20070965 Ver 1_Information Letter_20070904

~9-84-' ~7 12: 5i F1~OM-NCDENI~-U~SF~O 336-771-463 T-194 F't7~1~'t7~2 F-449
„ O4 WAT~9 Michael F. Easley, Governor
Vtlilliam G. Ross Jr., Secretary
`OCR ~G North Carolina Department of Environment and Natural Resources
Vj ~ Alan W. Klimek, P.E. Director
~ Division of Water Quality
~ "~
Division of Water Quality
Winston-Salem Regional Office
Address: 585 Waughtown Street, Vi,'inston-Salem, NC 27107
PHONE: [phone]
FAX: [phone]
FAX TO: Sonia Grebory FAX NUMBER: 919-733-6893
DATF,: 9/4/2007
FROM: Sue Homewood
NO.OF PAGES INCI.,UDING THIS Sl-iEET: 1
Sonia,
Project 07-0965, this is the signature page that was incorrectly left unsigned in their application. They specifically asked if
faxing to me was sufficient and l intended to fax to ~ou the same day but was out sick anloff fast week and it was buried.
Can you stamp it received in the CO as of Aug. 20' since it was totally my error. Thanks.
By the way, I need an !P number for this project, it'll get drafted in the next week or two.
Sue
Q~
~D
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone]
SEP-4-2087 TUE 13:47 TEL:[phone] NAME:DWQ-WETLANDS
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Customer Service
1 800 623-7748
P. 1

• @9-@4-'@? 12;52 FROM-NCDENI~-4~SF0 336-771-463@ T-194 P@@21@@2 F-449
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Construction of 3 new rest area
19. PROJECT PURPOSE (Ooscribe the re~s~n or purpose or the project. sec instructions)
To replace the one closed with the construction of New US 421
USE 8L4CKS 20.22 IF DREDGED ANOIOR FIL4 MATERIAL IS TO BE DISChIARGED
20. REASONS} FOR DISCHARGE
ExtEn3i0n of three existing pipes and plecoment of one new pipe for the construction o1 acceleration and deceleration lanes
to access tha proposed rest area.
21. TYPE(S) OF MATERIAL BEING DISCHARGED AND THE AMOUNT' OF EACH TYPE IN CU81C YA12DS
Corrugated steel pipes
22. SURFACE ARcA IN ACRES OF WETLANDS OR OTHER WATERS FILLED (sec instrt+ctionsl
657 feet of stream impacts
23. IS ANY PORTION OF TI•IE WORK ALREAgY COMPLt:TE? YES ~ NO Q IF YES, DESCRIAF.. THE WORK
24. ADDRESSES OF ADJOINING PRUPERTY OWNERS, LESSEES, ETC. WHOSE PROPERTY ADJOINS THE WATER80DY (lf more than
can be entered here, please attach a su;~plcmentaf Iist?
Lester Wilfong, Jr
252 E Edgewood Mill Road
Wilkesboro, NC 28697
Bessie Harris, et al
CIO Mary Smith
675 Camp Jas Harris Rd
N, Wilkesboro. NC 28659
James Wilson Harris
1195 Camp Joe Harris Rd.
N. Wilkesboro. NC 28659
25. LIST OF OTHER CERTIFICATIONS OR APPROVALS/DENIALS RECEIVED FROM OTf•tER FtIJtRAL. STATC, OR LOCf1l AGENCIES
FOR WORK DESCRIBED IN THIS APPL{CATiON
AGENCY TYPE APPROVAL` iDENT1FICATION NUMBtR DATE APPLIED DATE APPROVED DATE DENIED
x Would include but is not restricted to zoning building and flood plain permits.
26. Application is hereby made for a permit or permits to lutharizc the work described in this application. t certify that the info+~mation
in this application is Complete and accurate. I further certify that I posse55 the authority to undertake the work described herein nr 3m
actin as th duly thorized agc;nt of the applicant.
St AT OF APPLICANT DATE ~ ~ ~ .O~ SIGNATURE OF AGENT DA t:
Tne applicatian must be signed by the person who desires to undertake the proposed activity (applicant') or it may be signed by a auly
authorized agent if the statement in block 1 1 has been filled out and signed.
18 U.S.C Section 1001 provides that; Whoever, in Shy manner within the jurisdiction of any department or agency of the United
States knowingly and will fully falsifies. conceals, or covers up any trick, ^~chome, or disguises a m~teri~l fact or makes any false.
factitious, or fraudulent statements or representations or makes o~ use3 any false writing o* document knowing same to contain any
SEP-4-2007 TUE 13:47 TEL: [phone] NAME:DWQ-WETLANDS ~ P. 2