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19950994 Ver 1_Complete File_19950913
State of North Carolina Department of Environment, Health and Natural Resources Division of Environmental Management James B, Hunt, Jr., Governor Jonathan B, Howes, Secretary A. Preston Howard, Jr., P.E., Director [D F= F=1 September 20, 1995 Wilkes County DEM Project # 95994 APPROVAL of 401 Water Quality Certification Mr. D. K. Bennett Assistant District Engineer P. O. Box 250 North Wilkesboro, N.C. 28679 FILE COPY Dear Mr. Bennett: You have our approval to place fill material in 0.03 acres waters for the purpose of replacing existing pipes along SR 1123-A (High Rock Road), as you described in your application dated 7 September 1995. After reviewing your application, we have decided that this fill is covered by General Water Quality Certification Number 3026. This certification allows you to use Nationwide Permit Number 3 when it is issued by the Corps of Engineers. This approval is only valid for the purpose and design that you described in your application. If you change your project, you must notify us and you may be required to send us a new application. For this approval to be valid, you must follow the conditions listed in the attached certification. In addition, you should get any other federal, state or local permits before you go ahead with your project. 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. 276 1 1-7447. This certification and its conditions are final and binding unless you ask for a hearing. This letter completes the review of the Division of Environmental Management under Section 401 of the Clean Water Act. If you have any questions, please telephone John Domey at 919-733-1786. Sincerely, res n Howard, . E. Attachment cc: Wilmington District Corps of Engineers Corps of Engineers Raleigh Field Office Winston-Salem DEM Regional Office Mr. John Dorney Central Files 95994.1tr P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone 919-733-7015 FAX 919-733-2496 An Equal opportunity Affirmative Action Employer 50% recycled/ 10% post-consumer paper ?+. ,-ST ATE STATE OF NORTH CAROLINA DEPARTMENT OF TRANSPORTATION JAMES B. HUNT. IR DIVISION OF HIGHWAYS GOVERNOR P. 0. Box 250 North Wilkesboro, N. C. 28659 Sept. 7, 1995 RECEIVE=D SEP 1 3 1995 ENVIRONMENTAL SCIENCFS Subject: Nationwide Permit,, o. 3 t replace existing pipe along SR 1123-A ad'acent o small stream trib. to Warrior creek clas -c-. Mr. John Thomas U. S. Army Corps of Engineers Regulatory Branch _ 11413 Falls of the Neuse Road, Wake Forest, N. C. 27587 Dear Mr. Thomas, The Department of Transportation is scheduled to grade, drain base, and pave primarily along the existing roadway of SR 1123 (High Rock Rd)., in Wilkes County during the 1995-1996 fiscal year. Due to the proximity of a small stream being a trib to Warrior Creek Class-c we are requesting a 404 Nationwide permit no. 3 to allow us to upgrade the 2 existing cross line drainage structures that will need replacing, and or extending. Attached