PRODUCT.
(c) IF DFLINE ATION WAS PERFORMED 13Y A CONSULTANT, INCLUDE ALL llA"I'A SI-IEL"I'S
PI,:\CFMFNT OF THE DFI..INF.ATION LINE,
(d) AT 1 ACH A (_'(_)1'Y OP TI B.," STORNIWATER MANAGEMENT PLAN IF REQUIRED,
(e) WHAT IS LAND LISE OF SURROUNDING PROPER'T'Y?
(f) IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE,
NOTE: WETLANDS OR WATERS OF THE US MAY NOT BE IMPAC'T'ED PRIOR'TO:
i ISSUANC:I: OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
I;['111ER "I"f HE ISSUANCF' Olt WAIVER OFA 401 DIVISION OF WATF:I. QUAIJTY
CEat'1'I1:IC:\'T[ON. AND
? IN T1IF.. TWI NTY COASTAL COUNTIES ONLY), A LE'I-I'L'R FROM T1113- NORTH
C:\(tUl.lur\ DIVISION OF COASTAL. :k1ANAOF,MENT STATING THE PROPOSED
AC WIT)' IS CONSIS'TE'NTWITH T'I-fE NORTH CAROLINA COASTAL MANAGFMF,,NT
PROGRAM,
OWNL'R'S/AGENT'S SIGNATURE DATE: -*- 7/777-1
" - /A-
(AGENT'S SI(jNA'1 UM:? VALID ONLY ('/
IF AU"Tl-lUR1 .:3`I'fON LIT I"FIR FROM
THEOWNER JS NZOVIDFD),
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FEB-07-2001 WED 12:50 AM FAX NO, P. 01
010248
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DWQ Ili); ---, CORI'S ACTION ID: -----
NATIONWIDE PERMIT REQ[JItiSTKD (PROVIDE NATIONWIDE PERMIT #I) -----
PRE-C"ONSTRU'CTION NOTIFICATION APPLICATION
FOR NATIONWIDE PERtmiTS THAT RF.QUIRZ-;
1. NOTIFICATION TO THE CORPS OF ENGINEERS
API'(.IC,,1l'ION I'C)P Si?C'I'ION 40I CERTIFICATION
3. COORDINATION WITH THE NC DIVISION OF COASTAL MAN AGEME N"('
SEND '1'111" ORIGINAL AND (I) COPY OF THIS COMPLETED PORN TO THE APPROPRIATE FIELD
OFFICE OF TI{L`• CORPS OF ENGINEERS (SHE AGENCY ADDRESSES siinn-). SEVEN (7)
COPIES" NfUST BH SENT TO THE NC DIVISION OF WATER QUALITY,
Al'TN-. JOHN DORNEY 4401 REED'S CREEK ROAD IAA EIGH NC
27607. PLEASE PRINT OR TYPE.
1. OWN-R'S NAME: t??nn 5a rro "`1
MAILING ADDRESS: P.D'
SUBDIVISION NAME
CI'I'41A \'I'E: N,^ "LIP CODC: -Z% 03
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): -45-+"r j-anel
iaYlo,-sv?lle, N?
3. TLiLEPHONL NUMBER: (HOMI-,) (WORK) 3 _SgOo
$?$-3 -4 7-066U- g ag-
o. IF APPI.I('ABLE: AGENT'S NAMF. OR RESPONSIBLE CORPORA"!'!: OI I?ICIAL, ADDRESS,
PHONE NUMBER.
5. LOCATION OF WORK (PROVIDC A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AFRIAL WITH C OUNTYA V- TOEARES'I TOWN S-TGY)lors V'. I It, W,
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS. ECT.) ?1 nk -??, 6*7
La??- / ?????. on ri?h?cua-oss Frori, C?d1??icK CoveD?v
6. IMPACTED OR NEAREST STREAM/RIVER: RIVER BASIN: ?I Gko r Y
7. (a) IS PROX.CT LOCATED NEAR WA'('T:R CLASSIFIED AS TROUT, TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW). QU'C$TANDJNG RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-11)? YFS ? NON II' YES, EXPLAIN.
(b) IS 'I'I-IL YROJCCT LOCATED WITHIN A NORTH CAROLINA DIVISION OF C ASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCLRN (AEC)? YFS ? NO
(c) IN'['IIG PROJf:(" I' !S LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR MST OF,
COAtiTAL COUNTIES). WHAT IS TmE LAND USE. PLAN (L'UP) DESIGNATION? AfJA
FEB-07-2001 WED 12;50 AM FAX NO. P. 02
8, (a) HAVE ANY SECTION 404 PERMITS BEEN PRF,VIOIJSI.Y RF,QUF..STFD FOR USE ON THIS
PRoJI,C'T? YLS [I NO IF YES, PROVIDE; ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL, IN-O-RMATION (INCIAJDF. PHOTOCOPY OF 401 CF,.R'I"TFTCATION):
(b) ARF, ADDITIONAL PERMIT REQUESTS LXPECTLD POR THIS PROPCRTY IN THE FUTURE?
YES f NOME YIDS, DESCRIBE: ANTICIPATED WORK:
9. (a) ESTIMATLE) TOTAL NUMBERS OF ACRES IN TRACT OF LAND: Iq
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE:
10, (a) NUMBER OF ACRES OF WFTI,ANDS IMPACTED BY THE PROPOSED PROJECT BY: V
FILLING: __._ EXCAVATION:
FLOODING: ___ OTHER :
DRAINAGE:- TOTAL, AC'RJ-S TO BE IMPACTED:
(b) (I) STRL3AM CHANNEL TO BE IMPACTED BY THL PROPOSED PROJECT (IF RELOCATED,
PROVIDE. DISTANCE BOTH BE;1"ORL• AND AHT'LR RELOCATION: ? 1 JQ
LLNG H BEFORE. FT AFTLR; Fr /?/ ?1
W1L)'I 11 l3kiFORF (based on normal high water contours): FT
AVE:RACiI? t>EE''I"II F31 FORf;: „?,?., Fi' AFTER: 1 r
(b) (3) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY) NIA
OPFN CHANNEL RELOCATION: PLACEMENT OF PIPL: IN CHANNEL:
CHANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODINO:
OTHF,R:
11. IF CONS'T'RUCTION 01' A POND IS PROPOSED, WHAT IS T)4r,, SILL. OF THE WATEMSHFI)
DRAINING TO THF POND" WHAT IS TIM EXPECTED POND SURFACE AREEA?
12. DESCRIIY[7ON OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE. OF MLCHANICAL
RQUIPMLNT TO BE USED? (ATTACH PLANS; 81/2 BY I I DRAWINGS ONLY)
Fron4- -EhJ, d-oa- r
13. 1'lURll0SC OF PROPOSFD WORK. po,,S+LkrG La^ , mesi{e-
14. S'L'A'TE R( ASONS WHY IT IS 13L'LIEVE:D THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WFTLANDS (INCLUDE ANY MF.ASURL-'S TAKLN TO MINIMIZE WETLAND IMPACTS) A//#
15. YOU ARE R(?QUIRLD,ro CON T'AC"C THF. US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL.. MARINE FISHERIES SERVICE REGARDING THE PRESENCE 011- ANY I-ILDi RA11Y
LISTLID OR F'I?OPOSED FOR LISTING ENDANGERED OR THREATENED SPECIL,'S OR CRITICAL
THAT MAY BE AFFECTED AY THE PROPOSE:D PROJECT.
HAB['I'A'C IN "I'IIF PT;RMWX
DATE CONTAC TLD' 16. YOU
ARE RE QUIRED TO CONTACT THE THE STATE HISTORIC PRESI~RVATION OFFICER
(SI11'U) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY 11E AFFECTED RY THE PROPOSEr) PROJECT. DATE CONTACTED //R
FEB-07-2001 WED 12:51 AM FAX NO. P. 03
17. D(?E'.S TIME PROJECT INVOL AN EXPENDITURE OF PUBLIC PUNKS 0'l' TH8 USE OF PUBLIC
(STATE=) I.AN!)'' YF S ? NO 111 NO. GU TO lfi)
(A) I YES, DOGS "1')-11: PROJECT Rf:QUIR[ I'RLI'ARATION Or AN LNVIRONMENTAL
DOCU,vft;NT PURSUANT TO THE RLQUIREMENTS OF THE NORTH CAROf -INA
L'NVLRONNIENTAL POLICY ACT? YES ? NO ?
