20010467 Ver 1_COMPLETE FILE_20010402

O`- uvn??9 ivucnaei r. tasiey, uovernor
William G. Ross Jr., Secretary
y North Carolina Department of Environment and Natural Resources
> r-? Gregory J. Thorpe, Ph.D.
p Acting Director
Division of Water Quality
August 28, 2001
Caldwell County
DWQ Project # 010467
APPROVAL of 401 Water Quality Certification
Mr. Stangley Ray Benge
5549 Land Harbour Drive
Granite Falls, NC 28630
Dear Mr. Benge:
You have our approval, in accordance with the attached conditions, to place fill material in 100 square feet of waters for the
purpose of stabilizing the shoreline of lot 147, Doe Run s/d, Lake Rhodhiss on Lake Tillary, as you described in your revised
application received August 1, 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 Dave Penrose at 919-733-9502 or Mike Parker at our Asheville Regional Office at 828-251-6208.
Attachment
cc: Corps of Engineers Asheville Field Office
Asheville DWQ Regional Office
File Copy
Central Files
ENR
Wetlands/401 Unit 1650 Mail Service Center Raleigh, NC 27699-1650 Ph: [phone] Fax: [phone] Customer Service
1 800 623-7748
Sincerely,
7
r
Kerr T. Stevens
Division of Water Quality
a:7 .2001
T-a P County
DWQ Project # 611 46
APPROVAL of 401 Water Quality Certification
?eL)
1
y 9 1 - -k
Dear Mr. rQC ?) ??I W 1 ) ???Q' h
You rave ou a roval, in ccordanc7with the attached conditl ns, to place fill material in
ds or waters for the purpose of as you
d scribed n your pplication tatetf , 2001. After reviewing your application, we
have decided that this fill is covered by General Water Quality Certification Number Zbo
This Certification allows o as Permit Number 0":?, () when the Corps of
En ' I . 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 b®4given 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 %joins,& a se telephone at 919-733-1786 or
at our Regional Office
Sincerely,
",bl_?
Kerr T. Stevens
Attachment
cc:
o ps of ngineers Field Office
to DWQ Regional Office
FI e Copy
??, Central Files
AM
NZDEP,R
Michael F. Easley
Governor
William G. Ross, Secretary
Department of Environment and Natural Resources
Division of Water Quality 1650 Mail Service Center Raleigh, NC 27699-1650
Wetlands/401 Unit: [phone]
Fax: [phone]
F/1'. f
Michael F. Easley
Governor
William G Ross,Jr Secretary
Department of Environment and Natural Resources
Kerr T. Stevens
Division of Water Quality
May 18, 2001
DWQ # 010467
Caldwell County i.
d
Mr. Stanley Ray Benge 2711 ?All&-WeCrC[S-RCra-d or 515' C( 4fo0 h*-46°u2
-Gcar e; fdFr X630 G iC?-w? i rG' 1AJ'`'4-J N -C "
L.?6 1, 0
Dear Mr. Benge:
On May 10, 2001 the Division of Water Quality (DWQ) was notified by receipt of your applications
regarding your plan to fill waters for the purpose of stabilizing the shoreline of your lot on Lake Rhodhiss in
Caldwell County. Approval from DWQ is required to disturb these waters. Please provide seven copies of
the following information and refer to the DWQ # listed above in your reply You need to report the area of
water to be filled (i.e., length of shoreline times width of planned riprap).
Please call me at [phone] if you have any questions or would require copies of our rules or
procedural materials. This project will remain on hold as incomplete in accordance with 15A NCAC 2H
.0505(c). The processing time for this application will begin when this information is received. If we do not
hear from you by writing within three (3) weeks we will assume you no longer want to pursue the project and
will consider it withdrawn.
