20011381 Ver 1_Individual_20000121

Mitchell
ENVIRONM
113 West 3rd St. • Green,
3975 Market St. Bldg. D Suite A •
December 13, 1999
Mr. John Thomas
Raleigh Regulatory Field Office
U.S. Army Corps of Engineers
6508 Falls of the Neuse Road, Suite 120
Raleigh, North Carolina 27615
AsAciates, Inc.
PAYMENT
Dear Mr. Thomas: RECEIVED
NSULTANTS
.4077 • Fax: [phone]
910.254.0602 • Fax: [phone]
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The purpose of this correspondence is for Mitchell and Associates, Inc., representing PTR, Inc.,
to submit an application for the placement fill material within Section 404 Department of the
Army jurisdictional waters, Leak Fork Creek, and the relocation of an unnamed tributary, located
on the west side of Patterson Avenue, approximately 1400 feet north of the intersection of Motor
Road, northwest of the city of Winston Salem, in Forsyth County, North Carolina (General
Location Map, Page 1 of 4; Specific Location Map, Page 2 of 4).
The purpose of the fill and culverting was to facilitate the construction of an existing commercial
mobile home showcase site. Enclosed is a map of Leak Fork Creek and the unnamed tributary
before the fill, culvert, and redirection (Existing Conditions Map, Page 3 of 4). The construction
allows commercial amenities to be developed that are essential to business needs. Without
excavation, culverting, discharging of fill material, and the redirection of the tributary, the site
would be unsuitable to support this business endeavor. The proposed plan to culvert Leak Fork
Creek and to redirect the unnamed tributary are illustrated on map page 4 of 4.
The applicant considered other alternatives to the placement of fill material in jurisdictional
waters. However, the plan is the only practicable alternative available. Considering the
applicant presently owns and operates a commercial business on the existing site, relocating the
business to another area to avoid impacts was not an economically viable alternative. In
addition, the applicant does not own any other properties suitable for the business that would also
satisfy the plans for this commercial business operation. The facility on the existing site is the
only practicable alternative available to the applicant.
Only those areas essential to the expansion plan were included, and special care was used not to
exceed these designated boundaries. All fill and culverted areas were stabilized immediately and
prevented from effecting any wetland areas outside the permitted fill area.

By copy of this completed Department of the Army Individual Permit Application and attached
cover letter, I am requesting your consideration of this project and anticipate your response.
Please contact me at your convenience should you have any questions regarding this matter.
Thank you for your time and prompt attention to this request.
cc: Rocky Carter, PTR, Inc.
Post Office Box 1037
Kernersville, North Carolina 27285

APPLICATION V EPARTMENT OF THE ARMY PERMIT
(33 CFR 325)
OMB APPROVAL NO. 0710-003
Expires October 1996
Public reporting burden for this collection of information is estimated to average 5 hours per response, including the time for reviewing
searching the existing data sources, gathering and maintaining the data needed,and completing and reviewing the collection of information Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to
Department of Defense, Washington Headquarters Service Directorate of Information Operations and Reports, 1215 Jefferson Davis Highway, Suite
1204, Arlington, VA 22202 -4302; and to the Office of Management and Budget, Paperwork Reduction Project (0710-0003), Washington, DC
20503 Please DO NOT RETURN your form to either of those addresses. Completed application must be submitted to the District Engineer
jurisdiction over the location of the proposed activity
PRIVACY ACT STATEMENT
Authority 33 USC 401, Section 10 1413, Section 404. Principal Purpose: These laws require permits authorizing activities in, or affecting
navigable waters of the United States, the discharge of dredged or fill material into waters of the United States, and the transportation of dredged
material for the purpose of dumping it Into ocean waters. Routine Users: Information provided on this form will be used in evaluating the
for a permit Disclosure Disclosure of required information is voluntary. If information is not provided, however, the permit application cannot be
processed nor can a permit be Issued
One set of original drawings or good reproducible copies which show the location and character of the proposed activity must be attached to this
application (see sample drawings and Instructions) and be submitted to the District Engineer having jurisdiction over the location of the proposed
activity An application that is not completed in full will be returned.
5 APPLICANTS NAME
8. AUTHORIZED AGENTS NAME AND (an agent is not required)
PTR, Inc.
MITCHELL & ASSOCIATES, INC.
6 APPLICANTS ADDRESS
9. AGENTS ADDRESS
Post Office Box 1037
Kernersville, North Carolina 27285
113 WEST 3RD STREET
GREENVILLE, N.C. 27858
7. APPLICANT!S PHONE NOS. W/AREA CODE
7. AGENT'S PHONE NOS, WIAREA CODE
a Residence See Agent
a. Residence 252.752.4077
b Business See Agent
b. Business 252.752.4077
11, STATEMENT OF AUTHORIZATION
I hereby authorize to act in my behalf as my agent in the processing of this application and
furnish, upon request, supplemental information In support of this permit application.
SEE ATTACHED LETTER OF
APPLICANTS SIGNATURE DATE
NAME, LOCATION AND DESCRIPTION OF PROJECT OR ACTIVITY
12 PROJECT NAME OR TITLE (see Instructions)
Larry's Homes
13. NAME OF WATERBODY, IF KNOWN (Yapplicable) 14. PROJECT STREET ADDRESS (if applicable)
Leak Fork Creek and unnamed 4060 North Patterson Avenue
Winston Salem, North Carolina 27105
15 LOCATION OF PROJECT
Forsyth NC
COUNTY STATE
16. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see Instructions)
On the west side of North Patterson Avenue, approximately 1404 feet north of the
intersection of Motor Road.
17. DIRECTIONS TO SITE
Take highway 52 North out of Winston Salem, turn right on Patterson Avenue exit, and
look for the street address. "Larry's Homes" is on the left side of Patterson Avenue
North. -
ENG FORM 4345, Feb 94 EDITION OF SEP 9113 OBSOLETE (Proponent. CECW -0R)