(h) IF YES, HAS THE DOCUMENT BL:,.FiN 12FV1L:WL 1?'1'I11tOUGii'i'III; NOR'1'll CAROLINA
DE'PAR'TMt I:NT OFADMINTS'I'RATION STAT2 CLEARINGHOUSE YES ? NO ?
1l' ANSWE'R 171) IS YES, TIiLN SUBMIT APPROPRIATE; DOCUMENTATION FROM THF, STATE
C LF.ARINGHOUSE WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QUI:STIONS REGARDING'1 HF STATE CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS, CITRYS BAGGE'll', DIRUC 1'OR STATE CLl?ARiNC3I-IOUSE, NOR'T'H
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH.
NC: kTf-l CAROLINA 27603-8003, TE'LLPHONE [phone].
18. TITF: FOI.LOWIN(; ITEMS SHOULD 13F INCI.UDT,D WITH THIS APPLICATION IF PROPOSED
ACTIVITY INVOLVES THE DISCHARC: E, OF EXCAVATED OF FILL MATERIAL INTO
WLI'LANDS v 1A
(a) WL1'L.AND DELINEATION NI AP SHOWING ALL. WETLANDS, STREAMS, LAKES, AND
PONDS ON "ITI-fi' PROPERTY IFOR NATIONWIDF: PERMIT NUMBERS 14, 18, 21, 26, 29, AND 38).
ALL Sl'RCAM (INTERMITTENT AND 1'CRMANCNT) ON TIIL PROPERTY M'US'T' 132. SHOWN ON
THE: MAP. MAP SCALES SHOULD BF I INCH EQUALS 50 FEF,T OF I INCH EQUALS 100 FF.,FT
01: `I'fILIR 13QUWALENT,
(L) IF AVAII.A REPRESENTATIVE; PHOTOGRAPH OF WFTI.ANDS TO 13F.. IMPACTED BY
PRODUCT,
(c) IF DF LINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEETS
RZ .` ,1 V:ANT T O THF Pf,:ACFNIFNT OF THE DFLINF.ATION LINE,
(d A'1TACFi A COPY OF TI I13, STORNIWATER MANAGEMENT PLAN IF REQUIRED,
(e) WHAT IS LAND USE OF SURROUNDING PROPER'T'Y'?
(f) IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
SIGNED AND DATED AGENT AUTHORIZA'T'ION LETTER, IF APPLICARLZ.
NOTE: WETLANDS OR WATT RS OF THF US MAY NOT BT IMPAC'T'ED PRIOR TO:
I ISSUANCE: OF A SECTION (104 CORPS O ENGINEERS PERMIT,
I f R T I TILE ISSUANCE: OR WAIVER OF A 401 DIVISION OF WATF,R QUALITY
CE:RT[FICIATION. AND
? ? IN TFIF TWTFNTY C 0xSTAI. COUNTIES ONLY), A LL-1-11R. FROM TIIL NORTH
CAROLINA DIVISION U1' (:OASTAL. MANAGEMENT STATING THF PROPOSED
ACTIVITY IS CONSISTENT WITHTHE NORTH CAROLINA COASTAI, MANAGEMENT
PROGRAM,
OWNERS/AGENT'S SIGNATURF. DATI:
(AGENT'S STGNATUR1. VALID ONLY
IF AU'1 HORIZAl'ION 1. F-TTCR FROM
TH1.1 OWNER IS PROVIDFD).
?1 \ / CENTER // ?? \ \rM
FEB-07-2001 WED 12:50 AM
FAX NO, 010 2 4 8 P, 01
? -v
rn?
c7 -?
m ?
rn z
o ?
DWQ ID; CORPS ACTION ID: _____
NATIONWIDE PERMTT Rr-PQtJR,$'F 'D (PROVIDE NATIONWIDE PERMIT #) ____-
PRE-CONSTRUCTION NOTIFICA'T'ION APPLICATION
FOR NATIONWIDE.: 1'(?RIMITS THAT REQUIRE;
1. NOTIFICATION TO THE CORPS OF ENGINEERS
2. API'i.IC;1'I'ION 1'OR SL'C'1'ION 401 CI?RTIFICATION
3. COORDINATION WITH THE NC DIVISION OF COASTAL MAN AGEME N"('
SENT) T111: ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THE APPROPRIATE FIELD
OFFICE OF 1'IIL` CORPS OF ENGINEERS (SLE AGENCY ADDRESSES SHEET). SEVEN (7)
COPIES MUST BE SE NT TO THE NC DIVISION OF WATER QUALITY,
ATTN.- JOHN DORNEY, 4401 REEDY CREEK ROAD, RALEIGH, NC
27607. PLEASE PRINT OR TYPE.
1, OWNER'S NAME: ??nn i 5 Oct-rro v`1
2. MAILING ADDRESS; P'0' eo y- 3 '
SUBDIVISION NAMF.
Ct'CY: I'.?1 E: M ZIP CODC: -;I( 03
PROJLC T LOCATION ADDRESS, INCLUDIN3 SUBDIVISION NAME (IF OIFFFRrNT FROM
MAILING ADDRESS ABOVE): ___a-+T Jane,
aylorsV,
3. Tr:T.,EPHONI NUMBER: (HOMR) (WORK) 31 _ g00
4. IF APPLIC'ABLL: AGENT'S NAMF. OR RESPONSIBLE CORPORATE Of-l'1CIAL, ADDRESS,
PHONE NUMBER.
s. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF US05 1.OPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE)'
c'0UNTY;A/4 N> ARES•I" TOWN; -TaY fors v. ! Le, NC.
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS. F.CT.) k 'nk lba-t, ??• 40 6*T
L"e,- / •hi?? on ribhf ae -oss -Pro,>, G&eJlc.ujick dove Dcv?°-.
6. IMPACTED OR NEAREST STREAM/RIVER: RIVER BASIN: L Q. ?-`Gko r Y
7. (a) IS PROJECT I.OCATED NEAR WA"('J:R CLASSIFIED AS TROUT,'T'IDAL SALTWATER, (SA),
HIGH QUAIAT`c' WATERS (HQW). OU'1"TANDING RESOURCE WATERS (ORW), WA'T'ER
SUPPLY (WS-I OR WS-TI)? YES ? NO`.IF YES, EXPLAIN:
(b) IS TI IG PROJECT LOCATFD WITHIN A NORTH CAROLINA DIVISION OF C ASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCHMN (AEC)? YFS ? NO
(c) It '1'Ill.i PRORiC" f IS LOCA'T'ED WITHIN A COAS'T'AL COUNTY (SEE WAGE 7 FOR FIST ot,
COASTAL COUNTIES), WHA'r IS'f1.1L' LAND USE FLAN (LUP) DFSIGNA'I•ION? IV IA
FEB-07-2001 WED 12:50 AM FAX NO. P, 02
b. (a) HAVE ANY SFCTTON 4()4 PERMITS BEEN PRF,VIOUSI.Y RF,QUFSTFD FOR UST: ON THIS
PROJI?C-l-? YES NO IF YES, PROVIDE ACTION I.D. NUMBER OP PREVIOUS PERMIT AND
ANY ADDITIONAI, IN FORMATION (INCIAJDF. PHOTOCOPY OF 401 CF,.R'TTFICATION):
(b) ARE ADDITIONAL PERMIT R1LQUESTS EXPECTED POR'IHIS PROPER'T'Y IN THE FUTURE?
YES [f NO?,q IF YIDS, DESCRIBE: ANTICIPATED WORK:
9. (a) ESTIMATL•'C)TOTAL NUMBERS OF ACRES IN TRACT OF LAND: Iq
(b) I STIMATED TOTAL NUMBER Of- ACRES OF WETLANDS T.OcATFD ON PROJECT SITE: 0
lo. (a) NUMBLR OF ACRES OF WETLANDS IMPACTED BY THE PROPOSLD PROJECT BY: 0
FILLING: __._ EXCAVATION:
FLOODING: ___ OTHER :
DRAINAGE:_ TOTAL. ACR2-'S TO BE, IMPACTED:
(b) (1) S'I'RL;AM CHANNEL TO B IMPACTED BY THIS PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEI"ORL' AND AFTER RELOCATION: /,C / J?