I
k-t.L
n R. Dorney
Cc: Asheville DWQ Regional Office
AshevilleCorps of Engineers
File Copy
Central Files
*
t-UE
Division of Water Quality 1650 Mail Service Center Raleigh, NC 27699-1650
Wedandsl401 Unit [phone]
Fax: [phone]
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4 N, Michael F. Easley
Governor
IL E William G. Ross,Jr.Secretary
Department of Environment and Natural Resources
Kerr T. Stevens
Division of Water Quality
May 18, 2001
DWQ # 010467
Caldwell County
Mr. Stanley Ray Benge
2713 Villa Woods Road
Granville, NC 28630
Dear Mr. Benge:
On May 10, 2001 the Division of Water Quality (DWQ) was notified by receipt of your applications
regarding your plan to fill waters for the purpose of stabilizing the shoreline of your lot on Lake Rhodhiss in
Caldwell County. Approval from DWQ is required to disturb these waters. Please provide seven copies of
the following information and refer to the DWQ # listed above in your reply You need to report the area of
water to be filled (i.e., length of shoreline times width of planned riprap).
Please call me at [phone] if you have any questions or would require copies of our rules or
procedural materials. This project will remain on hold as incomplete in accordance with 15A NCAC 2H
.0505(c). The processing time for this application will begin when this information is received. If we do not
hear from you by writing within three (3) weeks we will assume you no longer want to pursue the project and
will consider it withdrawn.
Jo erel
n R. Dorney
Cc: Asheville DWQ Regional Office
AshevilleCorps of Engineers
File Copy
Central Files
LTPWI
Division of Water Quality 1650 Mail Service Center Raleigh, NC 27699-1650
Wetlands/401 Unit [phone]
Fax: [phone]
State of North Carolina
Department of Environment'
and Natural Resources •
Division of Water Quality Alk
A8;6;±1111
M1119M
James B. Hunt, Jr., Governor NC ENR
Bill Holman, Secretary NORTH CAROLINA DEPARTMENT OF
Kerr T. Stevens, Director ENVIRONMENT AND NATURAL RESOURCES
2001
010t,-7 ?
C o. ? I County
Dear Mr.?
On the Division of W er Quality (DWQ) was no feed by re eipt of your
applications reg ding your plan to fill 1 s for they purpose of in q iJeilCounty.
Approval from DWQ is required to disturb these y3e-?'4r? . Please provide seven copies of the
l4tiu-lar?
-Im
following information and refer to the DWQ # listed above in your rri
i
de ribe in 15 INCA 2B .05 Va r 4l;?CAV bcat all rehe
pe Ple sho : hese - °C e can
b n t d ine u P1 'ec e wt C 2H .0 500.
Please call me at [phone] if you have any questions or wopies of
our rules or procedural materials. This project will remain on hold as incordance
with 15A NCAC 2H .0505(c). The processing time for this application en this
ing within thwe will
information is received. If we do not hear from you by writ
assume you no longer want to pursue the project and will consider it withdD
Sincerely,
z ,
John R. Dorne
Y
U^'
C 1 DWQ Regional Office l I' I
C ?
1 V E' A/1
Corps of Engineers
File Copy 5?1 \
Central Files / i
ll'
114
Wetlands/401 Unit • 4401 Reedy Creek Road • Raleigh, North Carolina 27607
Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer
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State of North Carolinhi
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
Mr. Stanley Ray Benge
2713 Villa Woods Road
Granite, NC 28630
Dear Mr. Benge:
1 •
.NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
April 11, 2001
DWQ # 010467
Caldwell County
On April 2, 2001 the Division of Water Quality (DWQ) was notified by receipt of
your application regarding your plan to fill waters for an unspecified purpose in Caldwell
County. Approval from DWQ is required to disturb these wetlands. In particular as
described in 15A NCAC 2B .0502, we will require you to locate all streams and ponds on
the property. Please show these on maps of suitable scale (for instance 1" = 100 feet)
so we can begin to determine your projects' compliance with 15A NCAC 2H .0500. A
site plan showing proposed impacts and discussion of the area of water fill must be
included.
Please call me at [phone] if you have any questions or would require
copies of our rules or procedural materials. This project will remain on hold as
incomplete in accordance with 15A NCAC 2H .0505(c). The processing time for this
application will begin when this information is received. If we do not hear from you by
writing within three (3) weeks we will assume you no longer want to pursue the project
and will consider it withdrawn.