18 Nature of Activity (Description of projecf. Inc,uu. all features)
Applicant excavated, culverted, and filled 1510 linear feet of jurisdictional waters of
the United States. See map for linear assignment.
19 Project Purpose (Describe the reason or purpose of the project, see InstrucVons)
Facilitate a commercial mobile home showcase site to allow for additional commercial
amenities to be developed that is critical to applicants business needs.
USE BLOCKS 20 -22 IF DREDGED AND /OR FILL MATERIAL IS TO BE DISCHARGED
20 Reason(s) for Discharge
Fill area allowed for construction facility.' Without discharge of fill material, the
site is unsuitable to support this commercial endeavor.
21 Type(s) of Material Being Discharged and the Amount of Each Type In Cubic Yards
Approximately 3674 cubic yards of clean earthen fill material obtained from the upland
site.
22 Surface area In Acres of Wetlands or Other Waters Filled (see Instructions)
0.35 acre
23 Is any Portion of the Work Already Completed? Yes X No IF YES, DESCRIBE THE COMPLETED WORK
Site as shown is currently constructed.
24. Addresses of Adjoining Properety Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (If more than can be entered here,
please attach supplemental list).
BMT Auto Sales Freedom Homes
4028 North Patterson Avenue 4120 North Patterson Avenue
Winston Salem, N.C. 27105 Winston Salem, N.C. 27105
25 List of Other Certifications or Approvals/Denials Received from other Federal, State or Local Agencies for Work Described in this Application
AGENCY TYPE APPROVAL IDENTIFICATION NUMBER DATE APPLIED DATE APPROVED DATE DENIED
USACOE 199920144
26. Application is hereby made for a permit or permits to authorize the work described
application is complete and accurate. 1 further certify that I possess the authority t
duly authorized agent of the applicant.
SIGNATURE OF
DATE
The application must be signed by the person who desires to undertake
authorized agent if the statement in block 11 has been filled out and sigi
on. I certify that the information in this
work described herein or am acting as the
/01P 9
'DA YE
activity (applicant) or It may be signed by a duly
18 USC Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency of the United States
knowingly and willfully falsifies, conceals or covers up any trick, scheme, or disguises a material fact or makes any false, fictitous or
fraudulent statements or representations or makes or uses any false writing or documents knowing same to contain any false, flctitous or
fraudulent statements or entry, shall be fined not more than $10,000 or imprisoned not more than five years or both.
. US GPO 1904.52047WS2018

Mitchell
E N V I R 0 N
113 West 3rd St. • Gr
1121 South Front St. • V
December 4, 1998
Mr. Rocky Carter
PO Box 1037
Kernersv111e, NC 27285
Ws
es, Inc.
LTANTS
• Fax, 252 752.7380
12 • Fax [phone]
I, Rocky Carter, do hereby authorize Mitchell and Associates, Inc to act as my agent on the property
off Patterson Avenue in Winston -Salem North Carolina.
ZJ"��? ,,/,
Signature
Date

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40
17
40

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EXISTING SITE PLAN
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SKETCH NOT TO SCALE
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Win.ion Salem NC 1.36996 -13001
= Leak Fork
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— — — — — = Unnamed
Tributary
= Approx.
Property
Line
Existing Leak Fork Creek & Unnamed
Tributary
Forsyth County, North Carolina
Rocky Carter
Lat N 36° 9 638' Long W 80° 15 272'

SEDW"NTFENCE
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GENERAL NOTES, ••" • ,
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«cTYPE A DITCH . «cTYPE 8 OITCH • «cTYPE C ORCH - DITCH TEFI~TgN
" GeoSc7 Proposed Culvert of Leak Fork Creek &
I Redirection of Unnamed Tributary
Forsyth County, North Carolina
" Rocky Carter
Lat N 36e 9 638' Long W 80e 15 272'
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