LLN(_r1H REFORE. FI' AFTER: -,,,,-- FI' ?/
WID'I'll BEFORE chased on normal h1,h water contours): FT
AVFLR,lCi1? UEF''I"II F31 FURTi; ,,„ ?„ T°I' AFTER: 177
(b) (2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY) NIX
OPEN CHANNEL RELOCATION: _- PLACFNIENT OF PIPL IN CHANNEL:
CHANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODINO:
OTHER:
11. IF CONSTRUCTION 01: A PONE) IS PROPOSED, WHAT IS TJ42 SIZE OF THE WATI:3RsHFD
DRAINING TO THE POND" WHAT IS TIIG EXPECTED POND SURFACE AR2A'?
12. DE:SCRIPTJON OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE. OF MECHANICAL
T?QUIPML-NT TO BE USED? (ATTACH PLANS; 81/2 BY I I DRAWINGS ONLY)
-F r o n+- ?Erw ?-oar6r + 1 I _
13. Pl1I2POSL; OC' PI",OF'OSED WOI:K. f o?,STU,rG ?a?> 1 Y''P.SI??
14, STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS ( INCLUDE ANY MFASURLS TAKL',N TO MINIMIZE WETLAND IMPACTS) her//#
15. YOU ARE RT?QUTRLD'TO CON I-ACT THF. US FISH AND WILDLIFE, SERVICE AND/OR
NATIONAI.. MARINE FISHERIES SERVICE REGARDING THE PRESENCE 01T ANY FIDE-RALLY
LIS"1'UD OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL
AT MAY BE AF Fl-CTF,D AY THF PROPOSE:D PROJI?CT.
E \ TH
HABI'I'A'(' IN TIIF Pr-,RMW
DATE CONTAC•I•La lb. YOU ARE. REQUIRED TO CONTAC" I' THE STATE EIISTORIC PRI SI RVATION OFFICER
(SII)O) REGARDING, THF PRESENCE OF HISTORIC PROPERTIES IN THE Pf:RMIT AREA
WHICH MAY 131.- AFFECTED RY THE PROPOSED PROJFCT. DATE CONTACTED IVI?
FEB-07-2001 WED 12;51 AM FAX NO. P. 03
F). DOF{.ti THF: I'RO,ff:Cl" INVOLV AN EXIIENDITURE OF PUBLIC FUNDS OT THE USE OF PUBLIC
(STATF,) LAND)". YFS ? N0l11' NO. C30 TO 16)
(a) I )'ES, I)OLS'1TILL PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
D0CUML FNT PURSUANT TO THE' REQUIREMEN'rs OF THE NORTH C:AROI,INA
ENVIRONMENTAL POLICY ACT" YES ? NO ?
(h) I1= YES. HAS THE DOCUMENT RLUW 12 F;VII;?VEI?'1I1R0UU`II'i'IIL` NORTH CAROLINA
Df-PARTMFNT OF ADMINISTRATION STA'T'E C'LE.ARINGI400SE YLS ? NO ?
11' ANSWE=R 171) IS YES, THAN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
C:I.I**.ARINGI-I0LJlSf; WITH THE NORTH CAROLINA ENVIRONMENTAL POLICY ACT.
QL)I.STIONS REGARDING THF: STATE CI.,EARINGHOUSE REVIEW PROCESS SHOULD BE
D1RLCTED TO MS, CITRYS BAGGL'IT, DIRLCI'OR STATE CLEARINGHOUSE, NORTH
CAROIINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH.
NORTH CAROLINA 276013-8003, TE'LL•'PHONE [phone].
18. TIIF. IF01_1OWIN(i ITEMS SHO[JLD BE INCI.UDFD WITH THIS APPLICATION IF PROPOSED
AC"T'IVI"T'Y INVOLVES THE DISCHARGE OF EXCAVATED OF FILE. MATERIAL INTO
W Ir 1'L,ADS ?l ! /A
(a) \VL`i'LAiv'D DE=LINEATION VIAL S[IOWING ALL WETLANDS, STREAMS, LAKES, AND
PONDS ON "TI-I1' PROPERTY TOR NATIONWIDE., PERMIT NUMBERS 14, 18, 21, 26.29, AND 38).
ALL 5"FREA,M (INTERMITTENT AND PERMANCNT) ON THE PROPERTY MUST 132. SHOWN ON
THE; MAP. MAP SCALES SHOULD BE [ INCH EQUALS 50 hEF,T OF I INCH EQUALS 100 FEET
OF ,1-HEIR EQUIVALENT.
(L) IF AVAII,A RI,(;, RT;PRFSI3NTATIVF PHOTOGRAPH OF WFTI.ANDS TO 13F. IMPACTED I3Y
PRODUCT,
(c) IF DELINEATION WAS PISRF0IZMhE) 13Y A CONSULTANT, INCLUDL•' ALL DATA SHEETS
RELEVANT'['() THE PI.ACFMFNT OFTHE DFI..INF.ATION LINE,
(d) AT TACE1 A COPY OF TI 1Li STORNIWATER MANAGL'•MENT PLAN IF REQUIRED,
(e) WHAT I5 LAND LJSL'••; OF SURROUNDING PROPER'T'Y?
(f) 1f' ;?P1'I_IC'A131,I?, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
SIGNED AND DATED ;AGENT AUTHORIZATION LETTER, IF APPLICABI. .
NOTE: WETLANDS OR WATERS OF THF. US MAY NOT BE IMPACTED PRIOR TO:
1SSUAN(:1:: OF A SECTION (104 CORPS OFENGINEERS PERMIT,
fil'I'TIER T1 [C ISSUANCE: OR WAIVER OF A 401 DIVISION OF WATER QUALITY
CE:RTIFICATION. AND
? ( IN "l'EIF. '[WI NTY COASTAL COUN'T[FS ONLY), A LE'I'FER FROM T11G NORTH
CAROLINA DIVISION OF (_ OABTAL. NIANAOFNIENT STATINCT THF PROPOSED
ACTIVITY IS CONS IS'E'liNI' WITH TI [L• NORTH CAROLINA COASTAI, MANAGFMFNE'
PROGRAM,
OWNL;R'S/AGFNT:S SIGNrATURF, DATE
(AGENTS SE(iNATLJRic VALID ONLY
IF AUTHORIZATION LIi 1-FER FROM
THE OWNER 1S PI:GVIDFD).
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FEB-07-2001 WED 12:50 AM FAX NO, P. 01
n
010248 c m
z
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DWQ ID: CORPS ACTION ID: _____
NATIONWIDE PERlVTTT REQUESTED (PROVIDE NATIONWIDE PERMIT #) -----
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATION WIDI: I'FRIMITS THAT REQUIRE;
1. NOTIFICATION TO THE CORPS OF ENGINEERS
?. ?1PI'i.IC.r1TIUN 1'UIt SL'Cl'ION 441 CERTIFICATION
3, COORDINATION WITH THE, NC DIVISION OF COASTAL MANAGE MEN '
SEND TIM ORIGINAL AND (1) COPY OF THIS COMPLETED FORM TO THF, APPROPRIATE FIELD
OFFICE OF Tlil: CORPS OF ENGINEERS (SQL' AGENCY ADDRESSES SHL"Ln'), SEVEN (7)
COPIES MUST BE SENT TO THE NC DIVISION OF WATER QUALITY,
ATTN.- JOHN DORNEY, 4401 REEDY CREED ROAD, RALEIGH, NC
27607, PLEASE PRINT OR TYPE.
I. OWN-R'S NAME: ??nn i S Oct rro ?n7
P.0, boy.
2. MAILING ADDRESS:
SUBDIVISION NAMF.