FR rel ,
. Dorney
Cc: Asheville DWQ Regional Office
Asheville Corps of Engineers
File Copy
Central Files
Wetlands/401 Unit • 4401 Reedy Creek Road • Raleigh, North Carolina 27607
Telephone [phone] FAX # [phone]
An Equal Opportunity Affirmative Action Employer
50% recycled/ 10% post consumer paper
PP
DUKE POWER DIRECTIONS BY ROAD FORM
1
Lake Use Permit Applicants and Contractors: Ease of locating the proposed project site can have a big
impact on permit processing time. Please complete this form and return it along with your Conte ed
permit application to:
DUKE POWER
C/O LAKE MANAGEMENT - EC 12 Q
PO BOX 1006
CHARLOTTE, NC 28201-1006
1-800443-5193
Applicant's Name: ?S'T/9N E y t 4y
IV LNG C"
Street Address (at lake): SS' q 9 /++A)O H,14bouJC p1.
Lake Name: -k Q h top h 1 ss
Subdivision Name: Q O C- R uN
Property Section: sec--n Dx./ ONG, Lot # J 4 7
City: CJ&,Vf1.0E )crml S County: C h L io W E L L
State: P I C, Zip: 2 7 6 3 0
Telephone: F 2 0 37 G - 9zi 13
Directions (from major road or highway):
FROM 3.z/ 4 T-fkl'- 5-4w M o w s
? ?¢ u ? /tl?2?0? ? ,OR. T'NrL N G ? F?' G o SD yt?S. 1-41LAj ? -.-_
N? a rO 7-4 GetkE. -a1-42c R?-n?+r°.
Descriptive Structure on Property (i.e. brick garage, white fence, mobil hocme,
yo'irc Wir4 Goftonc booZS' l=f C;NJq Rod-v,
STo to S /G N 7-t,XX' G. C-- f7' D N r-o 004Y A4NO,r IZo?O ?

Type of Permit Requested
"Circle":
Private Facili
Commercia ?acility
Excavation
Stabilization
Conveyance
Miscellaneous Uses
*Note: Please use the back of this form if desired to draw us a map to the site.
6VE2
GPAL/LAKEMGMT/LMPPM/DI P,EC nONS.DOC
s
Effective Dale: 11/15/98
-.t d,.;Oa
,.vti i-.J

r'
10461
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 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 TYPE
I. OWNER'S NAME: 5774 N L Cc Y 'R,4y A} E N C c-
2. MAILING ADDRESS:. 7 11 V t I. W1' W a 66r
SUBDIVISION NAME _&6 IE5
CITY: -STATE: _ ZIP CODE: _ is /1?N1 ?'C' F'r I't`f N?? Y G J
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): 6*%r49 ?.hN?t7 Hf/u s toe v4
004 RNN
<+a,f Ail t& F¢?Lj l1?„?• 7- r6JC)
3. TELEPHONE NUMBER: (HOME) _ (WORK) _
fl? 314-7z0 1, Z'$ 7sQ' , jar 11 E*sr 2 aer
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: k
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: - NEAREST TOWN: _
ChLVwczQ g Gd?0 v/ 1,Is
tN?D i? RS, LANDMARKS, ECT.)
Q o CIF(C 4 N C 61F rr (I 1?•
?D 7 /?D
6. IMPACTED OR NEAREST STREAWRIVER:N$ RIVER BASIN:
7. (a) 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-In? YES Q NO Q IF YES, EXPLAIN: _
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES Q NO Nf
n
r i s
rn ?