is a straight line sketch with proposed erosion control, stream, stream embankment, pipe crossing, and marked county map. By copy of this letter I am asking Ms. Stephanie Goudreau Mt. Region Coordinator with the North Carolina Wildlife Resources Commission to comment directly to you concerning the 404 Nationwide Permit request. Also by copy of this letter, I am requesting authorization to proceed under Section 401 of the Clean Water Act from the Division of Environmental Management. T ?^ SAM HUNT SECRETARY We would like to begin construction as soon as possible. If further information is required, please let me know. Your early review and consideration will be greatly appreciated. ?Sincerely, D. K. Bennett Asst. District Engineer DKB Enclosures cc: W. E. Hoke, P.E., Division Engineer D. J. Tetzlaff, District Engineer County Maintenance Engineer W. N. Trivette, Area Roadside Environmental Engineer Eric Galamb, Water Quality Certification Unit DEM Ms. Stephanie Goudreau, Mt. Region Coordinator, NCWRC Doug Miller, Engineer Land Quality Section, DEHNR S R- 112 3 - /? N'E nh R o zA<- R o c>-A - Lk : 1 Ices Co L.-,,iA-y 1` PHILLIPS GAP • ?? 12w L12A '• 7°I 1, • / Q' ? WaIJI 1.9 •j.' Sf,o9 ir. M P ?W{Ibor /gyp 1742 LIC7 s 12l1 .71711 /? .138 123! ?, fPS 7 1 14 1]l1 J(/O 12s, 'S . I)sv a A -W O t6 r m JL : r r 1]W ro 3 131L -?a ? r L31LIE •s q y ,. THOMPKINS KNOB Y•c Summlr 4 , Isit 41 ELEV. 4100 Patron ` s 44 11 Al ouNTAI N 124, •? ! 17 ?- ? \ Ridge iti 1.1 ° ° \?"? J 17QQ 1iQ1 1774 12eo a '? RENDEZVOUS MIN. STATE PARK * f?J- Iss1 1241 J A J YATES Ponwmille 1311 \b 5 5 p T A • 2 11. y') N .e ?I S76 1 1.7 ? ' 11!! •1 e 1111 L 471 UZZ. .7 !?00 L91PC, 1224 1 S "? 1746 '' "Q of t)': 24 r 11ty i \ .../.? "?„ /12p1 ! .tio P X03 'HOUNTAIN 'J 1344 ! 9 // r 1 L 4! 1 MATCH -UA 4" uu(? 31 I iS ! / o • • E .t Foil 'fir' ~ZL 4 16 d 1.6 7 1 ]!] 1741 ; i a ?7' I . 1.172 J Had. / Al Lt41 Pvrlpr a 1711 u:e a 1 4 MilNen Cr k ' 12oe ? 4 ~ . 114E Maple Spring, I)ot .J L2 A4 t]lib 1172 16 it CRICKET ( .) o J x 244 1241 ? PA . 2,3 POP. P 7,2 0 "., . , . P LLZJ ?? ° ? . '? . ... !Cricket 4 ? 4 ?, o 1 207 f ?, .e 1791 11.2 1141 'Y '• ?. PAP 1.2 J1}! T ll.Lf - 1 71 3 Cw,po \ Mt. Zion '!/OC A . . /,e ? l $ l 7 F L1a CMnPbn A - \) !.J , a 7 Champion 1711 131 , ' fAf Pony driK 1161 Hen 1143 12Lt 4J - - , _ N 1!44 O a •`l` .J 3 \ 7 9 ? 26 ?4 . i o o '• , '? ) Ilso •a4 .r • '?' ,iSl - Shay LLSI r 1144 ? i:FV f? 11 ELK 1 ° n / 1I1Z F 1 Grove fh. •r w .6 x :t.. WCK 1J1\p 4.f 1171 1L24 114 1 ?£ 1 71?? 9 h 11H 1111 4 '< 1 r .Q s P:: 26E ?i l , ERVOI S OW04S 1174.1 .1 u 1 11 71 I.0 79 .4 12ot . y r 71147 KNOG %•' 1 Q//1_ E . s I .1 J V .? 1141 {L n 1LL ' 0. • 3 4_ / •4 y? • M M` ' o \^ i _ .s a \ 0 1227 r: 113Q .4 1' 4 1?1 I V !r;' 1114 1171 7 9 I f ry \1 I 1210 h . 117 list V ?L3 / \- 4 \!b 1107 1 i N ?_ o 7.6 > j ,b y 1114, .? S G • ah4e1 liv 1 a.ioo Q Ila II 6' ' 1.0 PAS Mr. Cornet 7.4 ?/ ?'f ?'?4e • 4° .J ,.o L24 11]s 761 1 'A 1147 1119 1117 7 Ch. ,\Q .S '!?' C Fall, 'Z/ ? 