Cl'CY:LI P '-1',\I,E: W-, ZIP CODE: o-o to 03
PROJECT LOCATION ADDRL'SS, INCLUDING SUBDIVISION NAME (IF DIFFFRFNT FROM
MAILING ADDRIESS ABOVE): -0-+T ?_Onel
{ o'ylorsYI I(o
3. TI:LF,PHONENLJM2ER:(HOME) (WORK) 3 00
ag-
4. IF APPLIC'ABLL: AGENT'S NAMF. OR RESPONSIBLE CORPORATI; OFT-ICIAL, ADDRESS,
PI.IONC" NUMBER.
s. LOCATION OF WORK (PROVIDE A MAP, I'REirERAOLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE)'
COUNrYA WOEAREST TOWN; -Tay (ors v.I le, N6
SPLCIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) A"nk ba-m 40 6*T
Lar,ei- / •n i/e on rioJA# a'C4-05s -From ? d1??ick Cove be v
6, IMPACTED OR NEAREST S'T'REAM/RIVER: RIVER BASIN: L. 47, (a) 1S PROJr,.CT I.OCATED NEAR WA"('I:R CI.ASSIFIED AS'1'1ZOUT,'fIDAL SALTWATER, (SA),
HIGH QUALI'rY WATERS (HQW), UUT$TANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-1 OR WS-TI)? YFS 0 NON II' YES, EXPLAIN:
(b) IS THL PROJECT LOCATFD WITHIN A NORTH CAROLINA DIVISION OF, C ASTAL
MANAGEMENT AREA. OF ENVIRONMENTAL CONCLRN (AEC)? YF.S ? NU
(c) IFT111.7 PROJiiCT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WHA'r is TI•IL' LAND USE PLAN (LUP) DESIGNATION?
IVJA
FEB-07-2001 WED 12:50 AM FAX NO, P. 02
S. (a) NAVE ANY SECTION 404 PERMIT'S BEEN PRF,VIO(JSI,Y RF,QUFSTIFD FOR USE ON THIS
PROJI''CT? YES [1 NO IF YES, PROVIDE ACTION I.U, NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL, IN tORMATION (INCT,UDF PHOTOCOPY OF 401 CERTIFICATION):
(b) .1RG ADDITIONAL PURMI T REQUESTS IIXPEC'TED I,'OR THIS PROPER'T'Y IN THE FUTURE?
YI:S f NO?,q ITF' YES, DESCRIBE: ANTICIPATED WORK:
9, (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: /q
(b) I STIMA UD TOTAL NUMBER OF ACRES OF WETLANDS T.OCATI:D ON PROJECT SITE: 0
lU. (a) NUMI3LR Or' ACRES OF WETLANDS IMPACTED BY THE PROPOSI-ID PROJECT BY: V
FILLING: __._ EXCAVATION:
FLOODING: __- OTHER :
DRAINAGE:- TOTAL. ACR1-S TO BE IMPACTED:
(b) (1) S"TRL. AM C IIANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
114
PROVIDE DISTANCE BOTH BEFORL AND AFTER RELOCATION: /1v/7
LENGTH BEFORE. P-r FT
FT
WIDTH I3El-0RF (based on normal hi-ti water c0ntOL S);
A\'F:R.1Ci1? t>Lf'"I°I'I I3I FORLi: „.,?„ F"i AFTER: 1•7I
(b) (2) STREAM CHANNEL IMPACTS WILL, RFSUL.T FROM: (CHECK ALL `FHAT APTLY) m/x
OPEN CHANNEL RELOCATION: I'i.ACFMFNT Or- PIPE; IN CHANNEL:
CHANNEL EXCAVATION: CONSTRUCTION OF A DAM/FLOODINO:
OTHFR:
11. IF CONSTRUC'T'ION OT' A POND IS PROPOSED. WHAT IS THE SIZE OF THE WATjmsHFr)
DRAINING TO THE POND? WHAT IS TIM EXPECTED POND SURFACE AREA'?
12. DESCRIKION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPME'N'T TO BE USED? (ATTACH PLANS; 99/2 BY I I DRAWINGS ONLY)
Fro Ai- E k l-Da-ci r
13. PuRPOSt ?r PROPnSF.D W()RK. P06+Lvc,
14. STATE' R[ ASONS WHY IT IS 13LLIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS ( INCLUDE ANY MEASURES TAKL;N TO MINIMIZE WETLAND IMPACTS) /A//#
15. YOU ART" RI,QUIRI,D'TO CON TACT THF, US FISH AND WILDLIFE SERVICE AND/OR
NATIONAI.. MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY FEDtERAI,L,Y
LIST LU) OR I'I:OPOSED FOR LISTING L:NDANGFRFD OR THREATENED SPECIES OR CRITICAL.
AT MAY BE- AFFECTED BY THE PROPOSED PROJECT.
k TH
HABIT'A'T 1N I'll F. PERMVP
DATE CON'TAC'TLD: 16. YOU ARE REQI.IIItED TO C)N'I'AC."I "1'11' STATE: HISTORIC PRI SPRVATION OFFICER
(SlII'U) REGARDING THF. PRESENCE, Of HISTORIC PROPER'T'IES IN THE PERMIT AREA
WHICH MAY BE ApI-ECTFD BY THE PROPOSED PROJFCT. DATE CONTACTED /i//?
FEB-07-2001 WED 12 51 AM FAX NO. P, 03
17. D(?F:ti TI IF f'ltC?JI:CT INVOLxf AN EXPENDITURE OF PUBLIC FUNDS 0'1' THE USE OF PUBLIC
(STATF,) LAND'? YES ? NO 11"NO, (30 TO 16)
(A) It 1'L-;S, DOLS'1'HL PROJEC=T REQUIRE PREPARATION OF AN ENVIRONMENTAL
I)OCUM17,NT PURSUANT TO TIME; RL-QUIREMENT5 OF THE- NORTH; CAROLINA
ENVIRONMENTAL POLICY ACT'' YES ? NO ?
(b) IF YES, HAS THE DOCUMENT BC-.F;N RF;VII:WL 1?'111IZOUCifI'i'fIL` NORTH CAROLINA
DI?l-'ARTMI;NT OF ADMINISTRATION STATE (12ARINGHOUSE YES ? NO ?
11, AN IN'T:R 1!h IS YL;S.'TliEN SUBM1'1' APPROPRIATE: DOCUMENTATION FROM THE, STATE
CLF'lA ZINC7HQLjSI WITH THE NOR'T'H CAROLINA ENVIRONMENTAL POLICY ACT.
QUI:STIONS REGARDING THE SKATE; C 1,EARINGHOUSE REVIEW PROCESS SHOULD BE
DIRLCTED TO MS. CIIRYS BAGGE'll'. D1RLC1'OR STATE CLI-ARINC;HOUSE, NORTH
CAROLINA DFP/dRTMFNT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH.
NORTH CAROLINA 27603-8003, " E'LL FRONE [phone].
18. TIiF I c)I_I.0WIN(3 ITFMS SHOULD BE INCLUDED WITH THIS APPI,ICATION IF PROPOSED
ACTIVITY INVOLVES THI DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO
WL' I'I-ANDS N /A
(,) WL'1'LANO DEIANCATION NIAP SHOWING ALL, WETLANDS, STREAMS, LAK1 S, AND
PONDS ON TI•II' PROPERTY 17OR NATIONWIDE PERMIT NUMBF-iRS 14, 18, 21, 26, 29, AND 38).
ALL 5"f'RCAM (INTERMITTENT AND PERMANENT) ON THE PROPLRTY MUST 132. SROWN ON
THE MAP. MAP SCALES SHOULD BE 1 INCH F.QUAI.S 50 FEFT OF I INCH EQUALS 100 FEFT
01: '1'llEfR EQUIVALENT.
(b) IF AVAII,Af31,1;, R13PRFSENTATIVE PHOTOGRAPH OF WETLANDS TO 13F,. IMPAC'T'ED BY
PRODUCT.
(c) IF DFLINEATION WAS PERFORMED BY A CONSULTANT, INCLUDL ALL DATA SHEETS
1:ELE VANT TO TI-IF: PLACEMENT OF THE DFLINF.ATION LINE,
(d) ATTACH A COPY OF TI ILi -STORNIWATER MANAGEMENT PLAN IF REQUIRED,
(e) WHAT IS LAND USE OF SURROUNDING PROPER'T'Y?
(F) IF APPLICABLIZ, WHAT IS PROPOSED METHOD OFSEWAQE DISPOSAL?
Sl(INED AND DATED AGCNT AUTHORIZATION LETTER, IF APPLICAI31. .
NOT G: W"L;"1 LANDS OR WATERS OF THF. US MAY NOT B) IMPACTED PRIOR TO-
I ISSUANC L' OF A SECTION Q4 CORPS OF ENGINEERS PERMIT,
f:11111:1t' 1fI7 ISSUANCE: OR WAIVER OFA 401 DIVISION OF WA"1'FR QUALITY
CE':IZTI1:I(-,.,\TION. AND
? IN "TEif TWI NTY COASTAL C'GUNTIFS ONLY), A LE'CI'LR FROM THE NORTH
(_,?ROLINA DIVISION OF COASTAL NIANAORMENT STATING THE PROPOSED
ACl'1VIT)' IS N T W CONS WITH'1HE NORTH CAROLINA COASTAI, MANAGEMENT
PROGRAM,
OWNER'S/AGENT ;S STGNr1TIJRF. DATE.