(=) ---q
(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? ?I ,?•

17. DOES THE PROJECT INVOLVE AN XPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES ? NO Rl (IF NO, GO TO 16)
(a) IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES E] NO
(b) IF YES, HAS.THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES Q 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].
l8. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
n (,-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 50 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? _
(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 IMPACTED PRIOR TO:
I. ISSUANCE OF A SECTION 404 CORPS OF ENGINEERS PERMIT,
2. EITHER THE ISSUANCE OR WAIVER OF A 401 DIVISION OF WATER QUALITY
CERTIFICATION, AND
a ' 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, I?4'G
OW^NER'S/AGENTS SIGNATURE DA
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
8. (a) HAVE ANY SECTI N 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ? NO V IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION): ,_
(b) ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES ? NO [g IF YES, DESCRIBE ANTICIPATED WORK: -
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: ! G
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: N?'
to. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: _ EXCAVATION: _
FLOODING: - OTHER : _
DRAINAGE : - 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: 0/ 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.-"
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? bWHAT IS THE EXPECTED POND SURFACE AREA? _
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 81/2 BY 11 DRAWINGS ONLY) N+
13. PURPOSE OF PROPOSED WORK N?
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS) X)lf'
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY FEDERALLY
LISTED OR PROPOSED FOR LISTING- ENDANGERED OR THREATENED SPECIES OR CRITICAL
HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: VLA
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER NIT
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED -
I , .
-- r
010467
DWQ ID: - CORPS ACTION ID: -
NATFONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT 9) -
PRE-CONSTRUCTION NOTIFICATION APPLICATION
F6R 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 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 CREED ROAD, RALEIGH. NC
27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: rrA N L r. y R.4y A} E N 6 c-
2. MAILING ADDRESS: _2,7/ 3 v i I. L.?t W a aos
SUBDIVISION NAME J1615 ?uN
CITY: -STATE: -ZIP CODE: _ GR+'N! 1 a r-'} LLj N?? p
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): cl%.5'4 i jhA7jV H,+,t4a kR 01.
G,(,f? tc F?L?S N c- z p?,?a
3. TELEPHONE NUMBER: (HOME) _ (WORK) _
7S8 • `t°f 11 EST 2 d?
f2 T- 3q 6^7zi3 1,2.-T
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: k _
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: - NEAREST TOWN: _
c?4W0 wcz 6O v/rE /:2;,f L. Is
SPECIF C WCATIQN (INCLUDE ROAD NJMBERS, LANDMARKS, ECT.) _
,poe 4 6Frr of.7poplor Ko*b.
6. IMPACTED OR NEAREST STREAMIRIVERJJ# RIVER BASIN: td
7. (a) 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-[I)? YES Q NO &f IF YES, EXPLAIN: _ .
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES Q NO Nf
770 --a
n A
rn ?
-c rrn
? _-H
(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? ?.+
17. DOES THE PROJECT INVOLVE AN XPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES ? NO ?l (IF NO, GO TO 16)
(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 27603-8603, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
n f -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 50 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? _
(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 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
i 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,
OWT(EI'S/AGENTS SIGNATURE DATE v
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
TI{E OWNER IS PROVIDED).
8. (a) HAVE ANY SECTI N 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ? NO V IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION): _
(b) ARE ADDONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES [I NO IF YES, DESCRIBE ANTICIPATED WORK: -
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: ! G
(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: _ EXCAVATION: _
FLOODING: - OTHER : _
DRAINAGE : _ TOTAL ACRES TO BE IMPACTED. N
(b) (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: 1g 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
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? /HAT IS THE EXPECTED POND SURFACE AREA? _
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 81/2 BY 1 l DRAWINGS ONLY) N4-
13. PURPOSE OF PROPOSED WORK: N'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) 0111-
Is. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY FEDERALLY
LISTED OR PROPOSED FOR LISTING-ENDANGERED OR THREATENED SPECIES OR CRITICAL
HABITAT 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 114E PERMIT AREA
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED

01 0467
DWQ ID: - CORPS ACTION ID: _
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT f .-
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 TO THE APPROPRIATE FIELD
OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN
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: S`TA N y ?y E N G' E
2. MAILING ADDRESS: _ 7 1 3 V J L ?? W o
SUBDIVISION NAME A615 ?uA)
CITY: STATE: ZIP CODE: G/l rN1rC_ F'9 L M"C Z p O
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): drdr49 ?,#A;v H*,u,%q QA#,
004 RuN
6aofAJcj-& Q.(f- Z 1"JZ)
3. TELEPHONE NUMBER: (HOME) _ (WORK) _
f'2.4. 714 -7z13 $• 2.1 - 7S? • g°t I I E*vr 2 09
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: k
C7 -<
rrt
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: - NEAREST TOWN: _
C4W (A)GZ 6,1,,A?vlrE ?t,CS
SPECIFIC LQ CATIgqN (INC U E ROAD NI?J1MBERS, LANDMARKS, ECT.) _
,pot X4N 6FF d 7/?ou7ds 9-e.r0.