114 E 1117 t'? .7 I ,1 .6 11 1, . IIIf 714 5 \ ., ' ' v \' t=" t r•. 112! y 1r` I 40" 1 26 OJ L? g1DG?- 1 Lu L7 1132 o Fvpuvon rl M 17 0 1117 ' J' \ dMlle a 1i L, 1274 ,I f v - 6 IAS ` 7.9 , 1171' '`r III ? •1 S 1 10 1?01 ?? !171 1 110, , 1, •/ ?? fAt? 761 i-4 1 1.3 boomer q \O '\ LIIl Ll3? 4 7J "'? .? !1LL J i7 . 1 p° 24 ii; Imo,} 11711 ?,; \1 ?? 1 16 1.ll7. ?Ov / , ornor . u . \ • ? ?\ tPS `? 1110 1120 (\ \1 LM •1 ,6 LIE A L K GAP AP i. 1127 ? RUSSELL /j 6 • \• 1 IOO NE • I6 O \A GAP ???? • _. tAS 1227 (j d4 11 \ ?' D E R CS .7 ? \O y S? 1 N 4 A,, q?3 , 0 0 , ' 76'00' HICKORY KNOB / m . 1 Y I •J P EROSION CONTROL SCNEDULF (1) All adequatR temporary ero+gion control measures will be installed before clearing and grubbing operations begin. (2) As construction progresses temporary and permanent erosion control devices shall be installed in a timely manner, according to any special permit requirements and /or requirements set out in G.S. 113A-57. MANDATORY STANDARDS FOR LAND-DISTURBING ACTIVITY Pursiinnt to G.S. 113A-57(3), Provisions for a ground cover stifficient to restrain erosion must be arr.omplished within 30 working days or 120 calendar dnyQ following completion of construction or development, whichever period is shorter, except as provided in 15A NCAC 49 .0024(e). DESIGN STANDARDS IN SENSITIVE WATERSHEDS P»rsuant to G.S. 113A-57(3) provisions for a ground rover st.ifficient to restrain erosion must be provided for any portion of A land-disturbing nrtivity in a HQW zone within 15 working days or 60 calendar days following completion of construction or development, whichevee period is shorter. (3) All siltation and erosion control devices shall be properly maintained until no longer needed. (4) On projects performed by D.O.T. Maintenance Forces, regttPRt will promptly be made to the Division Roadside Environmental Unit for stage and permanent seeding. (5) Any removal of siltation rondition of established device iq serving. devices will be based on the ground cover of that area the CONSTRUCTION ^ROUFNCr FOR INSTALLING ROADWAY CULVERTS 1. Clear only ennliah area and install the downstream measures anch as silt check dams, silt screens, and silt basins as noted on plan. 2. Excavate the 2' base tail ditch. 3. Excavate and install the roadway culvert. 4. Install sediment control measures at inlet as noted on plan. 5. Ttistall additional pipe outlet protection and inlet protection as noted. EROSION CONTROL DETAILS AND SPECIVICATIONS ZWLA bescwfttl -Smbd fftt 245.03 Temporary Sill bitch .............................. tth --- vt -1 215.05 Temporary Diversion ............................. t o --- A71- 4 vt 6 893.01 Temporary Sill Fence -111---Ill- ---- ?- e Drain *1111 ?arlh Elerm .. r Slo T ---- - ?-- Ivt - 890.05 _ y p empora ...... _ 245.01 .. _ Silt Rasin Type A ............................... ---- i?t Itl ---- 245.02 Silt Rash Type 8 892.04 Temporary Flock sill check Type-A --- ---- in - 14 895.10 Temporary hock silt check Type-13 -------- ---- vi -16 892.01 Tempoinry hock Sediment bam Type-A ... ........ . _ in - 18 892.02 Temporary Hock Sedimehl bgm Type-l3 ._ • ------- in - 20 ---- 897 01 hock Pipe Inlet Prolecllotl ....................... .. . 894.01 Flock Sill Screen ...................................... -------- All - 14 245.04 Stilling gasin .......................................... ........ .. ----- +?1 2? hock Inlet Prolecllon: A -- on 1 --A) 19 V11 896.01 Type A ............................... U - ----- 896.02 Type b ............................... g " 01`1 ' ----- tit - 32 896.03 Type C ............................... C U -- 01,1 - C ---- Vt :ld Et!; I "IV 1-1-no 1,11ir d I)! tt h .............. .... ..... esi rIhPrnl'i4'i hvvl?ld Llltad W11:01 .... .... ..... t nrvin?tnly?r-. arm. u7 n1v h:+h P111 S1,*0 h "401ttint' .... .... ..... ?A SMAII. skt-enm ne ntmicli .................... R 1r. o"l I".t t=-j(051 t,,-0A,-t,R IL- -- VI-1 Marcli, 1991 EROSION CONTROL PLAN SR I IZ3 -(a COUNTY W ; Ikc.3 LOCAL NAME ?A;p'h R oc?C WORK ORDER NO. /-- DRAWN BY: R M. ( rA,-? s 8-9-qS DISTRICT ENGINEER: ROADSIDE ENVIRONMENTAL ENGINEER v 6xZxL d 8xZ xZ J cu to SHEET?_OF ?k. PT, 9 }so r ® 8xzxz SxzxZ T IOx2K•Z NOTE: PIPE LOCATIONS MAY VARY DUE TO GRADE CHANGES IN ROADWAY SCALE 1" = 100' IoXZxZ.d®y - . ®1,o xzxz V ?. y v - V IV y - ? 10xzxz i0 xzxZB A A STA. O t 1 0 `Red A:?1 10Aoo Ao' x ?`d" C? P FI i z°+ SHEET Z OF?_ EROSION CONTROL PLAN F STA. fa?"?S SR 1 1 23 - A R?pl•« I Sa" COUNTY 40"K Cse Qlr.:a ILxZx2 - LOCAL NAME 14 c?c? ?oxzxL WORK ORDER NO.7G 26 (L_ cr- oL oL Iox1xL 118xexz -- /a A- Si- R. X A o0- E,c S?;ncl .40' Y,1161' pipe- +to h: c?c lt?.c? A M o v• cl -r o S'1-^. "7 t S E- STA. 1-7+30 - P J? qo u I?,, esc?-Typ?Q -- ®14Xzx2 14x2xZ [/J12xLxL IZxZ Ke- z x 7- xz T Bk.P?. ak. PT. 14 +Z5 r _ 14 +ZS v v I - d 8xz xZ. S'TA, Ilt'7S-P:ep1A« -?[ - ZS'x 15" O-SP-- QIA:13 O SCALE 1" = 100' 8xLxZ Ell 1 ID4JJ ® STA. 11 +'SU- R.eP1ACe. S o' x l g" CS P fTRtx2 ?? HRZrL lvxLRL 3 E }oo ` SHEET OF 77 ;ROSION CONTROL PLAN ?R 1123-A 5ra. z9i4o O OUNTY (,?.?'?CeS Replo?cc '' ,OCAL NAME Rock 25'x ls" CSP 'ORK ORDER NO. Co.-11??CopO Bk. p-r. d $t2KZ V STA. Z l-+oo- Re?a:?+ ?. ? O 20' k iS" csP-PEA:? /?u IJrar.? ?T'r:???cary 7o4x1rL® J O ® I0nLx2 ?:Fk1c Wcacr:or CK- CLASS C ? STA. z 4 + q O ---? - -? -? - - - --? R?Qlacc C??,c4Z" ? , csp-TyQ? g 8x2 xzA® © STA. z4+so R:?pIP.?? ;3 c- ® $xZxi A s-rA. 23 t-15- ?plp.?? A ? O 40 iaxzxL (? ® ' x ?8" csP-PIA:, T v 14 ?Lx2 %2xLxz 14 xZxZ "ALE 1" = 100' uo 4 4 ROSION CONTROL. PLAN IIZ:?-A vr_--- r D NTY OCAL NAME ?',?? Rtick Rop.d v ORK ORDER NO. l .1 Co2coon v, d - izXzxz ® O r/G Bxz„z STA. - 7 t 3,0- R?p1Ac? SO' x ? g" CsP-T?p? 6 - r ® la XZxZ IA ZxL ® V V O ' 34 -? Zvi - A r --? - - - : --? Z • S o' it 4 8" CSP-TJO-Q) - ® 14K 12xZ=t A A STA, 3b ?°1 O- ?cple,cc ' 50'x I$? CsP T???,lr O 14 xZXL ® 8xZx2 ALE 1" = 100' SHEET__4_0 Fr_ SO }OJ ROSION CONTROL PLAN ? 1123•- is OUNTY (?; ?keS OCAL 'NAME t--1, 1? R ?1c Ra . _ ORK ORDER NO.?„-7?Z[?pp IoxLxL SHEET 5 OF r7 7vr O ® 14x2 xZ S T'a.. 4 -1 ? 