(AGENT'S SKINATURE VALID ONLY
IF AU'1'i-101:1/ATION LETTER FROM
THE', OWNER IS PROVIDED),
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FEB-07-2001 WED 12:50 AM
FAX NO. P. 01
70 -0
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DWQ ID; ----- CORPS ACTION ID: _____
NATIONWIDE PERMIT RF.QtJh,9'I ED (PROVIDE NATIONWIDE PERMIT #) _____
PRF.-C;ONSI'RUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE: I'FRIMITS THAT REQUIRE;
1. NOTIFICATION TO THE CORPS OF ENGINEERS
2. AF'f'f,tC.,?'I•ION 1•'OIZ SL:C'I'ION 441 Cf;RTIFICATION
3. COORDINATION WITH THE NC DIVISION OF COASTAL MAN AGE ML-N"('
SEND'I'llE ORIOTNAL AND (1) COPY OF THIS COMPLETED PORM TO THE APPROPRIATE. FIELD
OFFICE OF THL`•, CORPS OF ENGINEERS (SEL'i AGENCY ADDRESSES SHEET). LSEV EN (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.
1. OWNER'S NAME: ??nn S {-?ct r•r0"`?
2. MAILING ADDRIsSS: P.O. SUBDIVISION NAME

CTIY: "LIP CODE: 03
PROJEC"I' LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): )-0-46
aY loss v ? 1(0) N ?
3. TF,.1..F,PHONE NUMBER: (HOME) (WORK) - 3Z _ 9Oo
g. S
4. IF APPLIC'ABLc: AGENT'S NAMF. OR RESPONSIBLE CORPORA'T'E. OFT-'ICIAL, ADDRESS,
PHONE: NUMBER.
s. LOCATION OF WORK (PROVIDC A MAP, PREI?ERADLY A COPY OF USCIS "TOPOGRAPHIC MAP
OR AFIZIAL PlI TOGRAPHY WITH SCALE)'
COUNTY- 544- FEAR s r rowN; 7Gy (ors !Le, N6
SPLiCII;IC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS. ECT.) R? nlc ?a m ?cl . 4 617
L "c'- / "0e- on ribh-f across -From CsMdl??icl? Cove bev WC16 6. IMPAC'T(.0 OR NEAREST STREAM/RIVER: RIVER BASIN: L ? r Y
7, (a) IS PR()JCCT I.OCATED NEAR wA"('PR CI.ASSIFIED AS 'T'ROUT, "TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW). OU'f$TANDING RESOURCE WATERS (ORW), WA•1'ER
SUPPLY (WS-1 N WS-ID? YFS ? N0Zp IF YES, EXPLAIN:
(b) IS TM: PROJECT LOCATFD WITHIN A NORTH CAROLINA DIVISION OF C ASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YFS ? NO
(c) IF T111.1 PROJIIS LOCATED WITHIN A COASTAL COUNTY (SEL WAGE 7 FOR LIST 0(,
COASTAL COUNTIES). WHAT IS THE LAND USE PLAN (LUP) DFSICYNATION•? AIfA
FEB-07-2001 WED 12:50 AM FAX NO. P. 02
b. (a) I [AVE ANY SFCTION 4()4 PERMITS BEEN PRF,VIO[JSI,Y RF,QUF..STFD FOR USE ON THIS
PRoJI:C r? YES El NOT IF YES, PROVIDE ACTION I.D, NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL IN t-0- (INCI,LJDF. PHOTOCOPY OF 401 CERTIFICATION):
(b) ,1RG ADDITIONAL PERMIT RLQULSTS I'XPEC1 ED POR'1HIS PROPERTY IN THE FUTURE?
YI:S f N0)q II= YES, DESCRIBE? ANTICIPATED WORK:
9, (a) ESTIMATLC) TOTAL NUMBERS OF ACRES IN TRAC:TOFI.AND: Iq
(b) I STIMn'1'lI TOTAL NUMBER OF ACRES OF WFTL,ANDS LOCATFD ON PROJECT SITE:
10. (a) NUMULl2 OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY: 0
FILLING: __._ EXCAVATIOM
FLOODING: ___ OTHER :
DRAINAGE : TOTAL. ACRES TO BE' IMPACTED:
(b) (1) STR' L'AM CHANNEL. TO BE IMPACTED BY THE. PROPOSED PROJECT (IF RELOCATED,
1/
PROVIDE, DISTANCE BOTH BEVORE AND AFI'ER RELOCATION: A Ivrl
LENGTH REFORE. FF AI'T-ER--- - FT
WIDTH BEFORE: (hascd on normal 11111h Watfr Con[aurs): FT
AvF.R,ticll? DEPI'II F3I:FORE:; ,?,?..r AFTER: F -r
(b) (2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY) IVIX
OPFN CHANNEL, RELOCATION: PLACFMI:N'T C)1 PIPE IN CHANNEL:
CHANNEL EXCAVATION: CONSTRUCTION OF A DAMIFLOODINO:
O'I`ZIFR:
11. IF CONSTRUCTION 01' A POND IS PROPOSED. WHAT IS TI42 SI1,L• OF THE WATI.RSHFD
DRAINING TO'THE POND" WHAT IS TIIE EXPECTED POND SUPFACE AREA?
12. DESCRIP'L'ION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE. OF MECHANICAL
E.QUIPMLNTTO BE USED? (ATTACH PLANS; 8I/2 BY I I DRAWINGS ONLY)
I r D A I E Y1- ?-Dajcr i (1 --4
13. PURPOSE OF' PROPOSED WORK. PaS+(,kr? l aA%A mCs(
14. STATE REASONS WHY IT IS 13LLIEVED THAT THIS ACTIVITY MUST BE, CARRIED OUT IN
WETLANDS ( INCLUDE ANY MRASURE,S TAKL:N TO MINIMIZF, WETLAND IMPACTS) /V/#
15. YOU ARE: RFQUIRLD,r0 CON PACT THE. US FISH AND WILDLIFE SERVICE ANWOR
NATIONAI.. MARINE FISHERIES SERVICL- RGCARDINCY THE PRESENCE OFANY FEDERALLY
LIS"I'l"D OR PROPOSED FOR LISTINCr ENDANG)" RI D OR THREATENED SPECIL,'S OR CRITICAL
T MAY BE AFFE:CTFI) BY THE PROPOSI--D PROJECT.
THA
1-iAI31'1'A•1' 1N "I'IIF PERMWX
)-SATE=. CONI?ACTL?D: 16. YOU ARE REQUIRED TO C ONTACI" 1'IlE STATE HISTORIC PRI SPRVATION OFFICER
(S1.11'0) REGARDING THF? PRESENCE OF HISTORIC PROPf:RTfES IN THE PERMIT AREA
WHICH MAY 13L: AFFECTED RY'I HE PROPOSED PROJFCT. DATE CONTACTED w __._. Nl?
FEB-07-2001 WED 12;51 AM FAX NO. P. 03
17. DOI'-.`+ THE PROJECT INVOL AN EXPENDITURE OF PUBLIC FUNDS O'1' THE USE OF PUBLIC
(STATE=) LAND? YFiS ? NO ?kI1 NO. GO TO 10(
(a) 1I: YES. DOLTS THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUN4T NT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES ? NO ?
(b) IF YES. HAS THE DOCUMENT I3l:F;N 12F;VIL;WL 1?'1111tOUGII'i'I1L` NORTH CAROLINA
Df'l`ART'MI;NT OF ADMINISTRATION STAT2 (LLARINGHOUSE YES ? NO ?
IP ANSWER 171) IS YES. T'I1L•'N SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
C LF*,ARINGH0L)$I: WITH THE NORTH CAROLINA ENVIRONMEN'T'AL POLICY ACT.
QUESTIONS REGARDING THF° STATE: CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS. CIIRYS BAGGE T. DIRLC fOR STATE CLEAR1NCiHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH.
NORTH CAROLINA 27603-8003, TE'LLPHONE [phone].