6. IMPACTED OR NEAREST STREAWRIVER:l* RIVER BASIN:
7. (a) 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-In? YES Q NO Q IF YES, EXPLAIN: _ .
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES E] 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? ?..}
17. DOES THE PROJECT INVOLVE AN XPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES ? NO ?Z (IF NO, GO TO 16)
(a) IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES 0 NO p
(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 THIS APPLICATION IF PROPOSED
AJ,}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 50 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.
(c) WHAT IS LAND USE OF SURROUNDING PROPERTY? _
(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 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, j., _ i1
OW ER'S/AGENTS SIGNATURE DA
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).

8. (a) HAVE ANY SECTI N 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ? NO ti IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION): _
(b) ARE ADDITJONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES ? NO [g IF YES, DESCRIBE ANTICIPATED WORK: -
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: ! G
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: IVA '
to. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: _ EXCAVATION: _
FLOODING: _ OTHER : _
DRAINAGE : - TOTAL ACRES TO BE IMPACTED. N
(b) (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: 0/ FT AFTER _ FT
WIDTH BEFORE (based on normal high water contours): _ FT
AVERAGE DEPTH BEFORE: _ FT AFTER _ I T
(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 MA
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? N15WHAT IS THE EXPECTED POND SURFACE AREA? _
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 81/2 BY 11 DRAWINGS ONLY) N.+
13. PURPOSE OF PROPOSED WORK: N'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) ?-?f'
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY FEDERALLY
LISTED OR PROPOSED FOR LISTING-ENDANGERED OR THREATENED SPECIES OR CRITICAL
HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: , V?I
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING THE PRESENCE Of HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED -
- t
010467.
f
DWQ ID:_ CORPS ACTION ID:
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT ft) _
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 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.
1. OWNER'S NAME: r. y A'? N ty E
MAILING ADDRESS: '2.,07 1 3 V
SUBDIVISION NAME _a6 E ?uN
CITY: STATE: ZIP CODE: G?-?} N? 1 ?' F'?VC
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): dr%r49 ??NR7 Hfx4,s qA of.
ID/ 0 4 'R/ "Al j
3. TELEPHONE NUMBER: (HOME) _ (WORK) _
of-3g6-?213 fZg-757• `0f 1I 6-ir 2d`r
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: k
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: - NEAREST TOWN:
C4L V Wcl;G 60 ,vIr _ Is
SPECIE C L CATI q'N (INC U E ROAD NyMBERS, LANDMARKS, ECT.) -
Doe u? dF?r .D>?opa7or /?0*0.
6. IMPACTED OR NEAREST STREAM/RIVER:P# RIVER BASIN: td
7. (a) 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-In? YES O NO Q IF YES, EXPLAIN: _
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES Q NO W
-b
C7 -C
n? s
? rn
rn z
(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? _ ,.+
17. DOES THE PROJECT INVOLVE AN XPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES ? NO 0 (IF NO, GO TO 16)
(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 THIS APPLICATION IF PROPOSED
nfj-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 50 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? _
(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 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, i, _ A
OWNE 'S/AGENTS SIGNATURE DA
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
S. (a) HAVE ANY SECTIgN 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ? NO V IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION): ,_
(b) ARE ADDIT ONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES ? NO Q IF YES, DESCRIBE ANTICIPATED WORK:
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: ! G
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: N?
10. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: _ EXCAVATION: _
FLOODING: _ OTHER : _
DRAINAGE : TOTAL ACRES TO BE IMPACTED. N
(b) (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: N47 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:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? 15WHAT IS THE EXPECTED POND SURFACE AREA? _
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 81/2 BY E I DRAWINGS ONLY) Nf
13. PURPOSE OF PROPOSED WORK: N1'
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS) O?
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE; AND/OR
NATIONAL MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY FEDERALLY
LISTED OR PROPOSED FOR LISTING-ENDANGERED OR THREATENED SPECIES OR CRITICAL
HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: Y-I
16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER O
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED _.
4 .
IPWQ ID: CORPS ACTION ID: _
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT 0 _
s'

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 TO THE APPROPRIATE FIELD
OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN C7)
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: ST'?1 N y ?? E N Cy E
2. MAILING ADDRESS: ?, -7 3 V t L
SUBDIVISION NAME A6 E ?uA)
CITY: STATE: ZIP CODE: aopirc- F?LGS N^C • Z
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): S%r49 1,,+,v
f?e}ILda ?2 Qo?.
pof RuN
Ga?Nttc- P.'tL?s N ?- Z pG,??
3. TELEPHONE NUMBER (HOME) _ (WORK) -
irl?- ldt 6-?Z-13 1, 7,1 , 7SY' • ` -r 11 E-iT
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: k
C-)
rTl Ez
m
rn Z
C7 ---i
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: - NEAREST TOWN:
C4L4We- Z 6J1? vIii _ /::;f i, Is
SPECIFIC LpCATI N (INC U E ROAD NjJMBERS, LANDMARKS, ECT.) _
loot 4N 6?F 07/?o?ldt KD?d.
6. IMPACTED OR NEAREST STREAM/RIVER:P# RIVER BASIN: td
7. (a) 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 p NO Ef IF YES, EXPLAIN: _ .
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO W
(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? ?,?
17. DOES THE PROJECT INVOLVE AN ENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES [] NO ?](RIFXP NO, GO TO 16)
(a) IF YES, DOES THE PROJECT REQUIRE PREPARATION OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENT'S OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES ? NO 0
(b) IF YES, HAS.THE DOCUMENT BEEN REVIEWED THROUGH THE NORTH CAROLINA
DEPARTMENT OF ADMINISTRATION STATE CLEARINGHOUSE YES Q 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 THIS APPLICATION IF PROPOSED
n #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 50 FEET OF 1 INCH EQUALS 100 FEET
OF THEIR EQUIVALENT.
(b) IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY
PRODUCT. . .1
(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? _
(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 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, y3??
OWNE t'S/AGENTS SIGNATURE DATE. v
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
8. (a) HAVE ANY SECTI N 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ? NO V IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION): _
(b) ARE ADDMONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES ? NO [q IF YES, DESCRIBE ANTICIPATED WORK: _
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: o G
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: AO
to. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: - EXCAVATION: _
FLOODING: _ OTHER
DRAINAGE : TOTAL ACRES TO BE IMPACTED: N
(b) (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: 0 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:
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? Nj!)VHAT IS THE EXPECTED POND SURFACE AREA? _
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 81/2 BY I I DRAWINGS ONLY) /V4-
13. PURPOSE OF PROPOSED WORK: 01t
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS) Olt
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY FEDERALLY
LISTED OR PROPOSED FOR LISTING-ENDANGERED OR THREATENED SPECIES OR CRITICAL
HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: v_lpr
IG. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER NI'T
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED _.
- r'
010467
WQ ID: _ CORPS ACTION ID: -
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT ft) -
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 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,
A=N: JOHN DORNEY, 4401 REEDY CREEK ROAD, RALEIGH, NC
27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: N Y K? E N C E _-:o ,D
rn?
2. MAILING ADDRESS: -2, 07 11 V °os
Fri
m
SUBDIVISION NAME6 t^ ?QuN Cj
CITY: STATE: ZIP CODE: G?.rN! re F'¢ LLJ NBC • ? P ? ? ?