3u = vdc? c? L ?I Zo'x is" GsP-PIP.:•? Ioxrxz®. STA. 4?0 -F S v - ?rt(?1/?.cG. 4RLaL? r 40' x 24?' CSP-?--?(?e g STA. s1•.(o -? 30- (Zap1..?? T O 40'x IS" CsP-P1A:r, I - 14xZxL v d - d r _ S-r A, Q , +fa5- Rep\t?e? _ 4 U' x I cs P -Typf- 13 © p 8 xzxt A - ? K?x V N ALE 1" = 100' • IOrl rl® (o o+ee :OSION CONTROL PLAN t 1123-? )UNTY l.l? ;'I Ices )CAL NAME I-a ; ?+n ock Rc? . _ )RK ORDER NO. (n .71 ? (a b O STA. S 8t O A Bxlxz 2D' X 15T' CSP- PIA:..A A 5-T A , S 1 + 5 - f?e??a?cc 20'x, lS"Cs.P- P1a;N N 8x LxZ A S-rn, sC? -FSo -Rep\oce ?AI 20'x Is,, ccx2xZ QfiJp D?; ( 8?clrz Oc??e sTA, SS-t'4o- R?Q\Ac? ; . 4o'), Dr:Jc r- -T 1 ZnZxZ v - S TA . s2 + c? o . C -f 30' x 15" CSP-Pl,o,,;ti AL I" = 100' 12xzxz i 0 O Dr. d? d SHEET to OF 1? Gk.P-% , s(oASo v A 8x Z xZ _ SHEET OF 3ROSION CONTROL PLAN 5R 11e3 -?1 'OUNTY LJ ''CAL NAME;ga R RoA _ ;ORK ORDER NO. (0 e, r? ( Q0 A ., (c>0tvq ?oP 10 xzrz 12 C ALE 1" = 100' q ?? Q lb J?nr? ? 1 a?,1?pr?k? " ?? s,cor J6? J J$.Y /eA G S D it ,c A (0 4- 1 40' I T S?'x i 8 C- 1 1 17 :1 ` '? --`-mo T n P) - t p ff?? 7+30 1 40- + 1 S 18" C's - A A H 3+vs _ e- P• 1 -A)", o f0' x I h - <. t? 'x,8 CSP-PIA; IYL 4 q o 6 , e- Qep)Ace- 5'x 4 „ - . 3o+ c?n .. 50,y. ,, 4 ' Y,4 8 37-+ •l v' x, 18 ,. 4&+ o X " 4 4. A- 5-- 1 eA 40 4/1 S q -7 :t2, o •' ? ', - ?? ? I a ?c i '' Cs ('- PIA, , t o Y, - 0 (; SS 0 4 ' ,' Lli 9, -t do o x 15 - e P,i2 1 v' s- 1 W '7 4-Sn r; e Ppr- - 'O'X C -P- 1r. k -7 - r, n Y' Je- 0' IS"C5 ,n ?UNTT-?a1' IIcPS S,e.1.lo. .Lj23- P Ngny\E ?;n 1 ID 25 N tisTlkLo PIple ---------- • - - - - - - - - - - - - - - - - - - ---------, -4- L sw PIPE -? II c,>;useR LINE SGA 1 iN - o FT .? E.x;s-F ; n? 4 ?, x 3? ,' LS P I I' 1 nl? Neor-mot T?:b. T? ? '??: ??'? Ron1L SiI+Sc?<c.+ Wc.rr:or Crct1?- CIP.ss G ,1 ?.eP1?c¢ (PS' X4Z" CSP'T???? ci e? G I ?N, a 10 FT ?. ,oTE: ?.MPORARy EROSIoI.{ Gc?JTRoI. ? ?v 1 ?t=S t?l aT S R O V4 61) -B uT SILL lu c?udE TEMpoQARy 51L-T FENCE) -Rock GNECk CAMS dud SJLZ ?3PS1?5 RS ?.l2EdEc? S A R.vE, b - - Golr?at,TED gel ' ? ,c , 7" f`-f' ? I --- ? J ;ouLJTY L)J; Ikes vsZIW6 PO NJ ek1 Read ?poSED Q W EVSTluta pipe ------------ W ;w P?oE I C?6??TER I.?NL? 1 1' I Node: Ex?s}:?c? Roadw4? .s 180' -'ro,•-- Ne,.+ Ca,..k.?1:NC oN e? g ?AaMF- h Pock. QQAA I 04? I ON ¢x.;s.+:ncl ror.?wr. N e 3o'x42" Csp P:p. Are to be CcMJJca °F A r;a rnp 1;n,.rj c\; ?-c6. ?p b.- "Pl. SGALE IIN, = 30.F,T•? Adc?-z-S?' x4$" ?n tsv,r•.e, ??ib. To ??,i-i-le- Wr{rr•?or (,'cc.e.+?' L'?pss C'' - T(?o?k 5:?.-tScre?..? c.m F 1, N. to FTC, NoT>r: TsrnpoaaRy 1:RDSIo?d CoaTamL DFEvIt-ES KJOT SAOv4o? -$uT WiLL JM GluAe TEMPoRAR.II 51LT F'ENC.Ej Rock GNELk DAMS NVA'a -SIQT -3P,S1?IS, NS 1iSF-,IEJ Su1RV>yy 'D : Q -I -GIB Cof48ac.TED s ue . i J- I DEH ID: ACTION ID: _ NATIONWIDE PERMIT APPLIED FOR (PROVIDE NATIONWIDE PERMIT JOINT APPLICATION FORM FOR NATIONWIDE PERMITS THAT REQUIRE NOTIFICATION TO CORPS OF ENGINEERS NATIONWIDE PERMITS TEAT REQUIRE SECTION 401 CERTIFICATION CONCURRENCE XATIONWIDE PERMITS THAT REQUIRE INDIVIDUAL SECTION 401 CERTIFICATION WILMINGTON DISTRICT ENGINEER CORPS OF ENGINEERS DEPARTMENT OF THE ARMY P.O. BOX 1890 WILMINGTON, NC 28402-1890. ATTN: CESAW-CO-E Telephone (919) 251-4511 WATER QUALITY PLANNING DIVISION OF ENVIRONMENTAL MANAGEMENT NC DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES P.O. BOX 29535 RALEIGH, NC 27626-0535 ATTN: MR. JOHN DORNEY Telephone (919) 733-5083 ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS OF ENGINEERS. SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEHENT. PLEASE PRINT. 1. OWNERS NAME: f? C ?EPA2TME7JT OF ITZAN45 F'Or-TA-110tJ 2. OWNERS ADDRESS: P.O. Bog 250 Nog--n4- uJ IkEs hcAc, ki e-2 8Co -79 3. OWNERS PHONE NUMBER (HOME): (WORK) : 9/0 - 667- 2111 4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL,, ADDRESS, PHONE NUMBER: 0 As? SEN?/F17- . D, Z v A/a,G ,/ ,¢ o L Z 8 fc 7 5. LOCATION OF PLANNED WORK (ATTACH HAP). COUNTY: I`?i1kES NEAREST TOWN OR CITY: W 11 KES B02c SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.): 52.1123-A lNICato 2OGK R.d? F20^, -52 t(25 1-0 51Z. lIZ2 5GE 6. NAME OF CLOSEST STREAM/RIVER: 1c10, R?lo2 G2EEK CLASS-G-' 7. RIVER BASIN: ADKI1-1 8. IS THIS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROUT, SA, HOW, ORW, WS I, OR WS II? YES ( ) NO [L'' 9. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROPERTY? YES ( ) no (V!" IF YES, EXPLAIN. I 10. ESTIMATED TOTAL NUMBER OF ACRES OF WATERS OF T E U.S., INCLUDING WETLANDS, LOCATED ON PROJECT SITE: D 0 S rac-tzE P' -l-?T1 PE PIt 330/92 i? -2- 11. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY THE PROPOSED PROJECT: FILLED: DRAINED: FLOODED: EXCAVATED: TOTAL IMPACTED: D.DaAC.P.t. •P? IP6 12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS): /Q?RGG? Z G'2o?sL/?/C' .S t?i,oE To pQarui?B i4.?Eoti.aT? TJoai?,aa? 1, 13. PURPOSE OF PROPOSED WORK: 0 'iG w 11 14. STATE REASONS WHY THE APPLICANT BELIEVES THAT THIS ACTIVITY MUST BE CARRIED OUT IN WETLANDS. ALSO, NOTE MEASURES TAKEN TO MINIMIZE WETLAND. IMPACTS. /o 4-A1,546eE -2M±j* S/GT !SKEINS/C.7 J6/GECf?S r Hr?a 3rG/ ???_ C? AG i?+n a.r _!G /ylie/i,r?iZ6 /_7lo,gL_, ? • 5f.?T A7T17?/??D A/<1?/s 1S. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE (USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) REGARDING THE PRESENCE OR 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. HAVE YOU DONE SO? YES (I.-? NO ( J RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS. 16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMIT AREA WHICH HAY BE AFFECTED BY THE PROPOSED PROJECT? HAVE YOU DONE S07 YES ( J NO (1?? RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS. 17. ADDITIONAL INFORMATION REQUIRED BY DEH: A. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, AND LAKES ON THE PROPERTY. B. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO BE IMPACTED BY PROJECT. C. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE. D. IF A STORMWATER MANAGEMENT PLAN IS REQUIRED FOR THIS PROJECT, ATTACH COPY. E. WHAT IS LAND USE OF SURROUNDING PROPERTY? F. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL7 &1A R'S SIGNATURE DATE