IS. THFi FOI-LOWINCi ITEMS SHOULD THF INCI.UDFD WITH THIS APPI,ICATION IF PROPOSED
ACTfVCI°Y TNvnJ.VF;S THE DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO
W L I'LANDS &/ /A
(a) WL'1'I..ANLD DEIANCATION MAP SI[OWING ALL. WETLANDS, STRL:AMS, LAKES, AND
PONDS ON THEE PROPERTY (TOR NATIONWIDF PERMIT NUMBERS 14, 18, 21. 26, 29, AND 3$).
ALL 5"1'RCAM (INTERMITTCNf AND 1'ERMANCNT) ON THE PROPERTY MUS`E' BE SROWN ON
THF? MAP. MAID SCALES SHOLJL.D BF I INCH FQUAI.S 50 FEF,T OF I INCH EQUALS 100 FEF,T
OF'1"E•1L;IR E0UIVALENT.
(b) IF AVAII,ARI.1E, RIEPRF.,SENTATIVI~ PHOTOGRAPH OF WFTI.ANDS TO 13F. IMPACTED BY
PRODUCT,
(c) IF DFLINEATION WAS PCRFORMED I3Y A CONSULTANT, INCLUDE ALL DATA ST-TE2TS
REI.,k VANT TO THF PLACEMENT OF THE DFLINF.ATION LINE,
(d) A'1" 1 ACE(A C: (_)NY OF TI fl,'ti'1'0I:hIWA1'L,R MANAGEMENT PLAN IF REQUIRED.
(e) WHAT 15 LAND USL OF SURROUNDING PROPER'T'Y?
(F) IC' APPLICABLE. WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE.
NOTC: WETLANDS OR WATERS OF THF. LJS MAY NOT BEE IMPACTED PRIOR'C0:
I ISSUANC:I. OF A SECTION 404 CORPS O1° ENGINEERS PERMIT,
1:'sf R T I T'EIE ISSUANCE: OR WAIVER OF A 401 DIVISION OF WATER QUALITY
CE:RTIFIC.\ ilON. AND
? t(N T'FIF T'WFNTY CC A.q'Al. COUN'TIF.S ONLY), A LE-1.1-LR FROM TIM NORTH
CAROLINA DIVISION OF COASTAL. &1ANAGFMENT STATING THE PROPOSED
ACTIVITY IS CONSIS'T'E'N'T` WITH "1'I-IL NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM,
OWNL,R'S/AGFNT':S SIGNATURF, DATE
(AGENT'S SKINATUI lE VALID ONLY
IF AUTHORIZATION FROM
THE OWNER JS PROVIDED).
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FEB-07-2001 WED 12:50 AM FAX NO, P. 01
010248
rTi
m?
m
m
DWQ ID; _--_- CORPS ACTION ID: --__-
NATIONWIDE PERMIT RFQtJ ,,STI,D (PROVIDE NATIONWIDE PERMIT #)
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE Pfi v,m TS THAT REQUIRE:
1. NOTIFICATION TO THE CORPS OF ENGINC-ERS
APPI.IC;ITION 1'OR SL,C'f10N 40I CERTIFICATION
3, COORDINATION WITH THE NC DIVISION OF COASTAL MANAGEMEN't
SENT) TIII: ORIQTNAI_ AND (I) COPY OF THIS COMPLETED I'Ofw TO THE APPROPRIATE FIELD
OFFICE OF T!(L`• CORPS OF ENGINEERS (SEE AGENCY ADDRFSSES SHELiT). SEVEN (7)
COPIES MUST BE SENT TO THE NC DIVISION OF WATER QUALIT'Y',
ATTN-. JOHN DORNEY, 4401 REED'Y' CRUET{ ROAD, RALEIGH, NC
27607, PLEASE PRINT OR TYPE.
1. OWNERS NAME: ??nn i s 1't0. rr0
2. MAILING ADDRESS:
SUBDIVISION NAME
cllyY i'1'.\'I,E: ZIP CODC: a? 03
PROJECT LOCATION ADDRL•:SS, INCLUDINO• SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADI)RC-SS ABOVE): I •+"(' ?-0416
1 o'ylorsvi lle? f\/ (?'
3. TC.LEPHONLNUMBER:(HOME,) (WORK) 31 00
ag-
4. IF APPLIC'ABLL: AGENT'S NAME. OR RESPONSIBLE CORPORAI'H 01'?I*ICIAL, ADDRESS,
PHONE NUMBER.
s. LOCATION OF WORK (PROVIDC A MAP, I'REFERAI3LY A COPY OF USCIS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCAI.Es)•
COUNTY:. CA EAREST TOWN: tGy lors V• lie-, N6 QQ
SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) ?i nk ?a m 0??. 40 6*T
La.??- / ???I?. On rohf aci-055 -p-or' C dlr wick Cove bev .
6. IMPACTED OR NEAREST STREAM/RIVER: RIVER BASIN: La? Q WGkOry
7. (a) IS PROJi?CT I.OCATED NEAR WA'fI:R CLASSIFIED AS'1'1t0UT,'FIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW). OU•1 ,TANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-I OR WS-I1)". YFS ? NO'P IF YES, EXPLAIN:
(b) IS TRI: PROJECT LOCATFD WITHIN A NORTI•I CAROLINA DIVISION OF C ASTAL
MANAGEME,NT AREA OF FNVIPONMENTAL CONCHMN (AEC)? YFS ? NO
(c) IF T111 PROJFC" I' IS LOCATED WITHIN A COASTAL COUNTY (SEL•; PAGE 7 FOR LIST OF
COASTAL- COUNTIES), WHAT is THE LAND USE PLAN (LUP) DFSIONATION?
IVfA
FEB-07-2001 WED 12:50 AM FAX NO. P. 02
s. (a) HAVE ANY SF.CTTON 4()4 PERMITS BEEN PRF,VIO[JSI,Y RF,QUESTFF) FOR UST: ON THIS
PRCIII.C'1"? YLS [] NO IF YES, PROVIDE ACTION I,D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL IN-ORMATTON (INCI,LJDF PHOTOCOPY OF 401 CFRTTFICATION):
(b) ;1R[; ADDITIONAL PERMIT REQUESTS EXPECTED L,'OR TI-IIS PROPERTY IN THE FUTURE?
YES U N0)q II' YIDS, DESCRIBE ANTICIPATED WORK:
9, (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: I q
(b) I STIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCA-rI:D ON PROJECT SITE: 0
10. (a) NUMBER OF ACRES OF WFTI,.ANDS IMPACTED EY THE: PROPOSED PROJECT BY: a
FILLING: __._ EXCAVATIOM
FLOOWNG: OTHER :
DRAINAGE ; ,,,..,,.,.. TOTAL, ACRES TO BE IMPACTED:
(b) (1) STRUAM CHANNEL TO BE, IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
//Q
PROVIDE DISTANCE BOTH BEFORE AND AFl'ER RELOCATION: /,[V?7
LENGTH BEFORE,. FT FT
WIDTH BEFORF: (based on normal ltlvh water contours): FT
AVFRAGL' DEP"I"II BEFORT::F -r AFTER: F'l
(b) (2) STREAM C=HANNEL IMPACTS WILL RESULT FROM: (CHECK ALL'I'HA'I' APPLY) NIX
OPEN CHANNEL RELOCATION: PLACF.MI:N'I C)I PIPE IN CHANNEL:
CHANNEL EXCAVATION: C:ONSTRUCI'ION OF A DAM/17I,00DING:
OTHER:
X
11. IF CONSTRUCTION OF A POND IS PROPOSED. WHAT IS T)-, SIZE Or- THE WATE:RISHFD
DRAINING TO THE POND" WHAT IS TIIG LXPECTFD POND SURFACE AR8A'?
12. DESC RIPTTON OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
F.QuIPML;N'f' f'O ICE USED? (ATTACH PLANS; 8I/2 BY I I DRAWINGS ONLY)
F r D A4- l-DaAcr
?? , rna4 sr{?
13, P[JI:POSC OF PROPOSED WORK. Pas+Lkw-c'
14. S'T'ATEREASONS WHY IT tS BE'LICVED THAT THIS ACTIVITY MUST Br-CARRIED OUT IN
WRTLANOS (INCLUDE ANY MF:ASURL-5 '1'AKEN TO MINIMIZE WETLAND IMPACTS) /A//#
15. YOU ART: R?QUTRLD'1'0 CON f*ACI' THF. US FISH AND WILDLIFE SERVICE ANWOR
NATIONAL. MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY 1`133D RA1,LY
LIS'I'L D OR PROPOSED FOR LIS'T'ING; ENDANGFRrD OR THREATENED SPECIL'S OR CRITICAL
HABITAT IN TIM. PERMIT l "THAT MAY BE AFFECTED BY THE PROPOSED PROJECT,
DATE CONTACTLD: i
16. YOU ARE; REQUIRED TO C,ONI'AC"I' TIME STATE HISTORIC PRI SI RVATf0N OFFICER
(51.11'0) REGARDING THF PRI SLNC'E OF HISTORIC PROPER'T'IES IN THE PERMIT AREA
WI ITCH MAY III" Ai7rcC'I'F:17 BY THE PROPOSED PROJECT. DATE CONTACTED ?/g
FEB-07-2001 WED 12:51 AM FAX NO. P. 03
IT DOI`.ti THE f'ltc:),II:CT INV01_vL ' : AN EXPENDITURE OF PUBLIC FUNDS O'rmE USE OF PUBLIC
(STATF) LAND:' YES ? NO , tit` NO. GO TO 16)
(a) 11: YE-I'S. UOLIS TIME, PROJECT REQUIRE PREPARATION Cif, AN L"•NVfRONMEN,rAL
DOCUMENT PURSUANT TO THE RLQU1REMEN1 S Of-- THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES ? NO ?
(h) IF YES, HAS THE DOCUMENT BLE,F-N 12F;VlL:W[ I?'1IlIt0UGiI'1'Tilr NORTH CAROLINA
DFI'ARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES ? NO ?
I1' ANSWER 171) IS YES. THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE STATE
CI,I`.ARINGHOUSF WITH THE: NORTH CAROLINA ENVIRONNIRNTAL POLICY ACT.
QUI:STIONS RWARDING THE: STNIT, CLEARINGHOUSE REVIEW PROCESS SHOULD BE
DIRECTED TO MS, CIIRYS BAGGL"IT, DIRECTOR STATE CLI'ARINGHOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, "1'l1LEPHONE [phone].
18. Tlff- FOLLOWING; ITEMS SHOULD BF INCLUDED WITH THIS APPLICATION IF PROPOSED
AC'T'IVITY INVOLVES THE DISCHARGR OF EXCAVATED OF FILL MA'T'ERIAL INTO
WLILAND-S N1A
(a) WL:`1LA;`'D DELINEATION NIAll SHOWING .ALL. WETLANDS, STREAMS, LAKES, AND
PONDS ON "i HE PROPERTY (FOR NATIONWIDF, PERMIT NUMBFiRS 14, )8, 2E, 26, 29, AND 38).
ALL S"FRL'•AM (INTERIMITTENi' AND PERMANENT) ON THE PROPERTY MUST BE SHOWN ON
THI? MAP, MAP SCALES SHOLJL.D BF 1 INCH FQUAI.S 50 FEF,T OF I INCH EQUALS 100 FEFT
01: '1'11L:fK E0UIVALENT.
(b) IF AVAII,ARI.1;, RliPRF.,SENTATIVF PHOTOGRAPH OF WETLANDS TO BF.. IMPACTED BY
PRODUCE'.
(c) IF DELINEATION WAS PERFORMED 13Y A CONSULTANT, 1NCLUDL ALL DATA SHEI:'I'S
1U.'LE V;ANT TO -1'I-IF. PI,ACFMFNT OF THE, DFL.INF.ATION LINE.
(d) A'1TACI-1.> COPY OF TI 11.' S'1'01:NIWA1'L:R MANAGEMENT PLAN IF REQUIRED,
(e) WHAT I5 LAND USE OF SURROUNDING PROPER'T'Y?
(E) II-' APPLICABLE. WHAT IS PROPOSFD METHOD OF SEWAC3E DISPOSAL?
SIGNED AND DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE,
NOT G: ViW'ETLANDS OR WATERS OF THE. IJS MAY NOT BE IMPAC'T'ED PRIOR TO:
I ISS(JAN(:l3 OF A SEC'T'ION 404 CORPS OI° ENGINEERS PERMIT,
L,ITIEI:R T[fE ISSUANCE, OR WAIVER OF A 401 DIVISION OF WATER QUALITY
CE:RTIFIC:' TION. AND
{ (IN T1IF. 1'WF:NI'Y CO.\.STAI. COUNTIFS ONLY), A LL-1°1'L-R. FROM T11G NORTH
CAROLINA DIVISION OF (. OASTAL. I IANAGF.MENT STATINCI THE PROPOSED
ACTIVITY IS CONSISTENT WITH TI-IL NORTH CAROLINA COASTAI, MANAGFMENT
PROGRAM,
OWNL'R'S/AGFNI':S SIGNATURF, DATE
(AGENTS SKINA 1 URL.' VALID ONLY
IF AUTHORIZATION 1.1:'fTER FROM
THE:. OWNER IS PROVIDFD).
?`l? \ / CENTER
A6
FEB-07-2001 WED 12:50 AM
FAX NO,
010248
DWQ ID-,._--- CORPS ACTION ID: _____
NATIONWIDE P[:RM[T ItR(Zi1IiS'TI+i) (PRO'VIDE NATIONWIDE PERMIT #)
P. 01
Ail
LUL1 TLO
PRE-CONSTRUCTION NOTIFICATION APPLICATION
FOR NATIONWIDE I'f:Rmrm THAT REQUIRE:
I. NOTIFICATION TO THE CORPS OF ENGINEERS
2. AI'P(.IC ,,\l'ION I'OIt SLC'1'ION 401 CERTIFICATION
3. COORDINATION WITH THG NC DIVISION OF COASTAL MAN AGE ME N'*('
SEND TIM' ORIGINAL AND (I) COPY OF THIS COMPLETED FORM TO TH APPROPRIATE FIELD
OFFICE OF THE CORPS OF ENGINEERS (Slit, AGENCY ADDRESSES SI:1LL'1'). SEVEN (7)
COPIES MUST BE SENT TO THE NC DIVISION OF WATER QUALITY,
ATTN: JOHN DORNEY 4401 REEDY CREED ROAD RALEIGH NC
27607. PLEASI? PRINT OR TYPE.
140.rrov?2
1, OwNT:R'S NAME: -I?C?nn ? S
2. MAILING ADDRESS: p 1 .0 , 430 ?.
SUBDIVISION NAME
CI'CY: "LIP CODs: - ?p 03
PROJECT LOCATION ADDRESS, INCLUDIN3 SUBDIVISION NAME (IF DIFFERENT FROM
MAILING AD1)R1:SS ABOVE): ,15-+ " )-exae,
__,15-+T
aY10rsv;I(e, N?-
3. TC?I.,FPHONI: NUMBER: (HOME) (WOIZIC) 31 -Sg oo
?X-3 ?7-066Z;_ g ag-
4. IF APPLIC'ABLL: AGENT'S NAMF. OR RESPONSIBLE CORPORA°I'l: OI 1?TCIAL, ADDRESS,
PHONI, NUMPIER.
5. LOCA'T'ION OF WORK (PROVIDE A MAP, PREI'ERADLY A COPY OF USCIS TOPOGRAPHIC MAP
OR AERIAL Pl[ TOGRAPHY WITH SCALE")'
COUNTY; I q EAREST I''OWN; TAY IDYS v i I ?C? lUC.
SPLsCIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ECT.) 4 6*T
Lan e,- / "4;/e- on ro hf act-055 •F'a", Ck.+jk v) 'e* Cove be
6, IMPACTED OR NEAREST S'I'RL:ALM/RIVER; RIVER BASIN: L4. ? -'Gk,, r Y
7, (a) IS PROJECT LOCATED NEAR WA'(7:R CLASSIFIED AS TROUT. TIDAL SALTWATER, (SA),
HIGH QUALITY WATERS (HQW). OUTSTANDING RESOURCE WATERS (ORW), WATER
SUPPLY (WS-1 OR WS-[I)'? YES ? NOT ir. YES, EXPLAIN:
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF C ASTAL
M,ANAGEMCNT AREA OF ENVIRONMENTAL CONCERN (AEC)? YF.S ? NO
(c) IF T111', PROJFC" I' IS LOCATED WITHIN A COASTAL COUNTY (SL•'L: PACE 7 FOR LIST Of",
COAtiTf\I- COUNTIES), WHAT IS'CI.1Is LAND USE PLAN (LUP) DESIGNATION? IVlA
FEB-07-2001 WED 12:50 AN FAX NO, P. 02
S. (a) HAVE ANY SFCTION 404 PERMITS BEEN PRF,VIOUSLY REQUESTED FOR USE ON THIS
PR(7)JEC:"I'7 YES [' NO IF YCS, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION ( INCI,UDF. PHOTOCOPY OF 401 CF,.RTTFTCATION):
(L+) .1RG ADDITIONAL PLsRNITT REQUESTS EXPECTED POR'iHIS P ROPCRTY IN THE FUTURE?
lf' YES, DESCRIBE ANTICIPATED WORK:
YES ff NO )q
9, la) ESTIMATL D TO'T'AL NUMBERS OF ACRES IN TRACT OF LAND: I q
(b) ESTIMATLD '1 OTAL NUMBER Of, ACRES OF WETLANDS LOCATED ON PROJECT SITE: 0
10, (a) NUMBER 01"" ACRES OF WFTL.ANDS IMPACTED BY THE PROPOSED PROJECT BY: a
FILLING: __._ EXCAVATION:
FLOODING: ___ OTHER :
DRAINAGE : TOTAL. ACR13'S TO BE, IMPACTED:
(b) (1) STRL?AM CHANNEL TO BE IMPACTED BY THL: PROPOSED PROJECT (IF RELOCATED,
PROVIDE L)TSTANCF BOTH BEE"Oki: AND Af,'I'ER RELOCATION: A / /Q
LL:NG I'I{ IiFI ORE. FI' CT
WIDTH BEFORE (haiscd on normal hi-fi water' Contours): FT
AFTER: 1 1'
(b) (2) STREAM CHANNEL IMPACTS WILL RESULT FROM: (CHECK ALL THAT APPLY) NIX
OPFN C,HANNCI. RCLOCATION: PI.ACF.ME:N"T OF PIPL IN CHANNEL:
CHANNEL EXCAVATION: C_UNSTRUC TION OF A DAM/FLOODING:
O'CZTRR:
11. 11' CONSTRUCTION OF A POND IS PROPOSED. WHAT IS TTMI3 SILL Or. TTHE WATI.RSHFD
DRAINING TO HE POND'' WHAT IS THE EXPECTED POND SURFACE ARL.A'?
12. DE; CRIPTJON OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MLCHANICAL
1?QLJIt'ML?N'1'TC) BE USED'? (ATTACH PLANS; KI/2 BY 11 DRAWINGS ONLY)
13, PURI'OSC; O'PROPOSFD WORK. po?STld,rr, ?a1 Y''l° 51TF,
14, STATE' REASONS WHY IT IS U LLIEVED THAT THIS AC'T'IVITY MUST B CARRIED OUT IN
WETLANDS ( INCLUDE ANY MEASURE-'S'I'AKEN TO MINIMIZE WETLAND IMPACTS) /4//,#
15. YOU ARE RFQUIRED TO CON I'ACT THF. US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL. MARINE FISHERIES SERVICis REGARDING THE PRESENCE OF ANY I-'CDERAI,M,,Y
LIS"11:1.) OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPC;CIL'S OR CRITICAI.
T MAY 8E, AFFECTED BY THE PROPOSE:D PROJEC ,
k THA
HAI31TAT IN TIM, PERMwl
DATE C0NTAC TLD: 16. YOU ARE REQUIRED TO CONTAC" TTIIC, STATE IISTORIC PRI SI RVATION OFFICER
(SI1PU) REGARDING THE. PRESENCE OF HISTORIC PROPNR'1'ILS IN THE PERMIT AREA
WIITCH MAY 11E AFFECTED BY'PHE PROPOSEI:) PROJECT. DATE CONTACT1311) ^VI?
FEB-07-2001 WED 12;51 AN FAX NO, P. 03
I?. DC?i=..ti TI (F I'IZ(:).IECT INVOLv -; AN EXPENDITURE OF PUBLIC FUNDS O'1" mE USE OF PUBLIC
(STATE,) LAND? YFS ? NO , (II? NO. GO TO 10)
(a) 11: YES, DOES TRL PROJECT REQUIRE, PREPARATION Of' AN ENVIRONMENTAL
DOCUMT?NT PURSUANT TO THE REQU1REMENTs Of THf,: NORTH C:AROI.INA
ENVIRONMENTAL POLICY ACT? YES ? NO ?
(h) IF YES, HAS THE DOCUMI;N T BLU."N RF;VICi\VL I)'1I1R000?Ii'i'11L` NORTH CAROLINA
DE'!'Al:?'MI;NT (?i ADMINISTRATION STATE CLEARINGHOUSE YES ? NO ?
11' ANSW'('at I'll) IS YL:S, THEN SUBMIT APPROPRIATE DOCUMENTATION FROM THE, STATE
CI,F.ARING1-I0L,1$I-. WITH THk: NORTH CAROLINA ENVIRONMEN'T'AL POLICY ACT.
QUFSTION5 1Rf'GARDING THF: STATE CLEARINOHOUSI: REVIEW PROCESS SHOULD BE
DIRLC TED TO MS. CITRYS BAGGE"IT, DfRLC717OR STATE CLEARIN01HOUSE, NORTH
CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH,
NORTH CAROLINA 27603-8003, " E'LL:PHONE [phone].
Is. Tlif: F01.I.0WINC, IT>~MS SHOULD BE TNCT.UDI?D WITH THIS APPLICATION IF PROPOSED
ACTWIT'Y INV(?I.VES THE DISCHARGE OF EXCAVATED OF FILL MA'1TRIAL INTO
WL N1 ANDS m /A
(a) \VL'1'LAND DELINCATION MAll STOWING ALL. WETLANDS, STREAMS, LAKES, AND
PONDS ON "1 HE'. PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21. 26. 29, AND 38).
ALL S'1'REA11 (INTERMITTENT AND PERMANEN'T') ON THE PROPERTY MUST 132, SHOWN ON
THE MAP. MAP SCALES SHOULD BF 1 INCH F.QUAI.S 50 FEF,T OF I INCH EQUALS 100 FFFT
OF 'l'1EL;fK EQUIVALENT.
(b) IF AVAIT,AI31.1;. RT;PRF.,SI-.NTATIVE PHOTOGRAPH OF WETLANDS TO BF.. IMPACTFD BY
PRODUCT.
(c) IFDHl.INIsATION WAS PERFORMI D BY A CONSULTANT, 1NCLUDL ALL DATA SHEL''1'S
Rk--'Lk VANT TO THE PI-ACFIVIF,NT O THE DRIANF.ATION LINE,
(d) ATTACH A COPY OF TI [l.i ti'l'ORNIWATER MANAGEMENT PLAN IF REQUIRED.
(e) WHAT IS LAND USE O SURROUNDING PROPERTY?
(f) IF APPLIC'A131.1:7, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL?
SIGNED ANL) DATED AGENT AUTHORIZATION LETTER, IF APPLICABLE,
NOTL: WETLANDS OR WATERS OF THE. US MAY NOT BE IMPACTED PRIOR'TO:
I ISSUAN(:I: OI- A SECTION c104 CORPS 01" ENGINEERS PERMIT,
I' (TIEIiR TI IE ISSUANCE: OR WAIVER OF A 401 DIVISION OF WATER QUALITY
T'Y
CFRTIFIC IATION. AN[)
? ( [N "T [IF TWT NTY C'OAS T.\I. C OUN'rns ONLY), ALL"i 1'LR FROM THE NORTH
CAROLINA L)IVIS((.)N OF COASTAL. MANAGEMENT STATING THE PROPOSED
ACTIVITY IS CONSISTENT WITH "1'1-11], NORTH CAROLINA COASTAL MANAGEMENT
PROGRAM.
OWNLR'S/AGEN"T ;ti STC;NA,rtJRF. DATE
'AX,6a14,f,?
(AGENT'S SKINATURI-17 VALID ONLY
IF AUTHORIZATION LI:1°TCR FROM
"THE OWNER JS PROVIDFD).
`? -' \ / CENTER /! ?/ \ lam / i