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): Sur4 9 1, h o o H,+, ,% Lt A at.
tool, AMA,
GQ,ftjttC- ??Lf s N.(f• z pe-Jc)
3. TELEPHONE NUMBER: (HOME) _ (WORK) -
31t 6"7213 12-1 - 7SP • q of 1 f <-ir Z 617
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: k
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: - NEAREST TO WN: _
C4WWIIf- ZQ G/1.virE ffLcs
SPECIr
?0f-j,#0 A17d f f-* RS, LANDMARKS, ECT.) -
Q OLL [(, 4 N C 61QC (I J
6. IMPACTED OR NEAREST STREAMIRIVER:N# RIVER BASIN: tj
7. (a) 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 Q NO &f IF YES, EXPLAIN: - ,
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION Of COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES Q 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? ?,J-
5
17. DOES THE PROJECT INVOLVE AN XPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES ? NO ?[ ] (IF NO, GO TO 16)
(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 E]
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 27603-8603, TELEPHONE [phone].
18. THE FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED
f,+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 50 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? _
(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 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
s 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, d:!'
OW^NER'S/AGENTS SIGNATURE DA
(AGENTS SIGNATURE VALID ONLY
IC AUTHORIZATION LETTER FROM
TI-IE OWNER IS PROVIDED).
8. (a) HAVE ANY SECTI N 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ? NO V IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION): _
(b) ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES ? NO [g IF YES, DESCRIBE ANTICIPATED WORK: _
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: ! G
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: N-.4'
10. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: _ EXCAVATION: _
FLOODING: - OTHER : _
DRAINAGE : 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: O/ TT 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 Y#
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? Vj?AVHAT IS THE EXPECTED POND SURFACE AREA? _
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 81/2 BY 11 DRAWINGS ONLY) N#
13. PURPOSE OF PROPOSED WORK: NA
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS) 01f-
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY FEDERALLY
LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL
HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED:'
IG. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER NIT
(SHPO) REGARDING TI{E PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED -

DWQ ID: _ CORPS ACTION ID: -
NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT If) _
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 TO THE APPROPRIATE FIELD
OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN ()
COPIES MUST BE SENT TO THE NC DIVISION OF WATER QUALITY,
ATTN: JOHN DORNEY, 4401 REED'S CREEK ROAD, RALEIGH, NC
27607. PLEASE PRINT OR TYPE.
1. OWNER'S NAME: 774 N L Cr Y R.4y, 43 6 N 6 E
2-,'7 1 3 V y I. L-f W ° 60T
2. MAILING ADDRESS: '
SUBDIVISION NAME _&6 f: ?ta m
CITY: STATE: ZIP CODE: as /f?•N;1"' F N"C 1-7401) Q --i
PROJECT LOCATION ADDRESS, INCLUDING SUBDIVISION NAME (IF DIFFERENT FROM
MAILING ADDRESS ABOVE): tSur49 f??}117a f *A4s t t QR.
004 RuN
64#01t & F'j'I.Lj 111.0- Z Pd?C7
3. TELEPHONE NUMBER: (HOME) _ (WORK) -
, ?s8 • ?t°t i 1 E,sr 2 0?
8'2.Q- 3q 6-7z13 g• 2.1
4. IF APPLICABLE: AGENTS NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,
PHONE NUMBER: k /?
5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP
OR AERIAL PHOTOGRAPHY WITH SCALE):
COUNTY: - NEAREST TOWN: _
,C4LV We-Z 61II vi rE t:;f L. is
SPECIFIC WCATI N (INC U E ROAD N?JMBERS, LANDMARKS, ECT.) _
Qoe !`?t d F d 7/?oui0s Ke*O.
6. IMPACTED OR NEAREST STREAWRIVER:P# RIVER BASIN:
7. (a) 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 Q NO q IF YES, EXPLAIN: _
(b) IS THE PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAL
MANAGEMENT AREA OF ENVIRONMENTAL CONCERN (AEC)? YES ? NO M
(c) IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNTY (SEE PAGE 7 FOR LIST OF
COASTAL COUNTIES), WIIAT IS THE LAND USE PLAN (LUP) DESIGNATION? J,,
17. DOES THE PROJECT INVOLVE AN XPENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES ? NO R] (IF NO, GO TO 16)
(a) IF YES, DOES THE PROJECT REQUIRE PREPARATION.OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENT'S 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
DIR13CTED 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
A/kACTIVITY 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 50 FEET OF 1 INCH EQUALS 100 FEET
OF THEIR EQUIVALENT.
(b) IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TQ 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? _
(1) 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 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,
OWN S/AGENTS SIGNATURE DA
(AGENTS SIGNATURE VALID ONLY
IF AUTHORIZATION LETTER FROM
THE OWNER IS PROVIDED).
8. (a) HAVE ANY SECTI N 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT? YES ? NO IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION): _
(b) ARE ADD ONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES ? NO [j IF YES, DESCRIBE ANTICIPATED WORK:
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: ! G
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: N-t'
to. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: _ EXCAVATION: _
FLOODING: _ OTHER
DRAINAGE : - 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: 0/ 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 DAMIFLOODING: _
OTHER
11. IF CONSTRUCTION OF A POND IS PROPOSED, WHAT IS THE SIZE OF THE WATERSHED
DRAINING TO THE POND? N,6VHAT IS THE EXPECTED POND SURFACE AREA? _
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 81/2 BY I I DRAWINGS ONLY) N14-
13. PURPOSE OF PROPOSED WORK: N,+
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS) 01f
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY FEDERALLY
LISTED OR PROPOSED FOR LISTING' ENDANGERED OR THREATENED SPECIES OR CRITICAL
HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED: ?J Jf
Il. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER N tT
(SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WI4ICI4 MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED -

17. DOES THE PROJECT INVOLVE AN ENDITURE OF PUBLIC FUNDS OT THE USE OF
PUBLIC (STATE) LAND? YES ? NO RNO, GO TO 16)
(a) IF YES, DOES THE PROJECT REQUIRE PREPARATION. OF AN ENVIRONMENTAL
DOCUMENT PURSUANT TO THE REQUIREMENTS OF THE NORTH CAROLINA
ENVIRONMENTAL POLICY ACT? YES Q 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 THIS APPLICATION IF PROPOSED
jV j -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 Ty 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? _
(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 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,
OWNWNE,RMIAGENTS SIGNATURE DA'C`E.
(AGENTS SIGNATURE VALID ONLY
-
IF AUTHORIZATION LETTER FROM,
THE OWNER IS PROVIDED).

8. (a) HAVE ANY SECTI9N 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS
PROJECT`? YES ? NO d IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND
ANY ADDITIONAL INFORMATION (INCLUDE PHOTOCOPY OF 401 CERTIFICATION):
(b) ARE ADDITpNAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE?
YES ? NO [)y IF YES, DESCRIBE ANTICIPATED WORK:
9. (a) ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: _, G
(b) ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: AO
to. (a) NUMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY:
FILLING: _ EXCAVATION: _
FLOODING. _ OTHER : _
DRAINAGE : TOTAL ACRES TO BE IMPACTED: N fT
(b) (1) STREAM CHANNEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED,
PROVIDE DISTANCE BOTH BEFORE AND AFTER RELOCATION:
LENGTH BEFORE: 1=? FI 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
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? _
12. DESCRIPTION OF PROPOSED WORK INCLUDING DISCUSSION OF TYPE OF MECHANICAL
EQUIPMENT TO BE USED? (ATTACH PLANS; 81/2 BY I1 DRAWINGS ONLY) JJ4-
13. PURPOSE OF PROPOSED WORK: NA
14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN
WETLANDS (INCLUDE ANY MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS)
15. YOU ARE REQUIRED TO CONTACT THE US FISH AND WILDLIFE SERVICE AND/OR
NATIONAL MARINE FISHERIES SERVICE REGARDING THE PRESENCE OF ANY FEDERALLY
LISTED OR PROPOSED FOR LISTING-ENDANGERED OR THREATENED SPECIES OR CRITICAL
HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT.
DATE CONTACTED:
IG. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER
(SHPO) REGARDING T14E PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA
WHICH MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED