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HomeMy WebLinkAbout19990924 Ver 1_Complete File_19990824State oi North Carolina �'� Department of Environment and Natural Resources � e� Division of Water Quality � ��� James B. Hunt, Jr., Governor ������ Bill Holman,�Secretary � Kerr T. Stevens, Director September 27, 1999 Caswell County DWQ Project # 990924 APPROVAL of d01 Water Quality Certification N[r. Wiliiam D. Gilmore, P.E., Manager Plannin� and Environmental Branch North Carolina Department of Transportation P.O. Box 25201 Raleigh, NC, 27611-�201 Dear Mr. Gilmore: You have our approval; in accordance with the attached conditions and those listed below, to place fill material in 0 acres of wetlands and 80 linear feet of streams for the purpose of replacing a bridae across Benton Creek. The project should be constructed in accordance with your application dated 18 August 1999. After reviewing your application, we have decided that this fill is covered by General Water Quality Certification Number 3103. This certification corresponds to the Nationwide Permit Number 14 issued by the Corps of Engineers. In addition, you should acquire any other federal, state or local permits before you proceed with your project including (but not limited to) Sediment and Erosion Control, Non-Discharge and Water Supply Watershed regulations. This approval will expire with the accompanying 404 permit, unless otherwise specified in the Water Quality Certification. This approval is valid solely for•the purpose and desi�n described in your application (unless modified below). Should your project change, you must notify the DWQ and submit a new application. If the property is sold, the ne�v owner must be given a copy of this Certification and approval letter, and is thereby responsib(e for complying with all the conditions. If total wetland fills for this project (now or in the future) exceed one acre, or of total impacts to streams (now or in [he future) exceed 150 linear feet, compensatory miti�ation may be required ns described in 15A NCAC 2H .0506 (h) (6) and (7). For this approval to remain valid, you must adhere to the conditions listed in the attached certification and those listed below. 1.) The project shall use include in the Sediment and Erosion control plan BMPs approved for High Quality Waters shall be used. 2.) The DOT will develop and submit for approval plans for the construction of appropriate Emergency Spill Catch Basins. The plans should be submitted no later than October 31, 1999 to the NC Division of Water Quality. If you do not accept any of the conditions of this certification, you may ask for an adjudicatory hearin;. You must act within 60 days of the date that you receive this letter. To ask for a hearinb, send a written petition that conforms to Chapter 1�OB 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 bindine unless you ask for a hearing. 1621 Mail Service Center, Raleigh, North Carolina 27699-1621 Telephone 919-733-5083 FAX 919-715-6048 An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post-consumer paper i'-� � .r� This letter completes the review of the Division of Water Quality under Section 401 of the Clean Water Act. If you have any questions, please telephone John Dorney at 919-733-9646. Sincerely, � � err . Stevens Attachment cc: Wilmin;ton District Corps of Engineers Corps of Engineers Asheville Field Office Asheville DWQ Regional Office Central Files c:\ncdot\brid�e No. 32\wqc\990924wqc.doc �� TEL� Feb 17'O1 2�22 No.001 P.01 �� ���L�.L\ Sl�ll l 1't�11 NORTH CAI20LINA DEPARTMEN'I' O�' TRANSPORTA.TIQN BRIDGE MAYN'�'ENANCE UMT P.O. $OX 289 SILER CYTY, N.C. FaK Number (919)663-0214 Telephon� Number (919)74?-5649 Date .2 q . q Fa.Y Se�t to ;�pHti �N�ESSY . FaY Sent by ; ���u�� �o +�cnl1/ L'�'� No. OfPa�es �' Re.marics : � r r ' � � � _ � , - � ► � � \ � �� e D � qq � - °►� 13� -"1SS 5�.� � ' r- .� ;,� r_ � �� �� M Y� �v� � �� a ��1 c M �1 �__ _ `�'` '' -' ------ ::` TEL� Feb 17'01 2�23 No.001 P.02 i V � I U,� �l�� �4 � � / w v '0 � n. W � � � � � � I L ti r �: I I ° M �. ' �. I � f � l,�Q • � I �.� `� } f e s � � M O ,V�n o N� �,t.. � OD I�. � J � o Z Q '� + "E � � °.� rC� s � � J ��� �,;� M :Y�Y4 u � e ,�, a. eE `a � = ;nl J . � �� � o. . ' O ' � O � . � 4� e 4 e9 • ,� —` ; � � a a �_ �I `� l� N. , �L �� � � . v� Q N } {i y � a �� � � � .y -� y1 h �� b n (- �u N 11 f, � � ,, Q O ._ � M � � �y� �! �� � ,y � s Q- o 1. ) '" �-- n w .L a h � � n Q�e O � ti n � � � .� r � � � �J y�ytY S E � o,.�� � V i O, rF\-. � ' � .� -�yr; `��rs � j�o � '. : .+�J u � •... ' � ��1.. �� �_~\_ iYlC J �!� �� ��!v:� ?�, �' �.Y"� 41�1 A � e � � �� i����iii�ii� I�iO�lll�lll Mq���jr'���i�i� �l� : �:E��IIIIAI�R111 �il fl ''_�?'�Qi�ll�11ll��i� f� I:C��d1:�liil�i�:l���l� ► ifl� � JY ` ' � StcTro.� {� -A �i,o� Zri � TEL� -rop or 3rRM . �\ . � �,p � pF �rn � �'�--� �,o• 7�I.o� . 2�° e �1�a� 1�� gF�rr. e' � � t, a Feb 17'01 2�24 No.001 P.04 i F� c �% � N �'r� `� F��L 5 LD F%� 2.0' rraP eF a��� i �• � —"� ; � 1.a �� � � ' �1.0 i _ �.. __ � ils"c^'+P �.o ��° �.o �L�ow — '�� 70� o� rit�- .� sc rlL � � J�MES B. HuNT Jx. GOVERNOA .,��i�,� `J r `4i1��` �"� � �"� STATE OF NORTH CAROLINA ' DEPARTMENT OF 'TRANSPORTATTON P.O. BOX 25201, RALEIGH, N.C. 27611-5201 P.O. BOX 289 Siler City, N.C. September 3, 1999 Division of Environmental Management John Hennesy, WQ Certification Unit P.O. Box 29535 Raleigh, N.C. 27626-0535 Dear Mr. Hennesy: � ���Q-� � SFp -1 � 0 l9gg � °�.�.W ,AT�fRTQ�q �S GROUP �'�.SE,cr�dN DavID MCCOY ACTING SECRETARY Please find the following information requested in a letter by Mr. John R. Dorney concerning DWQ # 990879 in Alamance County over Mary's Creek: Wetlands — None present Length of stream to be culverted — 801f I have enclosed a copy of the check for this permit sent on August 9, 1999. If I can answer any questions you may have or if you have any comments, please call me at (919) 742-5649. Thank you for your assistance in this matter. Attachments Sincerely yours �,p,�,,^'� p< ' Dennis L. Jo nson Bridge Maintenance Superintendent State of North Carolina Department of Environment and Natural Resources Division or iNater �uality James B. Hunt, Jr., Governor Wayne McUevitt, Secretary Kerr T. Stevens, Director E. B. Nelson NC DOT PO Box 289 Siler City, NC 2734� Dear Mr. Nelson: 1 • • � NORTH CAROLItvA DEPARTMENT OF ENViRONMENT AND NATURAL RESOURCES August 20, 1999 DWQ # 990879 Alamance County On Auaust 10, 1999 the Division of Water Quality (DWQ) was notified by receipt of your application regarding your plan to culvert streams for the purpose of to replace a bridQe over SR 2334 over tilary's Creek with a culvert in Alamance County. You will need to inform us of the linear feet of stream to be culvened and if wetlands are also present on ;he site. Approval from DWQ is re�uir?d to disturb these wetlands. Please call John Hennessv at 919-733-5694 if you have any questions or would require copies of our rules or procedural matenals. � 'ncereiy, � ��I � C� o n R. Do ev l '� cc: . Winston-Salem DWQ Re�ional Office Wilmin�ton Corps of Enbineers J�hn Dorney Central Files 990879.pnd �v WET �A►�os � �D p� P► P E Wetlands/d0] Unit =4=101 Reedy Creek Road Ralei�h, North Carolina 27607 Telephone 919-7= 3,1736 FAX # 733-9959 .4n Equal Opoonuniry �ffirmative .4ction Employer �09c recycled/1090 posr consumer paper � :� IF INCORRECT RETURN TO WARRANT NO. L� 2 7 6� S DEPARTMENT OF TRANSPORTATION 13 71 CONTROLLER'S OFFICE t INVOICE PURCHASE -� CODE NUMBER DATE ORDEA AMOUNT NUMBER F 04-28-9�3 , _I TOTAL REMARKS: MItddR `�JATER OUALITI PERtdIT F�E 'ScE RE`/ERSE SIDE OF STUB FOR CODES- DETACH BE 4Z7fi95 DISCOUNT I "'i"",,, . STATE OF NORTH CAROLINA !� ut °L '� P ` � �=�� DEFARTMENT OF TFANSPORTATION ' :, �� � RALEIGH, NORTH CAROLINA — ........ _ G DATE 0�-29-99 NETAMOUNT � Q � � 0 � ?00 � 00 i-10 531 Warrant No.427695 �I PAY TO . ��t0. I DAY YR. I � :�F,iGUNT I ii THE ORDER OF: ' S � I ;� N.C. DEPT OF ENVIRONMENT AP7D ,�D4 Z99.9i I��*st*2DQ:OG ; tJATURA'L'::RES O[IRCES �� DIVI;STON":<,OF WATER OU�,LITY � P:O, BO;� Z9:535 I� ':> `RALEIGH . N 'C , Z7626-0535 =-=_- =_=: - ==�;� : ,: , .:_� � � �=- - !� ,� " f ` _- �.y�� -�r�.y�/ _ 'i, . t`$'F'�3 = _ _ : � _- _ _ ; , • -: %' «:� :%.:.Y,>/`s '_ j ` r� _-_ :`.�3c"�'_c.. PRESENT;TO: STATETREASURER ` _ .,::., _ rr_tir,,r rn_ c_ _ ____ _ ?_ _ _____ ;I PAYABLE AT PAR THROUGH FEDERAL RESERVE SYSTEM ' =— • - """' = =-""O--"""=_ """ ' -°' :��-..-.,�-.������-. __...,._...,_ .... .........._ __ __ .. ._ _ __- -- - ��'4 2 769 5i�° �:0 5 3 L�0 594�: 5���000���60 L��■ J.AMES B. HUNT JR. GOVERNOR l .. �i. � .^.�' _ ., r�Yo � e ya� � ����¢��� Vr STATE OF NORTH CAROLINA DEPARTMENT OF TRANSPORTATION P.O. BOX 25201, RALEIGH; N.C. 276 1 1-520 1 P.O. BOx 289 Siler City, N.C. August 18, 1999 Division of Environmental Management John Hennesy, WQ Certification Unit P.O. Box 29535 • Raleigh, N.C. 27626-0535 Dear Mr. Hennesy: DAVID MCCOY ACTING SECRETARY Please find seven (7) copies of an application form attached for your review. If I can answer any questions you may have or if you have any comments, please call me at (919) 742-5649. Thank you for your assistance in this matter. Attachments � Sincerely yours �,P.�'►M.�� � , Dennis L. Jo son Bridge Maintenance Superintendent C A�l'� � t� --� �e,-,��.� C-� �� �-������� �� i�� � . s�,i� �.. �.����� , � o �.�,�. ��.� � � �� �� z z� ��-- �:� �� . ��s% � i . m` o� i�N o n m ;o m �g � o ,� `Y � € � � x � `y� t�� � �y� � � � Bo < ��d�� C i m m a g m �m � � N � N � �L� T g ? m ?� � N q� a � , ` i � � � � 2 2� a � i - Is _\�� �� �!`,I s b � ��� `� n I.., ,1 i t � � �" ! 2 ir I `J . n � � 0 � Q� eb ---- � !, �1 _ i � � � ��i ) \: � � vi Ii �� �I' y Ci] i � _: � � � �« � ; 0 ; �-- z ��'� � O �" i'i u� �,,,,I„ �,,,,I,,,,� A 2 � �V 0 � 2 . • i �' h � . 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M.��iAGEMENT' SE�iD THE ORIGI'�i1AL Ai�iD (1) COPY OF THIS COMPLETED FORM TO TF� APPROPRIATE FIELD OFFICE OF TF� CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (71 COPIES NIUST BE SENT TO THE NC DIVISION OF WATER QUALITY. ATT�: JOHN DORNEY. 4401_REEDY CREEK ItO�. RALEIGH. NC 27607. PLEASE PRINT OR TYPE. i. OWivER'S Nt1iVfE: 1�1.G. �6PT. �� TRANSPDEZTAT►ON 2. MAII..I�i1GADDRESS: P �. g�x 2B�i S�L�P� C�z� 4�1.C. 213�►�1 SUBDMSION NA.ME CITY: S��E� C�-��t STATE: N.C. ZIPCODE: z�3yy PROJECT LOCATION ADDRESS, INCLUDING SUBDNISION NAME (IF DIFFERENI' FROM MAILING ADDRESS ABOVE): 3. TELEPHONE NUI�iBER: (HOME) (WORK) `� �9 - ��2 - s 1�4°► 4. IF APPLIC.�BLE: AGE��I'I"S NAi�fE OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS, PHONE NUMBER: � D.1_ �DN�.15oN P.D. aox 2Qq S��EQ C���c �u.e. 2�344 --- 5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGRAPHIC MAP OR AERIAL PHOTOGRAPHY WTI'H SCALE): COUNTY: C ASti1E `�- - NEAREST TOWN: � ANCE�! v►►.�� , SPECIFIC LOCATION (LNCLUDE ROAD NUMBERS, LANDMARKS, ECT.) �R�pG6 ND, 3,Z D� SR \��D PtCRDSS BEN�(oN Ctt'EEK 6. IMPACTED OR NEAREST STRE.4M/RIVER: � E NTaw1, C REE K RIVER BASIN: C APE ��aft, 7a. IS PROJECT LOCATED 1VEAR W:�TER Ci,ASSIFIED AS TROUT, TIDAL S�L.TWATER, (SA), HIGH QUALIT'Y WATERS (HQW), OUTST.4NDING RESOURSE WATERS (ORW), WATER _ SUPPLY (WS-I OR WS-II)? YES ( X) NO ( ) IF YES, EXPLAIN: K[�v.l 7b. IS THE PROJECT LOCATED WITHIl�i A NORTH C�IROLINA DNISION OF COASTr1L, MANAGEMEiVT AREA OF EYVIROMEi�t'I'AI. CONCERN (AEC)? YES ( ) NO ( X j 7c. IF TI� PROJECT IS LOCATED WTTHIN A COASTAL. COUNTY (SEE PAGE 7 FOR LIST OF COASTAI. COUNTIES), WHAT IS T'I� LAND USE PLAN (LUP) DESIGNATION? 8a. HAVE AI�(Y SECTION 404 PERNIITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROJECT? YES (� NO ( ) IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMTT AND ANY ADDITIONAL I'�i tFOR1�IATION ( INCLUDE PHOTOCOPY OF 401 CERTIFTCATIOI�: SeNZ �-1$-qq gvt o�► ��s� F��anr� — D�nl R*'� 99Dq2`� 8b. ARE ADDTI'IONAL PERMI't REQUESTS EXPECTED FOR THIS PROPERTY IN Ti� FUTURE? YES ( ) NO (� IF YES, DESCRIBE ANTICIPATED WORK: 9a. ESTINIATED TOTAL NUMBERS OF ACRES IN TRACT OF LAND: �•O� ACR6S '�'�- 9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: t�1oNE 10a. i�1UMBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROTECT BY: FII.LING: _ FLOODING: DRAINAGE i ► D D EXCAVATION: � • � ; O _ TOTAL, ACRES TO BE IMPACTED: � lOb. (1) STREAI�1 CHANNEL TO BE IMPACTED B Y'I`HE PROPOSED PROJECT (IF RELOC,�TED, PROVIDE DISTr�'�10E BOTH BEFORE AND AFI'ER REI:OCATION: LENGTH BEFORE: 8 � FI' AFTER: S � FT WIDTH BEFORE (based on normal hish water contours): L15 FT AVERAGE DEPTH BEFORE: 3.S FI' AFTER: 3�5 FT (2) STRE.��i CHANNEL IvIF.�CTS WILI, RESLJL.T FROM: (CHECK AL.L THAT A�PL� OPEN CHANIVEL RELOCATION CHr�1NNEL EXCAVATION PL�CEiV1ENI' OF PIPE IN CFiANNEL: COONSTRUCTION OF A DAM/FLOODING: OTHER: C4NSTRUCT�Ot.! DF A gR�D`E (35PAe�s pF SD EA�N� 11. IF CONSTRU�TION OF A POIv'D IS PROPOSED, YVHAT IS THE SIZE OF Th� WATE�SHED DRAINING TO TF� POND? WHAT IS TF� EXP�CTED POND SURFACE AREA? 12. DISCTTPTION OF PROPOSED �VORK I�i 1CLUDING DISCUSSION OF TYPE OF MECHrLi�iICAL EQIJIPME��IT TO BE USED? (ATTACH PLANS; 81/2 BY 11 DRAWPIGS ONLY) BR�OLE REP�ACEMEN'� �.i�-[N �, COR�� rJ4AP� �R��.�. (oE 1.3 SPf�1rSQSp�, El. V\P MENT WSfA - CRANE .� RAc.k Ir�oF 13. PURPOSE OF PROPOSED WORK: REP�Aee�cv�E��r �F STftuCTuR�_ �6�\C�CNT otZ�D�E '— �Ei�oceE C�uSE(J �vE \o �a���RE- 14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE C.�RRIED OUT IN WETLANDS ( INCLUDE ANY �fEASURES TAKEN TO MINIMIZE WETLAND IMPACTS) - N 15. YOU ARE REQUIltED TO CONTACT TF� US FTSH AND WILDLIFE SERVICE AND/OR NATIONAI. MARIIVE FISHERIES SERIVE REGARDING THE PRESENCE OF .ANI' FEDERALY LISTED OR PROPOSED FOR LISTING E�IDANGERED OR THREATE�IED SPECIES OR CRITICAL HABITAT IN Ti-� PERMIT AREA THAT MAY BE AFFECTED BY TI�-PROPOSED PROJECT. DATE CONTACTED: �-1 �-°tg 16. YOU ARE REQUIItED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) REGARDING TF-� PRESENCE OF HISTORIC PROPERTIES IN THE PERi�1IT AREA WHICH MAY BE AFFECTED BY TI� PROPOSED PROJECT. DATE CONTACTED �-\��R4 17. DOES THE PROTECT liNOLVE AN EXPE�iDITURE OF PUBLIC FUNDS OT TF� USE OF PUBLIC (STATE) LAND? YES (� ) NO ( j( )(IF NO, GO TO 16) _ a. IF YES, DOES THE PROJECT REQUIItE PREPERATION OF AN E�1VIltUNMENTAI. DOCUII�NI' PURUANT TO THE REQUIlZEMENTS OF TF-� NORTH CAROLINA ENVIRONMENI'AL POLICY ACT? YES ( ) NO ( ) b. IF YES, HAS TT� DOCU��i'I' BEEN REFIEWED THROUGH THE NORTH CAROLINA DEPAR'Ii�fE�i'I' OF ADMINISTRATION STAT'E CLEARINGHOUSE YES ( ) v0 ( ) IF r1i�tSWER 17b IS YES, TI�N SUBMIT APYROPRiATE DUCUME1�tTATIONFROM 'I� ST,�TE CLEARINGHOliSE WTTH THE NORTH C.�ROLINA E�iVIlZONN1Ei�1TAL POi.ICY ACT. QUESTIONS REGf1RDING TI-� STATE CLEARINGHOUSE REVIEW PROCESS SHOUi,D BE DIItECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH CAROLINA DEPARTMENf.OF ADNIINISTRATION, 116 WEST JONES STREET, RALEIGH, NORTH CAROLINA 27603-8003, TELEPHONE (919) 733-6369. 18. TI� FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED ACTMTY INVOLVES Ti� DISCHARGE OF EXCAVATED OF FII.L MATERIAL INTO WETLr�'vDS: a. WETLAND DELINEATION MAP SHOWING ALL WETI,ANDS, STREAMS, LAKES, AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, AND 38). ALL STREAM (INTERMIITENT AND PERMANEN� ON TI� PROPERTY MUST BE SHOWN ON THE MAP. MAP SCAI.ES SHOULD BE 1 INCH EQUALS 50 FEET C7F 1 INCH EQUALS 100 FEET OF TE-�IR EQUNALEN'T. b. IF AVAII.ABLE, REPRESE�ITATNE PHOTOGRA.PH OF WETLANDS TO BE �IPACTED BY PRODUCT. c. IF DELINEATION WAS PERFORMED BY A CONSULT.�u'�1T, INCLUDE ALL DAT.� SHEETS RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE: d. ATTACH A COPY OF TI� STORMWATER MANAGEMENT PLAN IF REQUIRED. e. WHAT IS LAND USE OF SLTRROtJNDING PROPOERTY? . � . , � .' ► � � � � ■ f. IF APPLIC.�BLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL.? g. SIG�IED AND DATED AGENT' AUTHORIZATION LETTER, IF APPLICABLE. NOTE: WTLANDS OR WATERS OF TI� US MAY NOT BE IMPACTED PRIOR TO:__. 1) ISSUANCE OF A SECTTON 404 COR.PS OF ENGli�iEERS PERMTT, 2) EITHER THE ISSUANCE OR WANER OF A 401 DNISION OF WATER QUAL,?TY CERTIFICATION, AND 3) (IN TI� TWENTY COASTAL COUNTIES ONLY), A LE'ITER FRONi THE NORTH C�ROLINA �NISION OF COASTAI. MAi�iAGE1�ivT' STATL�iG THE PROPO�ED ACTIVITY IS CONSISTENf WITH THE NORTH C:�ROLINA COASTAL _ MANAGE.TVIENT PROGRA1tiI, , q _ �2-qq OWNER'S/AGE�I'I" SIGNATURE N�oOT DATE (AGE?VT'S SIGNATURE VALID ONLY IF AUTHORIZATION LETTER FROM THE OWNER IS PROVIDED). � , s. i: � DWQ ID: CORPS ACT'ION ID: NATIONtiVIDE PER�ti1IT REQUESTED (PROVIDE NATIONWIDE PERYITT #) N W P �`{ PRE-CONSTRUCTION i�OTIFICATION APPLICATION FOR NATIOI�IWIDE PER�fITS TH?�T REQUIRE: 1) NOTIFICATION TO Ti� CORPS OF ENGINEERS - 2) r1PPLIC.�TION FOR SECTIOI�t 401 CERTIF'C�TION � �) COORDIN�ITION WITH THE NC DMSION OF COASTr�L. M.��1AGEti1ENI' SE�iD T� ORIGLVAL, r�v� (1) COPY OF THIS COMPLETED FORI�I TO TI� APPROPRIA'I� FIELD OFrICE OF T� CORPS OF E�1GI'�Ii EERS (SEE AGENCY ADDRESSES SHEET). SEVEN (71 COPIES �IUST BE SENT�TO THE NC DIVISION OF WATER QLTALITY. �TT�: .TOHN DORNEY. 4401 REEDY CREEK I20�D. RALEIGH. NC 27607. PLE�SE PRINT OR TYPE. i. OWi�tER'S iVt1:�/1E: N.C. O�PT. OF TRANSPOftTAT�ON 2. NIAII..L`iGADDRESS: P.�. ��x 2��i 5��,�� C�i�t 4N.C. 273�►H SUBDMSION NA.�fE CITY: S� �� R C►-c �( STATE: N. C. ZIP CODE: 2 � 3'i �l , PROJECT LOC?,TION ADDRESS, INCLUDING SUBDIVISION N.41�IE (IF DIFFE:ZENI' FROM MAII.,ING ADDRESS A.BOVE): 3. TELEPHONE NUbtBER: (HOME) (WORK) `��9 --►'�2 - S l�yq 4. IF APPLIC.ABLE: AGEVT'S N.�VLE OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS, PHONE NUNfBER: \ . �.L. �JDHw�SoN P.D. 8�x 2gq 5►�EQ C.��t �u.e. 2�3yy LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGR�PHIC MAP OR :�ERIAL PHOTOGRAPHY WTI'H SCAL.E): COWi TY: C AS�.IE `�- - iVEAREST TOWN: �{ AtvCE �( v►��� SPECIFIC LOC�TION (LNCLUDE ROA.D NUMBERS, LAIVDMARKS, ECT.) �R�pGC ND. 32. D�j SR \1�� PtCROSS BEN"CoN CCt'EEK 6. IMPACTED OR NEAREST STRE.S1�'URNER: � E NT �w� C RE E K R1VER BASI�i 1: C APE �EA� 7a. IS PROJECT LOCATED N`��1R WATER C"LASSIFTED AS TROUT, TIDAL S�I.TWATER, (S�), HIGH QUALITY W?�TERS (HQW), OUTST�'�tDI�i 1G RESOURSE WATERS (ORtiV), WATER _ SUPPLY (WS-I OR WS-II)? YES ( X) NO ( ) IF YES, EXPL�1: K4�r.1 7b. IS TF� PROJECT LOCATED VVITHI�1 A NORTH C�ROLINA DNISION OF COAST.�I. MANAGEMENI' AREA OF E�IVIlZOMENI'�L CONCERN (AEC)? YES ( ) ti0 ( X j 7c. IF TI� PROJECT IS LOCATED WITHIN A COASTAL, COUNTY (SEE PAGE 7 FOR LIST OF COASTAL COUNTIES), WHAT IS TF� L:II�tD USE PL.4Iv (LL�') DESIGNATION? 8a. HAVE ANY SECTION 404 PERMTTS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROJEC'T? YES (� NO ( ) IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND ANY ADDITIONAL I'�Ii FORNIATION ( INCLUDE PHOTOCOPY OF 401 CERTIFICATIOl�: SeNZ a-��-�19 Bvt o�► O�.c� F�attnn — D�rJ Q*'� �l�iDq2y 8b. ARE ADDITIONAL PERMI't REQUESTS EXPECTED FOR THIS PROPERTY IN THE FU'I'�TRE? YES ( ) NO (� IF YES, DESCRIBE AN'IZCIPATED WORK: 9a. ESTINIATED TOTAL NUMBERS OF ACRES IN TR�CT OF L.�vD: �•O� ACReS }I- 9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETL.��iDS LOCATED ON PROJECT SITE: t�1o�aE 10a. NiJNIBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PROJECT BY: n• FILLING: FLOODING: t � � D EXCAVATION: • � • L DRr�INAGE : � _ TOT.aL, ACRES TO BE IMPACTED: lOb. (1) STRE.A�VI CHANN�EL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOC,3TED, PROVIDE DISTAI�ICE BOTH BEFORE AND AFTER RELOCATION: � LENGTH B EFORE: $ � F'I' AF'I'ER: $ p FT WIDTH BEFORE (based on normal hiQh water contours): �15 FI' AVERAGE DEPTH BEFORE: 3.S FT AFTER: 3�5 �' (2) STRE:��f CHA1�Ni EL I�IF.�CTS �VII.,L RESiJI..T FFtOM: (CHECK ?.LL THAT APPL� OPEN CHr11�NEL RELOC�TION CHANNEL EXCAVATION PL.3CEl�fENI' OF PIPE I'iV CH��1�iEL: COONSTRUCTION• OF A DPuv1/FLOODING: OTHER: _ CoNSTRUC'�►OtJ DF A gR�D`E ��3 SPAI�S oF Sp EA�N� i l. IF CONSTRU�TION OF :� POND IS PROPOSED, WI�r1T IS THE SIZE OF Th� W�TEFSHED DRA.INI'YG TO TF� POND? POND SURFACE ARE.A? 1�VHAT IS T� EXPECTED 12. DISCTIP'ITON OF PROPOSED �VORK INCLUDING DISCUSSION OF TYFE OF MECH.�.�YIC.AL EQLJ�MMEiENI' TO BE USED? (ATTACH PLANS; 81/2 BY 11 DRAW1iVGS ONL� gR�o�F REP�ACE�nENr �,.��T� P� CnREO S4A(3 �R��(�E �3 SPAt�S Q50, E�V\P MENT �SFQ — CRA�aE � 1 RACk NoF 13. PURPOSEOFPROPOSEDWORK: R6P�qee�nENT oF STftvCTURA�i.� �E�\C�EN'r Di��DVrc -- p(i�0[.rc CL�Sfc(� � E �o �A��.uRE - 14. STATE RE:�SONS WHY IT IS BELIEVED TH:1T THIS ACTIVITY MUST BE CARRIED OUT I�i i WETLANDS ( INCLUDE ANY �fEASURES TAKEN TO MIlVINIIZE WETLri��iD IMPACTS) - N � 15. YOU ARE REQUIl2ED TO CONTACT TI� US FISH ��iD WII.DLIFE SERVICE AND/OR NATIONf1L MARIIVE FISHERIES SERIVE REGARDING THE PRESENCE OF .Ai�iY FEDERALY LISTED OR PROPOSED FOR LISTING E�IDANGERED OR THREATE�IED SPECIES OR CRITICAL HA.BITAT IN TI� PERMIT AREA THAT MAY BE AFFECTED BY T'HE PROPOSED PROJECT. DATE CONTACTED: B- l4s-°�q 16. YUU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) REGARDING TT� PRESENCE OF HISTORIC PROPERTIES IN TF� PERMIT AREA WHICH NIAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED � - �4�-R9 17. DOES THE PRO7ECT li�iVOLVE AN EXPE�IDITURE OF PUBLIC FLNDS OT TI� USc OF PUBLIC (ST�TE) L.4iVD? YES ( ) NO (�( )(IF NO, GO TO 16) _ a. IF YES, DOES THE PROJECI' REQUIRE PREPERATION OF A1V E.�1VIl20NME�rI'.�I. DOCUMEN'T PURUANT TO THE REQUIRE�NI'S OF TI� NORTH CAROLINA E�IVIRONMENI'r1L POLICY ACT? YES ( ) NO ( ) b. IF YES, HAS THE DOCLTi�fF.��1T BEEN REFIEWED THROUGH TI� NORTH C:�ROLINA DEPARTv1ENT' OF AD�YISTR.�TION STATE CLEARINGHOUSE YES ( )�10 ( i IF ��tSWER 17b IS YES, THEN SUBMIT APYROPRIATE DUCU1�fEVTATTONFROti1 TI� STATE CL�4RINGHOliSE WITH THE NORTH Cr1ROLP1 iA E�IVIROi�fENT'AL PGi.iCY ACT. QUESTIONS REGAR.DING Ti� STATE CLE.ARINGHOUSE REVIEW PROCESS SHOUL.D BE DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEA.RINGHOUSE, NORTH CAROLINA DEPARTMENT OF A.DMINISTRATION, 116 WEST JONES STREET, RALEIGii, NORTH C:�ROLINA 27603-8003, TELEPHONE (919) 733-6369. 18. TF� FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS A.PPLICATION IF PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO WETL��IDS: a. WETL.AI�(D DELIlVEATION MAP SHOWING ALL WETI.ANDS, STRE.AI�IS, LAKES, AND PONDS ON THE PROPERTY (FOR NATIONWIDE PERMIT NUMBERS 14, 18, 21, 26, 29, A1VD 38). ALL STREAM (INTERMITTENT AND PERMANENI') ON TI� PROPERTY MUST BE SHOWN ON THE MAP. MAP SCAi,ES SHOULD BE 1 INCH EQUALS �0 FEET GF 1 INCH EQU?,L.S 1Q0 FEET OF TE�IR EQUTVAL,ENI'. b. IF AVAILABLE, REPRESE.VTATTVE PHOTOGRAPH OF WETL.41'VDS TO BE I��IPACTED BY PRODUCT. . c. IF DELINEATION WAS PE?tFORMED BY A CONSULTr��1T', INCLL�E AL,L DAT.� SHEETS RELEVANT TO TI� PLACEMENI' OF THE DELINEATION LINE: d. �TTACH A COPY OF TI� STORIvIWATER MANAGEMENT PLr��I IF REQLTIRED. e. WHAT IS LAND USE OF SURROUNDING PROPOERTY? RES�O�.�T�A� R�RAL FARM�A�►D � e ; � f. IF APPLICABLE. WHAT IS PROPOSED METHOD OF SEWAGE DISPOS,aL,? N �. SIG�IED AND DATED AGE�I'T AUTHORIZATION LETTER, IF.IPPLICABLE. NOTE: WTLAi�iDS OR WATERS OF TI-� US MAY NOT BE IMPACTED PRIOR T0:__. 1) ISSUANCE OF A SECTION 404 CORPS OF ENGI�'�iEERS PERI�IIT, 2) EITHER'I� ISSUA.NCE OR WAIVER OF A 401 DIVISION OF WATER QU,1L?TY CERTIFICATION, AND 3) (liv T'HE TWENT'Y COAST.AL COUNTIES ONZY), A LETI'ER FRONi THE NORTH CAROLINA ,'�NISION OF COAST.aI. M.��tAGE�i�IT' ST�TPi 1G THE PROPO�ED ACTNITY IS CONSISTE�IT WITH TF-� NORTH C.�.ROLI�i iA COAST.Ai. _ iV1ANAGE.�IENI' PROGR��I, � y - 22-99 OWi�tER'S/AG��I'I" SIGNATURE ►��ovT D�TE (�GEVT'S SIGNATURE VAI.ID ONLY IF AUTHORIZATION LETI'ER FROM TI� OWNER IS PROVIDED). , m 0 `` jF . , � DWQ ID: CORPS �,CTION ID: NATIOIV�VIDE PER�vIIT REQUESTED (PROVIDE NAT'IONWIDE PERl�1IT #) t�1 W P ��l PRE-CONSTRUCTION NOTIFICATION APPLICATION FOR NATIONWIDE PER1ti1ITS THAT REQUIRE: 1) NOTIFTCATION TO TI� CORPS OF ENGINEERS - 2) APPLIC�TTON FOR SECTIOIV 401 CERTIFCATION - 3) COOR.DIN�TION WITH THE NC DMSION OF COASTAi. M��IAGEMENT' SE�1D TF� ORIGPi 1AL r��iD (1) COPY OF THIS COMPLETED FORl�1 TO TF-� APPROPRIr1TE FIELD OF�rTCE OF TF-� COR.PS OF ENGP�tEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (71 COPIES NIUST BE SENT TO THE NC DIVISION OF WATER QUALITY. ATT�: ,JOHN DORNEY. 4401 REEDY CREEK I20�D. R�SLEIGH. NC 27607. PL�ASE PRTi�1T OR TYPE. i. O`V�1�ER'S Nr11V1E: I�S.C. O�PT. DF TCtANSPORTAT�Ot•l 2. VIt1II_.L�iGADDRESS:--___(�.�. �3�x 2Bq S��E� C�z�t 4N.C. 213�►N SUBDMSION Nt�ME CITY: S� � E� C�T K STATE: N. C. ZIP CODE: 2 � 3y �l PROJECT LOCATION r1DDRESS, INCLUDING SUBDIVISION NAIvIE (IF DIFFERENT' FROM MAILING ADDRESS ABOVE): �. TELEPHO�iE NUbfBER: (HOME) (WORK) °►�9 -1H2 - 5 �,yq IF APPLIC.4BLE: .4GENT'S N?uI�IE OR RESPONSIBLE COR.PORATE OFFICIAL, ADDRESS, PHONE NiJMBER: , o.�. Jo�,�so� P.D. �ox 2gq S��.EQ C.-r�t ��.1.e. 2�3yy LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGR�PHIC MAP OR AERIAL PHOTOGRA.PHY WITH SCALE): COU�iTY: C AS�.IE �-�- - NEAREST TOWN: �{ AcvCE � v �►.�� I "f� SPECIFIC LOC�TION (LNCLUDE ROA� NiIMBERS, LAIVDMARKS, ECT.) ����G6 i�p. 32. Da SR \\�D PtCRpSS BE�v-(oN C�'�EK 6. IMPACTED OR �1EAREST STRE.4M/RIVER: a E tvT�wx C REE K RIVER BAS�Y: C APE �EA� 7a. IS PROJECT LOCATED iVE.�R WATER C"LASSIFED AS TROUT, TTDAL S.-�LTWATER, (SA), HIGH QUAL.ITY W.=�TERS (HQW), OUTSTP.��(DING RESOURSE WATERS (ORW), WATER _ SUPPLY (WS-I OR WS-II)? YES ( X) NO ( ) IF YES, EXPLAIN: K(�v.l 7b. IS TF� PROJECT LOC.�TED WITHI��1 A NORTH CAROLINA DNISION OF COASTAL, MANAGEME�i'I' AREA OF EWIROMENT?�L. CONCERN (AEC)? YES ( ) NO ( X j 7c. IF THE PROJECT IS LOCATED WITHII�T A COASTAI. COUNTY (SEE PAGE 7 FOR LIST OF COASTAL COINTIES), WHAT IS TF� Lr1ND USE PLAN (I.UP) DESIGNATI�N? 8a. HAVE AIVY SECTION 404 PERMI'I'S BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROJECT? YES (� NO ( ) IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMIT AND ANY ADDTITONAL IVi FORI�IATION ( INCLUDE PHOTOCOPY OF 401 CERTIFTCATIOI�: SeN-� �-��-99 6�t bN o�c� r�Dann — D�►J R*� 9q�q2y 8b. ARE ADDTI'IONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE? YES ( ) NO (� IF YES, DESCRIBE ANTTCIPATED WORK: 9a. ESTI'Vi IATED TOTr3L NUMBERS OF ACRES IN TRACT OF LAi�1D: 0.02 ACR6S �'I- 9b. ESTID�IATED TOTAL. NUMBER OF ACRES OF WETL.��DS LOCATED ON PR07ECT SITE: t�1oNE 10a. i�IUMBER OF ACRES OF WETL.4NDS INiPACTED BY THE PROPOSED PROJECT BY: J •. FILLING: FLOODING: � DRAINAGE : � ti D D EXCAVATION: • 1 ' n TOT.aL, ACRES TO BE �IPACTED: � lOb. (1) STRE.41�1 CH.��1N"EL TO BE ll�i IPACTED BY THE PROPOSED PROJECT (IF RELOC,�TED, PROVIDE DIST.��iCE BOTH BEFORE AND AFTER RELOCATION: LENGTH BEFORE: �d � FT AFI'ER: S � FI' WIDTH BEFORE (based on normal hiQn water contours): y5 FI' AVER.4GE DEPTH BEFORE: 3.S FI' AFI'ER: 3�5 FI' (2) STRE.�vf CHr1iWi EL �fF.-�CI'S tiVII_L. RESLTL,T FROM: (CHECK ALL THAT ?.�PLI� OPEN CH�NNEL RELOC.�TION CHANNEL EXCAVATION PL.�CE�NT' OF PLPE IN CH��INEL: COONSTRUCTION OF A D.A�l�I1FLOODL�iiG: OTHER: CoNSTRUCT►�N DF A gR�O`E ( 3 Sp�tit oF SD EA�N� 11. IF CONSTRU�TION OF :� POiv'D IS PROPOSED, 'vVFiAT IS THE SIZE OF TI� WF,TERSHED DRAINI'VG TO TT� POND? WH.�T IS THE EXP�.CTED POND SURFACE ARE.A? 12. DISCTIPTION OF PROPOSED �VORK I�i tCLUDING DISCUSSION GF TYFE OF MECH��1ICAi. EQITIPMMEN"NI' TO BE USED? (ATTACH PLANS; 81/2 BY 11 DRAWI��tGS ONLY) aR��C,E 1�EP�ACEMEN'� �nl��cH P� CnREt� S�,A� $R��r�E �3 SPpNS�SO, _ E�v�P �nEN-r WSEa - CRANE �� RACk NoF 13. PURPOSEOFPROPOSEDWORK: REP�qee�cv��NT oF STfZJCTUR�_ C�E���,e�vT �tZ,n�E — 6tz,oc.E e�csEO fl�E �o �a,w�E _ 14. STATE RE:�SONS WHY IT IS BELIEVED TH:1T THIS ACTIVITY �1UST BE C.4RRIED OUT IN WETL?.IVDS ( INCLUDE ANY tifEASURES TAKEN TO MIIVI1�fIZE WETL��iD Il�i 1PACI'S) - � 15. YOU ARE REQUIlZED TO CONTACT TI-� US FISH Ai�iD WILDLIFE SERVICE AND/OR NAT'ION.4L MARINE FISHERIES SERIVE REGARDING THE PRESENCE OF Ai�1Y FEDERALY LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATE�iED SPECIES OR CRITICAL HABITAT IN TF-� PERMIT AREA THAT MAY BE AFFECTED BY TI-� PROPOSED PROJECT. DATE CONTACTED: � -1 �-°l9 16. YOU ARE REQUIlZED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN TF-� PERi�iTT AREA WHICH NIAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED a �4��RV 17. DOES THE PR07ECT i dVOLVE .4��i L�ENDITURE OF PUBLIC FUNDS OT T'r�E USc OF PUBLIC (STATE) LAND? YES ( ) NO (�( )(IF NO, GO TO 16) _ a. IF YES, DOES TF� PROJECT REQUIRE PREPER=�TION OF Ai�t EVVIl20NMENf,�I. DOCUII�NT PURUANI' TO THE REQUIRE?�NI'S OF THE NORTH C.�ROLINA EWIRONI�NI'r1I. POLICY ACT? YES ( ) NO ( ) b. IF YES, HAS TI-� DOCLT�fE�E�1'T BEEN REFIEWED THROUGH Ti� NORTH C.-�ROLINA DEPART'�fE.�IT OF ADMIIVISTRATION STATE CLEr1RINGHOUSc YES ( )�i0 ( ; IF r1i�1SWER 17b IS YES, TF�N SUBMIT APPROPRIATE DUCUI�IENTATIOi�FR0�1 TI� STATc CL� 4RINGHOliSE WITH THE NORTH Cr1ROLIl�iA EWIROi�1ENI'AL POLiCY A�. QUESTIONS REGARDING THE STATE CLE.4RINGHOUSE REVIEW PROCESS SHOUL.D BE DIRECT'ED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH, NORTH C.4ROLINA 27603-8003, T'ELEPHONE (919) 733-6369. 18. THE FOLLOWING TTEMS SHOULD BE INCLUDED WITH THIS APPLICATION IF PROPOSED ACTNITY INVOLVES THE DISCHARGE OF EXC �VATED OF FILL MATERIAL INTO WETLr��iDS: a. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAlI�IS, LAKES; AIv"D PONDS ON THE PROPERTY (FOR NATIONWIDE PERMTT NUy1BERS 14, 18, 21, 26, 29, A1VD 38). ALL STREAM (INTERMITTENT AND PERMANENI') ON TF-� PROPERTY MUST BE SHOWN ON TI� MAP. MAP SCAI.ES SHOULD BE 1 INCH EQUALS �0 FEET OF 1 INCFi EQUALS 160 FEET OF THEIR EQUIVALENT'. b. IF AVAILABLE, REPRESEVTATIVE PHOTOGRAPH OF WETLANDS TO BE �fPACTED BY PRODUCT. c. IF DELINEATTON WAS PERFORMED B�' A CONSULT.,u'�IT, INCLUDE :�L.L D?�T.� SHEETS RELEVANI' TO THE PLACE.TvIENT OF TI� DELINE.4TION LINE: d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PL.1N IF REQLTIRED. e. WHr1T IS LAND USE OF SURROIJNDING PROPOERTY? RES�DEw�T►AL RVRA�- FAP.MIAi.►'p .� IF APPLIC.�.BLE. WHAT IS PROPOSED NiETHOD OF SEWAGE DISPOSAL? N �. SIG�iED AND DATED AGE�i'I' AUTHORIZATION LETTER, IF APPLICABLE. NOTE: WTL.4��iDS OR WATERS OF THE US MAY NOT BE IMPACTED PRIOR TO: _. 1) ISSUANCE OF A SECTTON 404 CORPS OF ENGPi iEERS PERI�IIT, 2) EITHER TI� ISSUf1NCE OR WAIVER OF A 401 DNISION OF WATER QUAL?TY CER'TIFTCATION, AND ' 3) (IN TF-� TWENIY COASTAL COUN`I'IES ONZ.Y), A LETTER FROM Ti-� NORTH CAROLINA DNISION OF COASTAL. M.��iAGE�VT ST.�TPi 1G THE PROPO�ED ACTNITY IS CONSISTEVT WITH TF-� NORTH C.�ROLI'i�i�. COASTAL _ i1�1ANAGE.7VIENI' PROGR�vi, � y - 22-99 OWiVER'S/AGE:VT' SIGNATURE N�oO-t D�TE (�GE.�1'I"S SIGNATUR.E VALID ONLY IF AUTHORIZATION LETTER FROM TI� OW�tER IS PROVIDED). ,� .�,... ,, .� DWQ ID: CORPS ACTION ID: NATION�VIDE PER��fIT REQUESTED (PROVIDE NATIONWIDE PERI�ITT #) N W P �'�l PRE-CONSTRUCTION NOTIFICATION APPLICATION FOR NATIONWIDE PER,�IITS THAT REQUIRE: 1) NOTIFICATION TO THE CORPS OF E1�IGINEERS • ' 2) APPLIC�TTON FOR SECTION 401 CERTIFCATION - 3) COORDINATION WITH TI� NC DMSION OF COASTAL �1.1NAGEMENI' SE�iD TF� ORIGINAL At�ID (1) COPY OF THIS COI�SPLETED FORIvi TO THE APPROPRIr1TE FLELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVE�I (71 COPIES NIUST BE SENT TO THE NC DIVISION OF WATER QUALITY. ATTN: JOHN DORNEY. 4401 REEDY CREEK I20�D. R�SLEIGH. NC 27607. PL�ASE PRINT OR TYPE. 1. OW�'ER'S N?��fE: I�1.C. O�pT. oF TtiA�►SPottTA'��oN 2. MAII..P1iGADDRESS: P.�. gox 2B�i S�LE� C�z�t 4 N.C. 2�3�►N SUBDMSION NA.�IE CITY: S�►.g� �,►T�( STATE: N.C. ZIPCODE: 213y�1 PROJECT LOC�TION r1DDRESS, INCLUDING SUBDMSION NAME (IF DIFFE?2ENT' FROM MAILING ADDRESS ABOVE): �. TELEPHONE NUNLBER: (HOME) (WORK) 9�`� -1'�2 - S 1�y9 4. IF APPLIC.4BLE: AGEN`f'S NP,Iv1E OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS, PHONE NUIvIBER: o.�. J��,�SDN P.D. a�x 2gq 5►�EQ C.-��c �u.e. 2�3yy LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGR�PHIC MAP OR AERIAL PHOTOGRAPHY WITH SC.4LE): COWi TY: C AS�IE `�- - NEAREST TOWN: � AtvCF�! v ���� SPECIFIC LOCATION (INCLUDE ROA_D ��1[IMBERS, LAI�iDMARKS, ECT.) �R�pG6 ND. 32. D� SR �\�� PtCROSS BEN-(oN CCtEEK 6. IMPACTED OR NEAREST STRE.4IvU�tIVER: a E ti�r�.a C 4LEE K RNERBASIN: CAPE �EA(Z 7a. IS PROTECT LOC.4TED N�:�R WATER C-i.ASSIFgD AS TROUT, TIDAL S�.L,TWATER, (S?�), HIGH QUALITY W?.TERS (HQW), OUTST.�'�iDP11G RESOURSE WATERS (ORW), WATER _ SUPPLY (WS-I OR WS-II)? YES ( X) NO ( ) IF YES, EXPLaI'�i 1: KQW 7b. IS TI� PROJECT LOCATED WITHI�t A NORTH C:3ROLINA DNISION OF COASTt�L, MANAGEMENI' AREA OF E�iVIROME`1T?,L CONCERN (AEC)? YES ( ) NO ( X j 7c. IF TF� PROJECT IS LOCATED WITHIN A COASTAI. COUNTY (SEE PAGE 7 FOR LIST OF COASTAL COUi�1TIES), WHAT IS THE LAND USE PLAI�i (LUP) DESIGNATTON? 8a. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROJECT? YES (�} NO ( ) IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMTT AND ANY ADDTI'IONAL INFORI�IATION ( INCLUDE PHOTOCOPY OF 401 CERTIFICATIOI�: SeN,-� a-��-9v g�� bN o►.s� FDann — D�,J C� ''� qq�q2y 8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN TT-� FUTURE? YES ( ) NO (� IF YES, DESCRIBE ANTICIPATED WORK: 9a. ESTII�i IATED TOTAL NUMBERS OF ACRES IN TRACT OF LA1VD:' 0.02. ACR6S }�- 9b. ESTI1�Ii ATED TOTAL NUMBER OF ACRES OF WETL.�'VDS LOCATED ON PROJECT SITE: NOt•�E 10a. NLTMBER OF ACRES OF WETL.ANDS IMPACTED BY THE PROPOSED PRO.TECT BY: FILLING: FLOODING: DRAINAGE �❑ [� � - �i. EXCAVATION: � OTHER: � _ TOTr3L ACRES TO BE IMPACTED: � lOb. (1) STRE��I CH.�'�tN"EL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED, PROVIDE DIST.AI�iCE BOTH BEFORE AND AFI'ER RELOCATION: LENGTH BEFORE: $ D FT qFI'ER; 4� p FT WIDTH BEFORE (based on normal hiQn water con�ours): L\5 FT AVER�GE DEPTH BEFORE: 3.S FT AFI'ER: 3�5 FT (2) STRE.��f CI-ir��Ni EL II�fF.�.CTS tiVII.L, RESIJL,T FROM: (CHECK �i.L TH�T �PLi� OPEN CHANNEL RELOC�TION: PLACE:l�1ENI' OF PIPE IN CHt�,Ii�iEL: CHANiVEL EXCAVATION: COONSTRUCTION QF A DAMIFLOODING: OTHER:_ CcNS7RUCT��I�! D�' A gR�o�F (3Sp��S oF SD EA�N� 11. IF CONSTRUi TIO�t OF A POND IS PROPOSED, 'v�'HAT IS THE SIZE OF Th� W�,TERSHED DRAINING TO TF-� POND? tiVH.AT I� THE EXPECTED POND SURFACE ARE.A? 12. DISCTIPTZON OF PROPOSED �VORK P1ICLUDING DISCUSSION OF TYPE OF MECHr11�TIC.AL EQLTIPMF.��t'T TO BE USED? (ATTACH PLANS; 81/2 BY 11 DRAWNGS ONLi') 9R�oLF REP�ACEnn¢tiT vJ�zti P� C�RF� S�q� �R���E �3 SPAriS@So', E�V�P MENY 41Stip - CRAn�E � RAC� NoF 13. PU'RPOSEOFPROPOSEDWORK: REP�qee�c�n�NT oF STR.JCTURA�I,� �EF�c�c►v�- �R�a�E — �tZ�oc.E C�csEt� S� E �o �a�wRE- 14. STATE RE.�SONS WHY IT IS BELIEVED THAT THIS ACTNITY MUST BE CARRIED OUT IN WETLANDS ( INCLUDE ANY �fEASURES TAKEN TO MININIIZE WETLAIVD Il�i IPACTS) - N � l�. YOU ARE REQUIltED TO CONTACT THE US FISH Ai�iD WII.DLIFE SERVICE AND/OR NATIONAI. MARINE FISHERIES SERNE REG.�RDING THE PRESENCE OF Ai�iY FEDERALY LISTED OR PROPOSED FOR LISTING E�IDANGERED OR THREATE�IED SPECIES OR CRITTCAL HABITAT IN TI-� PERMIT AREA THAT MAY BE AFFECTED BY TI� PROPOSED PROJECT. DATE CONTACTED: S -1 �-°t9 16. YUU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN TF-� PER�v1IT AREA WHICH NIAY BE AFFECT'ED BY TI-� PROPOSED PROJECT. DATE CONTACTED a ���RV . 17. DOES THE PROJECT liNOLVE Ai�1 EXPE�IDITURE OF PUBLIC FUNDS OT THE USE OF PUBLIC (STATE) LAND? YES ( ) NO (�( )(IF NO, GO TO 16) _ a. IF YES, DOES THE PROJECI' REQUIlZE PREPER.4TION.OF A1V E�IVIl20NME\rI'AL DOCUMENI' PURUANT TO THE REQUIlZE�NI'S OF TI� NORTH C.AROLINA E�IVIRONiv�NI'r1L POLICY ACT? YES ( ) NO ( ) b. IF YES. HAS THE DOCLJ1�fE:VT BEEN REFIEWED T'HROUGH THE NORTH C:�ROLINt1 DEPARTVfENI' OF ADi�fII�iISTR�TION STATE CLEARINGHOUSE YES ( ) NO '( j IF r1NSWER 17b IS YES, THEN SUB�IIT APPROPRIATE DUCU1�iEl�t'I'ATI0�0�1 T'n� ST:�TE CLr..4RINGHOUSE WITH THE NORTH Cr1ROLP1 iA E�IVIROi�T�IENI'AL PGi.iCY ACT. QUESTIONS REGARDING'TF� STATE CLE.ARINGHOUSE REVIEW PROCESS SHQULD BE DIRECTED TO MS. CHItYS BAGGETT, DIRECTOR STATE CLE.ARINGHOUSE, NORTH CAROLINA DEPARTMENI' OF ADMINISTRATION, 116 WEST JONES STREET, RALEI�H, NORTH CAROLINA 27603-8003. TELEPHONE (919) 733-6369. 18. TI� FOLLOWING ITEMS SHOULD BE INCLUDED WITH THI5 APPLICATION IF PROPOSED ACTTVITY INVOLVES T'HE DISCHARGE OF EXCAVATED OF FILL MATERIAL Pi 1T0 `VETL��tDS: a. WETLAND DELINEATTON MAP SHOWING ALL WETLANDS, STREAl�IS, LAKES, AIv� PONDS ON T'i� PROPERTY (FOR NATIONWIDE PERMTT NCTMBERS 14, 18, 21, 26, 29, AI�iD 38). ALL STREAM (INTERMITTENT AND PERMANEN'1� ON TI-� PROPERTI' MUST BE SHOWN ON THE MAP. MAP SC�I.ES SHOULD BE 1 INCH EQUALS 50 FEET OF 1 INCH EQUALS 100 FEET OF TF�IR EQUNAI.ENI'. b. IF AVAIL�,BLE, REPRESENI'ATTVE PHOTOGRAPH OF WETL�'VDS TO BE I�iPACTED BY PRODUCT. c. IF DELINEATION WAS PERFORMED BY A CONSULT��1'I', INCLUDE :�L,L DAT.� SHEETS RELEVANT TO TI-� PLACEMENI' OF THE DELINE.4TION LIlVE: d. ATT�CH A COPY OF THE STORMWATER MANAGEMEN'I' PLr�'v IF REQUIltED. e. WH.aT IS LAND USE OF SURROtINDING PROPOERTY? RES��rtw�T►AL RvRA�. FAP.M�A�.►D � f. IF APPLIC.�BLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL,? ' tJ �. SIG�IED AND DATED AGENI' AUTHORIZATION LETTER, IF r�PPLICABLE. NOTE: WTL.4I�IDS OR WATERS OF Ti� US MAY NOT BE L1�IPACTED PRIOR TO:._ 1) ISSUANCE OF A SECTTON 404 CORPS OF ENGPi tEERS PERl'�1IT, 2) EITHER THE ISSUA.NCE OR W,aIVER OF A 401 DMSION OF WATER QUAL?TY CERTIFICATION, AND � 3) (IN THE TWE�ITY COAST.AL COUNTIES ONZ.Y), A LETTER FRON1 TF� NORTH CAROLINA �NISION OF COAST?�I. M.��tAGE�:VT STATPl iG THE PROPO�ED ACTNITY IS CONSISTENI' WITH TF� NORTH C.�ROLI'�i iA COAST.aI. _ �'�1AGE.�vtEN'T PROGR.�'�4, � � - 22-99 OWVER'S/AGE.�IT" SIGNATURE NCD�T D�TE (AGE�IT'S SIGNATURE VALID ONLY IF AUI'HORIZATION LETTER FROM TI-� OWNER IS PROVIDED). ,,� . �r ;a� y DWQ ID: CORPS ACTION ID: NATIOI�VIDE PERtifIT REQUESTED (PROVIDE NATTONWIDE PERVITT #) N W P �`� � PRE-CONSTRUCTION NOTIFICATION APPLICATION FOR NATIONWIDE PER�ti1ITS TH�.T REQUIRE: 1) NOTLF�iCATION TO THE CORPS OF ENGINEERS - 2) APPLIC�TION FOR SECTION 401 CER'I'IFCATTON - 3) COORDIN�,TION WITH TI� NC DMSION OF COAST:�L, tiSr��(AGEVIENI' SE�iD TE� ORIGINAL, :�ti"D (1) COPY OF THIS COMPLETED FOR�'�1 TO Ti� APPROPRIATE FIELD OFFICE OF TF� CORPS OF ENGINEERS (SEE AGEVCY ADDRESSES SHEET). SEVEN (71 COPIES NIUST BE SENT TO THE NC DIVISION OF WATER QUALITY. ATTN: JOI�i t DORNEY. 4401 REEDY CREEK RO�D. RALEIGH. NC 27607. PL�ASE PRINT OR TYPE. i. O��NER'S N:�:�fE: 1�1.C. D�PT. pF TRANSPORTAT�ON 2. Mr1ILL�iGADDRESS: P:�. gox 28�1 S��,EP� C\T`i 4N.C. 213�►H SUBDMSION NP�� CITY: S�►.�R �.�-r� STATE: N.C. ZIPCODE: 2'�3y� PROTECT LOCATION ADDRESS, INCLUDING SUBDIVISION NANfE (IF DIFFE:ZENT' FROM MAII.ING ADDRESS ABOVE): 3. TELEPHO�iE NUNLBER: (HOME) (WORK) `� �9 -�1 H 2- S I� yq 4. IF APPLIC.4BLE: AGEN'T'S N.�.1�IE OR RESPONSIBLE CORPOR.ATE OFFICIAL, ADDRESS, PHONE NUMBER: . � o.�. Jo�,�SoN �;�r�a 5�►.ER C.�� �u.e, 2�3yy 5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGR�PHIC MAP OR AERIAL PHOTOGRAPHY WITH SC.AL:E): ' COWi TY: C AS�.1E `�- - iVE.AREST TOWN: � AcvCE �t v �►.�� ». SPECIFIC LOCATION (LNCLUDE ROA� ��I[IMBERS, L.ANDMARKS, ECT.) I�R�OGC �D. 3,Z. D�j SR ���� PCCRDSS BEti'(oN C(ZreEK 6. IMPACTED OR NEAREST STRE.4�'vf/RIVER: a e N•s�.a C RE E K RNER BASIIV: C APE �EA2 . 7a. IS PROJECT LOCATED N�.�R WATER C'LASSIFiED �S TROUT, TIDr1L S�1i.TW.�TER, (S�), HIGH QUAI.ITY WATERS (HQW), OUTST:INDI�i 1G RESOURSE WATERS (ORW), WATER _ SUPPLY (WS-I OR WS-II)? YES ( X) NO ( ) IF YES, EXPL.�Iiti: N4�r.1 7b. IS TI� PROJECT LOCATED WITHI��t A NORTH C�ROLI'�i iA DIVISION OF COASTAL. MANAGEVIENI' AREA OF E�iVIROMEVTAL. CONCERN (AEC)? YES ( ) NO ( X j 7c. IF THE PROJECT IS LOCATED WITHIN A COASTAL COUNi Y(SEE P?�GE 7 FOR LIST OF COASTAL COUNT�S), WHAT IS THE LAND USE PLAI�i (LUP) DESIGNATION? 8a. HAVE AIYY SECTION 404 PERMI'TS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROJECT? YES (� NO ( ) IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMTT AND ANY ADDTTIONAL riVFORi�IATION ( INCLUDE PHOTOCOPY OF 401 CERTIFTCATIOI�: SeNZ �-��-99 6�i b�.► o►.s� F"�ttnn — D�rJ R*K 99oq24 86. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN THE FUTURE? YES ( ) NO (� IF YES, DESCRIBE ANTICIPATED WORK: 9a. ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LA1�1D: O.O� ACR6S �'�- 9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETL.��1DS LOCATED ON PROJECT SITE: t�1oc�E 10a. NiINIBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PRO7ECT BY: .. FII.LING: FLOODING � L►� DRAINAGE : O EXCAVATION: • � � n TOTAL, ACRES TO BE Il�IPACTED: � lOb. (1) STRE�'�I CH.�'VIVEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOCATED, PROVIDE DISTrli�iCE BOTH BEFORE AND A�TER RELOCATION: LENGTH B EFORE: �d � FI' pF'I'ER; g p �' WIDTH BEFORE (based on normal hiQh water contours): y5 FI' AVERAGE DEPTH BEFORE: 3. S FI' AFTER: 3� 5 �' (2) STRE.��f CH�vNEL �iF.�CTS tiVII.L. RESIJL.T FROM: (CHECK �L,L THAT �PPL� OPEN CH�NNEL RELOC�TION CHANNEL EXCAVATION PL.�CE�NI' OF PLPE I�i 1 CHt�Y�tEL: COONSTRUCTION OF A DA1�1/FLOODING: OTHER: CcNSTR�IC'T��Pi DF A gR�O�E t�3 SPA�S pF SD EA��+\ 11. IF CONSTRU�TION OF � POND IS PROPOSED, W�iAT IS THE SIZE OF Th� WATERSHED DRAINING TO THE POND? WH�,T IS TF� EXPECTED POND SURFACE ARE.A? 12. DISCTIPTION OF PROPOSED �VORK Pi 1CLUDING DISCUSSION GF TYPE OF MECFir1i�TIC.�L. EQiJ�ME��tT TO BE USED? (ATTACH PLANS; 81/2 BY 11 DRAWI�iGS ONLI� gR�o�E REP�AcE►�nEc�T vJ�tti Pti C�REO S�AP� �R���E �3 SPp,HS@So, E�V�P MENY �S&Q - CRAtvE � RAc1� HoE 13. PURPOSE OFPROPOSED WORK: _ REP�Aeec�r�ENT pF STtZ�c.TVRA��� �EF\C�L-N'�- DR\a�E — ��i��(sE C�us t� � E 10 �A�L�RE- 14. STATE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY MUST BE CARRIED OUT IN WETLANDS ( INCLUDE ANY �fEASURES TAKEN TO MIIVIMIZE WETL.4i�iD �iPACTS) - �1 �; l�. YOU ARE REQUII2ED TO CONTACT THE US FISH .Ai�1D WILDLIFE SERVICE AND/OR NATIONAI. MARIlVE FISHERIES SERIVE REGARDING THE PRESENCE OF A1�iY FEDERALY LISTED OR PROPOSED FOR LISTING ENDAi�1GERED OR THREATE�IED SPECIES OR CRITICAL HABITAT IN TI-� PERMIT AR.EA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED: B-.1�-0�9 16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) REGARDING TF-� PRESENCE OF HISTORIC PROPERTIES IN Ti-� PERMIT AREA WHICH Iv1AY BE AFFECTED BY Ti-� PROPOSED PROJECT. I?ATE CONTACTED �-��-aq 17. DOES THE PROJECT lidVOLVE AN EXPE�iDITURE OF PUBI:IC FUNDS OT TF� USE OF PUBLIC (STATE) LAI�iD? YES ( ) NO (�( )(IF NO, GO TO 16) _ a. IF YES, DOES THE PROJECT REQIJIRE PREPER=ITION OF Ai�1 E.�IVIlZONMENT.�,L, DOCUMEVT PURUANT TO TI-� REQUIRE�NI'S OF TI� NORTH CAROLINA Ei�1VIRONME�1'I'r1L POLICY ACT? YES ( ) NO ( ) b. IF YES, HAS TI� DOCLJI-fE��1'I' BEEN REFIEWED TT�tOUGH TH� NORTH C.�ROLINA DEPARTViENT' OF ADivIPt tISTRATION STATE CLEARINGHOUSE YES ( )�i0 ( i IF r��1SWER 17b IS YES, TF�N SUBi�IIT APPROPRiATE DUCU1�fEVTATIONFR0�1 T"riE ST.-�TE CLr..4.RINvHOUSE WITH THE NORTH Ct1ROLIIvA E�iVIROi,11�fENI'AL POi.iCY A�. QUESTIONS REGARDING'I'I� STATE CLEARINGHOUSE REVIEW PROCESS SHQUL.D BE DIRECT'ED TO MS. CHItYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE. NORTH CAROLINA DEPARTMENT OF ADMINISTRATION, 116 WEST JONES STREET, RALEIGH, NORTH C:�ROLINA 27603-8003, TELEPHONE (919) 733-6369. 18. TI� FOLLOWIlVG ITEMS SHOULD BE INCLUDED WITH THIS A.PPLICATION IF PROPOSErJ ACTIVITY INVOLVES Ti-� DISCH�RGE OF EXCAVATED OF FILL MATERIAL INTO WETL��iDS: a. WETLAIVD DELINEATTON MAP SHOWING.ALL WETI.ANDS,.STREA1vIS, LAKES, AIv� PONDS ON THE PROPERTY (FOR NATTONWIDE PERMTT NU�IBERS 14, 18, 21, 26, 29, AND 38). ALL STREAM (INTERMITTENT AND PERMANEN"1� ON THE PROPERTY MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS �0 FEET GF 1 INCH EQUALS 100 FEET OF TI�IR EQUIVAL.ENI'. b. IF AVAILABLE, REPRESEVTATIVE PHOTOGRAPH OF WETLANDS TO BE I�1�fPACTED BY PRODUCT. c. IF DELINEATION WAS PERF'ORMED B�' A CONSULTr�u'v'I', INCLUDE AI.L DAT.� SHEETS RELEVAN`f TO T'i-� PLACEMENT OF T� DELINEATION LINE: d. ATTc1CH A COPY OF TI� STORMWATER MANAGEMENI' PLr1IV IF REQUIlZED. e. WHAT IS LAND USE OF SURROUNDING PROPOERTY? � � � ' � .' ► . ,� IF,�.PPLIC.�BLE. WHAT IS PROPOSED NiETHOD OF SEWAGE DISPOS,�L? g. SIG�IED AND DATED AGENI' AUTHORIZATION LETTER, IF APPLICABLE. NOTE: WTLAi�iDS OR WATERS OF TI� US MAY NOT BE IMPACTED PRIOR TO:_. 1) ISSUANCE OF A SECT'ION 404 CORPS OF ENG�YEERS PERI�IIT, 2) EITHER THE ISSUANCE OR Wr1NER OF A 401 DNISION OF WATER QUAL?TY CERTIFICATION, AND ;) (.N TI-� TWENI'Y COASTAL COUNTIES ON"LY), A LETI'ER FRONi TI� NORTH C�IROLINA DNISION OF COAST?�L. N1�vAGE�iv'I" ST�TPi iG THE PROPO°ED ACTNITY IS CONSISTEVT WIT'ri TF-� NORTH C.�ROLIN�. COASTAL _ i�1ANAGE.�IE�I'T PROGR.�uVf, � � - Z2-99 OWivER'S/AGE.�IT" SIGNATURE wco0�t D�,TE (AGENI"S SIGNATURE VALID ONLY IF AUTHORIZ�TION LETTER FROM TI� OWNER IS PROVIDED). . ='°i �; - � • �� CORPS ACTION ID: NATIOIVtiVIDE PER�ti1IT REQUESTED (PROVIDE NATIONWIDE PERIVII'T #) N W P �`� PRE-CONSTRUCTION NOTIFICATION APPLICATION FOR NATIONWIDE PER,�fITS TH.1T REQUIRE: 1) NOTIFiC�TTON TO TI� CORPS OF ENGINEERS - 2) APPLIC�TION FOR SECTTON 401 CER'I'�'CATION ' 3) COORDI�i 1�TION WITH THE NC DMSION OF COASTAL, �Ir11�1AGEME�IT SE.�iD T� ORIGPi 1AI. r��tD (1) COPY OF THIS COMPLETED FORI�i TO TI� APPROPRIATE FIELD OFrTCE OF T� CORPS OF E�tGI'�i IEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (7) COPIES NIUST BE SENT TO THE NC DIVISION OF WATER QUALITY. ATTN: .TOHN DORNEY. 4401 REEDY CREEK RO�D. RALEIGH. NC 27607. PLEASE PRINT OR TYPE. i. OWNER'SN,�V1E: I�I.C. ��PT, pF' TCtANSP�EtTATtOt�l 2. NIAILL�iGADDRESS: P.�. g�x 28�1 5���� C�i�t *N.C. 213�►H SUBDMSION NA.�fE CITY: S� ��� C�-r � STATE: N. C. ZIP CODE: 2"� 3y PROJECT LOCATION t1DDRESS, INCLUDING SUBDIVISION NAIvIE (IF DIFFERE�1'I' FROM MAILING ADDRESS ABOVE): 3. TELEPHONE N�CTI�iBER: (HOME) (WORK) 91°1--142-51,yq 4. IF A.PPLIC.4BLE: AGENI"S N,�'�1E OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS, PHONE NUMBER: o.�. Jo�,�SoN P.D. 6oY 2 5►�sR C.��t ,u.C. 2�3yy LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF LISGS TOPOGR�PHIC M.AP OR :�..ERL4L PHOTOGRA.PHY WITH SCALE): COWi TY: C AS�1E `�- - i�iEAREST TOWN: �{ AtvCE �! v ���E i �� SPECIFIC LOCATION (INCLUDE ROA� NUMBERS, L��iDMARKS, ECT.) �R��G6 �D. 3Z. �t1 SR �\�� PcCRpSS BEti�(oN CCZ'�EK 6. IMPACTED OR �1EAREST STRE.41�1/RIVER: a e ti-r ��.�, C RE E K RNER BASIN: C APE CrEACt. 7a. IS PRO.TECT LOC�TED N�.�R WATER C-i.ASSIFIED AS TROUT, TIDAL S�L,TWATER, (SA), HIGH QUAI,ITY W�TERS (HQW), OUTST�'VDI�i1G RESOURSE WATERS (ORW), WATER _ SUPPLY (WS-I OR WS-II)? YES ( X) NO ( ) IF YES, EXPL.�I'�i 1: H(�v.1 7b. IS THE PROJECT LOCATED WITHI�i A NORTH CAROLINA DNISION OF COAST.�I. MAIVAGEMEi�1'I' AREA OF E.VVIROMENT�IL. CONCERN (r1EC)? YES ( ) NO ( X j� 7c. IF Ti-� PROJECT IS LOCATED WITHIN A COASTAI. COUNTY (SEE PAGc 7 FOR LIST OF COASTAL COUNTIES), WHAT IS THE LAND USE PL.AI�t (LL'P) DESIGNATTON? 8a. HAVE .A1VY SECTION 404 PERMI'I'S BEEN PREVIOUSLY REQLTESTED FOR USE ON THIS PR07ECT? YES (Jn NO ( ) IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMTT AND ANY ADDTITONAL INFORMATION ( INCLUDE PHOTOCOPY OF 401 CERTIFICATIOI�: SeN-� �-�s-� g�t oN o�c� FD�nn — D�,J R*� qg�q2y 8b. ARE ADDITIONAL PERMIT REQUESTS EXPECTED FOR THIS PROPERTY IN TF� FUTLTRE? YES ( ) NO (� IF YES, DESCRIBE AN'IZCIPATED WORK: 9a. ESTIIVIATED TOTAL. �tU1�IBERS OF ACRES IN TRACT OF LAi�iD: �•02 ACR�S {'�- 9b. ESTIMATED TOTAL, NUMBER OF ACRES OF WETL��IDS LOC�TED ON PRO.TECT SITE: t�1 o N, E 10a. NITNIBER OF ACRES OF WETI..4NDS IMP.ACTED BY THE PROPOSED PROJECT BY: � I r FILLING: FLOODING: , � O D EXCAVATION: � OTHER: DRAINAGE : O _ TOTAL, ACRES TO BE I'�i IPACTED: lOb. (1) STRE.��I CH.��iN�L TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOC.�TED, PROVIDE DISTr��10E BOTH BEFORE AND AFTER RELOCATION: � LENGTH B EFORE: �d � FI' AFZ'ER: $ � F`[' WIDTH BEFORE (based on normal hiQn wacer contours): �-1S FT AVER;IGE DEPTH B EFORE: 3. S FI' AFTER: 3� 5 F"I' (2) STRE.��t CHAi�iEL I�IF.�CTS tiVII..L, RESUL,T FROM: (CHECK A.LL THAT ,�PL� OPEN CH��Ni EL RELOC�TION: PL.�CEI�fENI' OF PLPE LN CH��INEL: CHr1NNEL EXC.�V�TIOti: COONSTRUCTIOti OF A D:�VI/FLOODING: � OTHER: CoNSTRUCT�OtJ DF A �R�O�E ��3 SPAe�t pF SD� EA�N� 11. IF CONSTRU�TION OF � POiv'D IS PROPOSED, `vVI�T IS THE SIZE OF Ti� WATERSHED DRA.INI'�1G TO THE POND? � WHAT IS THE EXPECTED POND SURFACE ARE.A? 12. DISCTIPTTON OF PROPOSED �VORK Pl iCLUDING DISCUSSION OF TYFE OF �CHr1i�iIC.4I.. EQiTIPMMEN'ENT TO BE USED? (ATTACH PLANS; 81/2 BY 11 DRAWI�IGS ONLY) SR�o�F REP�AcE�n¢,.►T �,J�tH p� C�RFO SLAR �R���E �3 SPAHS@So, E���P nnEN-r �SFa — CRANE .� RACx NoE l�. PU'RPOSEOFPROPOSEDWORK: REP�qce�cv�ENT DF STfZUCTURP�_ �Err\C\L-N'r g(�\Dt�rc '— �(i�0(ofc C�DSEC� �vE �o �4���.uR�c - 14. STATE REASONS WHY IT IS BELIEVED TH.�T THIS ACTNITY N1UST BE CARRIED OUT I�i 1 WETLANDS ( INCLUDE ANY �fEASURES TAKEN TO MININIIZE WETL?.i�1�D �1PACTS) - N I5. YOU ARE REQUIl2ED TO CONTACT TI-iE US FISH Ai�iD WILDLIFE SERVICE AND/OR NATION.�1L MARINE FISHERIES SERIVE REGr1RDING THE PRESENCE OF Ai�iY FEDERALY LISTED OR PROPOSED FOR LISTING E�iDANGERED OR THREATE�iED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFECTED BY Ti� PROPOSED PROJECT. DATE CONTACTED: �- 1 �-°1q 16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERI�IIT AREA WHICH NiAY BE AFFECTED BY TI� PROPOSED PR0IECT. DATE CONTACTED � - �4�-qV 17. DOES THE PROJECT liNOLVE AIV EXPENDITURE OF PUBLIC FLNDS OT T'r� USc OF PUBLIC (STATE) L.4ND? YES ( ) NO (�( )(IF NO, GO TO 16) _ ' a. IF YES, DOES THE PROJECI' REQUIIZE PREPERATTON OF A1�1 E�IVIRUNMENT'.�L. DOCUMENT PURUANT TO TI� REQUIIZEMENI'S OF TI-� NORTH C.AROLINA Ei�iVIRONMEN'Tr1L POLICY ACT? YES ( ) NO ( ) b. IF YES, HAS THE DOCLJ1�fENT BEEN REFIEWED THI2OUGH THE NORTH C:�ROLL'�iA DEPART�IENT' OF ADMINISTR�TION STATE CLEARINGHOUSE YES ( ) NO ( i IF r11�tSWER 17b IS YES, THEN SUBi�IIT APPROPRLATE DUCUNfENTATIOivFRO�f T'n'E ST:�Tc CLr..4RINGHOliSE WITH THE NORTH Ct1ROLIIvA E�iVIROiWIEi�1TAL POi.iCY ACi . QUESTIONS REGAR.DING TI� STATE CLEARINGHOUSE REVIEW PROCESS SHOUL.D BE DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLE.4RINGHOUSE. NORTH CAROLI'iVA DEPARTMENT OF A.DNIINISTR.ATION, 116 WEST JONES STREET, RALEIrri, NORTH C.4ROLINA 27603-8003, TELEPHONE (919) 733-6369. 18. TE-� FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS A.PPLICATION IF PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF FILL MATERIAL IIv°I'O WETL�'vDS: a. WETLAI�ID DELINE.ATTON MAP SHOWING ALL WETLANDS, STREAMS, LAKES; AIv� PONDS ON TT� PROPERTY (FOR NATIONWIDE PERMTT NLMBERS 14, 18, 21, 26, 29, AI�1D 38). ALL STREAM (INTERMITTENf AND PERMANEN� ON Ti� PROPERTY MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS �0 FEET GF 1 INCH EQUALS 100 FEET OF TI�IR EQUIVAI.ENT'. b. IF AVAILABLE, REPRESE.VTATNE PHOTOGRAPH OF WETL.4NDS TO BE �fP.�CTED BY PRODUCT. c. IF DELINEATION WAS PERFORMED BY A CONSUI.T.�'vT, INCLUDE ALL DAT.� SHEETS RELEVANT TO TI� PLACEVIENT OF T� DELINEATIOI�i LPi iE: d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIItED. e. WHAT IS LAND USE OF SURROUNDING PROPOERTY? RES�DF,�T�a�. RvitAL FARM�A�lD � IF APPLIC.�BLE. WHAT IS PROPOSED 1�fE7'HOD OF SEWAGE DISPOSAi.? N g. SIG�IED AND DATED AGE1�I'I' AUTHORIZ4TION LETTER, IF APPLICABLE. NOTE: WTLAi�tDS OR WATERS OF TI-� US MAY NOT BE IMPACTED PRIOR TO:_ 1) ISSUANCE OF A SECTION 404 CORPS OF ENG�"EERS PER��fIT, 2) EITHER TI� ISSUA.NCE OR WAIVER OF A 401 DMSION OF WATER QUr1L?TY CERTIFICATION, AND 3) (I'�i i TI� TWENT'Y COASTAL COUNTIES ONLY), A LETTER FROM Ti-� NORTH C,�ROLINA DIVISION OF COAST.�.L, M.��tAGE�i�1'I' STATI'�i 1G THE PROPO°ED ACTNITY IS CONSISTE�IT WITH TF-T� NORTH C.-�ROLIi�iA COASTAL, _ �IANAGE.�NT PROGR�'1�1, \ q - 22-q9 OWiVER'S/AGE_�IT' SIGNATURE H�cO�t DATE (�GEVT'S SIGNATURE VALID-ONLY IF AUTHORI7ATION LETTER FROM THE OWNER IS PROVIDED). � .;. . ,�� D�VQ ID: � �.. CORPS ACT'ION ID: NATION�VIDE PER�ti1IT REQUESTED (PROVIDE NATIONWIDE PER�vITT #) N W P �`� ' PRE-CONSTRUCTION NOTIFICATION APPLICATION FOR NATIONWIDE PERI�IITS THAT REQLTIRE: 1) NOTI�iCATION TO TI� CORPS OF ENGINEERS - 2) APPLIC.�.TTON FOR SECTTON 401 CER'I'IFCATION 3) COORDINATION WITH TE� NC DMSION OF COASTAI. �I,��iAGEMEi�iI' SE�iD THE ORIGPi 1AL r��1D_(1) COPY OF THIS COMPLETED FORI�I TO THE APPROPRIATE FIELD OFFICE OF THE CORPS OF ENGINEERS (SEE AGENCY ADDRESSES SHEET). SEVEN (71 COPIES �IUST BE SENT TO THE NC DIVISION OF WATER QUALITY. ATTN: ,JOHN DORNEY. 4401 REE1�Y CREEK RO�D. RALEIGH. NC 27607. PI.EASE PRINT OR TYPE. l. OW�iER'S N.��1E: tJ.C. D�PS. �F TRA�.►SPoR-cA��o�a 2. �IAILL�iGADDRESS: P.O. 6ox 2Bq S��E� C�z�t }N.C. 213�►M SUBDIVISION Nt�ME CITY: S� ��� C��r �( STAT'E: N. C. ZIP CODE: �"13y 4 PROJECT LOCATION e�.DDRESS, INCLUDING SUBDMSION NAME (IF DIFt�EERENI' FROM MAILING ADDRESS ABOVE): 3. TELEPHONE NUNIBER: (HOME) (WORK) �1�°1-1N2-51�49 4. IF APPLIC.ABLE: AGENT"S N?u� OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS, PHONE NUMBER: o.�. Jo��soN P.D. Qox 2gq S►►.EQ C.-��c . u.e, 2�3ti 5. LOCATION OF WORK (PROVIDE A MAP, PREFERABLY A COPY OF USGS TOPOGR4PHIC MAP OR AERIAL PHOTOGRA.PHY WTl�i SCALE): COUiVTY: C ASv.►E `�- - ivEAREST TOWN: � AcvCE�! v�►.�E SPECIFIC LOC�TION (INCI.UDE ROA� �IIJMBERS, LANDMARKS, ECT.) �R�pGC {�jD. 32. �n1 SR \1D� RCROSS BE�u'(oN CCZ'EEK 6. IMPACTED OR iVE.AREST STRE.�vURNER: P.� E tv�c �.a C RE E K RIVER BASIN: C APE r"EACZ ' 7a. IS PROJECT LOCATED N�AR WATER C"t,ASSI�iED AS TROUT, TTD,�L S.-�LTWATER, (S�), HIGH QUALITY WATERS (HQW), OUTST�'VDI�i iG RESOURSE WATERS (ORW), WATER _ SUPPLY (WS-I OR WS-II)? YES ( X) NO ( ) IF YES, EXPLAII�t: KQ�nI 7b. IS TI� PROJECT LOCATED WITHIN A NORTH CAROLINA DIVISION OF COASTAI. MANAGEMENI' AREA OF E1�iVIROMEVTAI. CONCERN (AEC)? YES ( ) ti0 ( X j 7c. IF THE PROJECT IS LOCATED WITHI'�t A COAST�L. COUNTY (SEE PAGc 7 FOR LIST OF COASTAL COUNTIES), WHAT IS TI� L..��� USE PLAN (LUP) DESIGNATION? 8a. HAVE AI�tY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS PROJECT? YES (� NO ( ) IF YES, PROVIDE ACTION I.D. NUMBER OF PREVIOUS PERMTT AND ANY ADDITIONAL INFORI�IATION ( INCLUDE PHOTOCOPY OF 401 CERTIFICATIOl�: Se�� �-�'3-�1 8�s DN O�ta F-�Rnn — D�r�l C� *K q°1Dq2.y 8b. ARE ADDITTONAL PERMI't REQUESTS EXPECTED FOR THIS PROPERTY IN THE FLTTURE? YES ( ) NO (� IF YES, DESCRIBE Ai�1TICIPATED WORK: 9a. ESTIMATED TOTAL NUMBERS OF ACRES IN TRACT OF LA1VD: O.O� ACRc�s �'�- 9b. ESTIMATED TOTAL NUMBER OF ACRES OF WETLANDS LOCATED ON PROJECT SITE: t�1otiE 10a. NUI�IBER OF ACRES OF WETLANDS IMPACTED BY THE PROPOSED PRO.TECT BY: � �.. FII..LING: FLOODII�iG: DRAII�IAGE � �� + D D EXCAVATION: • 1 • [�7 � TOT.�L, ACRES TO BE IMPACTED: � lOb. (1) STRE�VI CH.��i1VEL TO BE IMPACTED BY THE PROPOSED PROJECT (IF RELOC�TED, PROVIDE DIST��ICE BOTH BEFORE AND AFI'ER RELOC�TTON: LENGTH B EFORE: _ 8 � FT ,�F'I'ER: g � F'T WIDTH BEFORE (based on normal hiQh wa�er contours): y5 FT AVERP.GE DEPTH BEFORE: 3. S FT AFTER: 3� 5 FT (2) STRE��i CHANNEL I�fF.-�CTS `VII.,I. RESUL.T FROM: (CHECK AL.L THAT ,�.�PL� OPE�1 CHANNEL RELOC.�TION CHANNEL EXCAVATION PLACE�NI' OF PIPE IN CH��IEL: COONSTRUCTION OF A D,�WFLOODING: 0 OTI�R: CoHStRV�-r�oca o� A gR�o�F ( 3 SPA�s pF SD EA�t+� 11. IF CONSTRL'�TION OF :� POND IS PROPOSED, WI-iAT IS TI� SIZE OF T�� WA'I�RSHED DRAIlVI�fG TO TI-� POND? WH.�T IS THE EXPECTED POND SURFACE ARE.A? 12. DISCTIPTION OF PROPOSED �VORK LvCLUDING DISCUSSION OF TYPE OF MECHr��iICAL EQIJIPi1��IT TO BE USED? (ATT�CH PLANS; 81/2 BY 11 DRAWPi 1GS ONLI� BR�o�F REP�AcEnnEN't' V.1�TH P� CnREO S4AF� �R��,�. t�E �3 SPANS�l..%S0, E�v.e nnetiT `•1sct� — CRa,.�F � ttacx NoF 13. PURPOSEOFPROPOSEDWORK: REP�qe¢�c�nENT DF ST(LUcTvRA�I,� �EF�c.►c�vT BtZ�a�E — B��oc.E C�usEO � �E �o �ra����F - 14. ST�TE REASONS WHY IT IS BELIEVED THAT THIS ACTIVITY NIUST BE CARRIED OUT IN WETT.ANDS ( INCLUDE ANY I��ASURES TAKEN TO MINIMIZE WETL��iD �IPACTS) - �1 s r �;; * 15. YOU ARE REQUIItED TO CONTACT TI� US FISH AND WILDLIFE SERVICE AND/OR NATIONAI. MARINE FISHERIES SERIVE REGr�RDING THE PRESENCE OF Ai�1Y FEDERALY LISTED OR PROPOSED FOR LISTING E�IDANGERED OR THREATEi�tED SPECIES OR CRITICAL HABITAT IN Ti-� PERMIT AREA THAT MAY BE AFFECTED BY THE PROPOSED PROJECT. DATE CONTACTED: �-12�-°19 16. YOU ARE REQUgtED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) REG.�RDING TF� PRESENCE OF HISTORIC PROPERTIES IN TI� PERi�fIT AREA WHICH MAY BE AFFECTED BY TI� PROPOSED PROTECT. DATE CONTACTED �-14�-Rq . 17. DOES THE PROJECT uNOLVE Ai�i rXPE�TI'URE OF PUBLIC FUI�iDS OT TF� USc OF PUBLIC (STATE) LAIVD? YES ( ) NO (�( )(IF NO, GO TO 16) _ a. IF YES, DOES THE PROJECT REQUIIZE PREPERATION OF AN E.�IVI�20NMENT.�L, DOCUMENI' PURUANT TO TF� REQUIlZE�NI'S OF TI� NORTH CAROLINA EWIRONMENI'AL POLICY ACT? YES ( ) NO ( ) b. IF YES, HAS TF� DOCLTVfE:�i'I' BEEN REFIEWED THROUGH THE NORTH C.4ROLINA DEPAR'IiV1ENI' OF ADivIL'.i1ISTR�TION STATE CLE.ARINGHOUSE YES ( )�i0 ( ) IF r��iSWER 17b IS YES, TF�N SUBiVIIT A.PPROPRIATE DUCU1�iENTAT'IO�YF�O�1 TI� ST:�TE CLr..�RINilHOtiSE WITH THE NORTH CAROLIl�iA E�IVIRONI�IENT'AL POi.iCY ACI'.. QUESTIONS REGARJING'I'I-� STATE CLE.ARINGHOUSE REVIEW PROCESS SHOUL,D BE DIRECTED TO MS. CHRYS BAGGETT, DIRECTOR STATE CLEARINGHOUSE, NORTH CAROLINA DEPARTMENT OF ADMIlVISTR.ATION, 116 WEST JONES STREET, RALEIG'rI, NORTH C.AROLINA 27603-8003, TELEPHONE (919) 733-6369. , 18. TI� FOLLOWING ITEMS SHOULD BE INCLUDED WITH THIS APPLICA'?'ION IF PROPOSED ACTIVITY INVOLVES THE DISCHARGE OF EXCAVATED OF FILL MATERIAL INTO WETLr��TDS: � a. WETLAND DELIlVEATION iv1A.P SHOWING ALL WETLANDS, STRE.4i�15, LAKES, AN� PONDS ON THE PROPERTY (FOR NATIONWIDE PERMTT NUYiBERS 14, 18, 21, 26, 29, A1VD 38). ALL STREr3M (INTERMITTENT AND PERMANENl� ON TF� PROPERTY MUST BE SHOWN ON THE MAP. MAP SCALES SHOULD BE 1 INCH EQUALS �0 FEET OF 1 INC�1 EQUALS 100 FEET OF TI�IR EQUIVAL.ENI'. b. IF AVAII_,ABLE, REPRESEi�1T�TNE PHOTOGRAPH OF WE1Z.4NDS TO BE I��iPACTED BY PRODUCT. c. IF DELINEATION WAS PE:tFORIV�D BY A CONSULTr�u�1'I', INCLUDE AI.L DAT.� SHEETS RELEVANT TO THE PLACEMEiVT OF T'HE DELINEATION LINE: d. ATTACH A COPY OF THE STORMWATER MANAGEMENT PLAN IF REQUIlZED. e. WHAT IS,LAND USE OF SURROLTNDING PROPOERTY? RES �OE,aT �A� �JQLA�. FAP.MI A�►D � r � , ;, � f. IF APPLICABLE. WHAT IS PROPOSED NIETHOD OF SEWAGE DISPOS,�L? �. SIG�IED AND DATED AGEi�I'I' AUTHORIZATION LETTER, IF APPLICABLE. NOTE: WTLANDS OR WATERS OF Ti� US MAY NOT BE IMPACTED PRIOR TO:. 1) ISSUANCE OF A SECTION 404 COR.PS OF ENG��ERS PERI�IIT, 2) EITHER TT-� ISSUA.NCE OR WAIVER OF A 401 DNISION OF WATER QUr1L?TY CERTIF�TCATION, AND 3) (IN THE TWENTY COASTAL COUi�lTIES ONZY), A LETTER FROivi TF� NORTH C�ROLINA DNISION OF COAST?.L, Mt��1AGE�:�1T ST�TING THE PROPO°ED ACTIVITY IS CONSISTEVT WITH T� NORTH C:�ROLINA COAST.�L. _ MANAGEMENI' PROGR��I, � � - �2-99 OW�tER'S/AG��I'I" SIGNATURE N�ooT D,-�T� (AGE�1'I"S SIGNATURE VALID ONLY IF AUTHORIZATION LETTER FROM TF� OWNER IS PROVIDED). IM—�% � � ��r . ;' � � ' '' � -��,� y � . isia � � • �o �oj .m 5 . � �1�l1 � �2 �ix� S � , �� �� � � t� 1 � �� �o � � � � � �� � P3� ° `` 1tL . -18. 'u' RI15 � • � - �» c,°'` �°° ;r�o. �" _ �. `�` d i . � . .e � ° :«1 ,�� is.i .4� , �t;. � � � �;,v y, .. A .6 ' 1 1 . y ` 1]21 1 1 . P�y; �.115 1 . 'O_ 1 > �. � ,l _ Z „3, �. , � ,34, „�. 43 s b \. 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H-«� r1 �h�_'::._ •.l �1- 1 �\Y�■v � 1 �'\ � v',�:r �' ;r ��.ih. .t�; (='=�a � t T`t l� -,.;r\� _r_� '_'T_F`i �:'; „�' l, I � 1 t , �. � . � : , . . : -7 i ,,, _ i _ �� ��;. } . � --r � •; `-, � � : i �, . �� .. '�-! �t ' I .'• : ! _' .:....� I- :: .', :i �: �? ' 7 • �. �,Ii���� L�,`it-`�_1 �. '•y_'"_ ' .. _� � _. " .` . : � ..: . . . . .: . . . . . . ... . ' . . . . �. � . _. _ J c.... - �,. �. . . . .. . WAkRANT NO. 4 3 8�j 2 6 , � ,� �_, .r IF INCORRECT RETURN TO DEPARTMENT OF TRANSPORTATION DATE .l " l 1. CONTROLLER'S OFFICE 4� 8� L� G u-'� 5-;'' + ; PURCHASE , : - irvVOice DATE . oROeR AMOUNT DISCOUNT NETAMOUNT CODE "���, NUMBER � �-�NUMBER � �� � � � i i� J_��_ ��� ur�n �,1r. 'J TOTAL I �; � �' ' - REMARKS: - Y1' L'} 1 L r �.i� J:-1 L 1.'+ rT Y L LT i 1 J. T . *see aevease sioe oF srue Foa eooes- DETACH BEFORE DEPOSITING <.. <; 5, .E,. --. ; 66-1059 �Y �, ,�. -.�p= STATE OF NORTH CARO;LINA ; 531 �`� x �; ,•��� DEPARTMENT OF TRANSPORTATION _ i � z <: RALEIGH NORTH CAROLINA , , , , . �larrant No. �+38326 k. .�... ..w..�•' :�. :._: `: .:. . �V '�PAY`TO ' MO. DAY YR. AMOUNT THE ORDER OF: � :'.Pv.C. L�EPT. %F E�t�J.IRCIdMENT'`_ AND 5 :59° �:.**xxxx��y��n -_�: at�,.T.::;7F�,L;>;.RE5LUF�ES .. ^I:;V�:uIC.t :;CF tc�ATEP. �LAiIT�' r.�- 5.�s P 0.;' B�.� ?�;.,,� , �ALEIGH. :: '�._ :.�b��—��3v -:„ � :: : �r = _, __ � ' p" �� s :�'�' ^ 71i2 :i':�:•� SS �* .1 '� - ''i�� ='�#t r��': _ Y .f _ •�is z r _ztf; _ _ _��' - _s._..._._if='� rt. , PRESENT:70: STATE TREASURER - \` = -- °�i: --: -�'�;?' -'t.� :. _-1«� "_ :6i:t=sei�cie' i��?�-�3�:.� PAYABLE AT PAR THROUGH FEDERAL RESERVE SYSTEM =_= �°^"" i�'4383 26i�' �:053 � L0594�: 5���000���60 Lii■ � {.�_. . . � �:: �-►:- . State �f� fVarth Carolina-: � - �- � ` - Depa.rtm.��t of Envircnment �°� and Natural Resourc�s Division of_Water Qual�ty Jam�s B. Hunt, Jr., Govern�r Biil Holman, Secretary Kerr T. Stevens, Directcr L�.L. Johnson NC DOT PO Box 289 Siler City, NC 27344 Dear Mr. Johnson: RP: Bridae 32 repiacemeTit, Benton Cc?ek Caswell County � DWQ # 990924 � � � � �.:� �� ., . � i• .'.:�` T i �t_ ;, r � _ _ ' �:�'�£� - 5. � ::T_... i . � . .. NORTH CAROLINA DEPARTMENT OF ENV{RONMENT AND NATURAL RESOURCES September 13, 1999 The Division of Waier Quaiity has reviewed your submittai for a 404/40i Permii for hridge repiacemenc at bridge 32 over Benton Creek in Caswell County. Your application was not complete since 1; thc curreat application was not used (see enclosed) 2) a wetland determination was not made, and 3) stream length was nr�t reported. Please provide information regarding the location of your project. This information is needed by DWQ in order for us to decide whether this project is approvable. Please respond with three weeks of tHe date of this letter by sending us the appropriate information. If we do not hear from.you in three weeks, we will assume that you no longer want to pursue this project and we will consider the project as withdrawn.. Please call Mr. John Hennessy of my staff at 919=133-5694 if you have any questions. Unti! this infurrnation is received, I vvill request (by copy of this letter) that the Corps of Engineers place this project on hold. Aiso, the projec[ will be placed on hold for our processing due to incomplete informa[ion (15A NCAC 2H .0�07(a)(4)). Your processing time will begin once we receive a complete application. Sincerely; 7o n R. Uorney W ter Quality Certifi ation Program Attachment cc: Winston-Salem DWQ Regional Office Wilmington Disfrict of Corps of Engineers Ra'teigh Field Office Carps of Engineers •File=l=.op� � Central Files John Hennessy 990924.h1d D;visior, ot Water (�uality • Ncn-Discharge Branch 4401 Reedy Creek Rd., Raleigh, NC,27607 Telephone 919-733-1786 FAX # 733-9959 An Equal Opportunity Affirmative Action Employer • 50% recycled/10% post consumer paper . -� � '.�.. DEM ID: ACTION ID: NATZONWIDE PERMIT REQUESTED (PR�VIDE NATIONWIDE PERMIT �): JOINT FORM FOR NATIONWIDE PERMITS THAT REQUZRE NOTIFICATION TO THE CORPS OF ENGINEERS NATIONWIDE PERMITS THAT REQUIRE APPLICATION FOR SECTION 4Q1 CERTIFIGATION WILMINGTON DISTRICT ENGINEER CORPS OF ENGINEERS DEPARTMENT OF THE ARMY P.O. BOX 1890 WZLMINGTON, NC 28402-1890 ATTN: CESAW-CO-E Telephone (919) 251-4511 WATER QUALITY PLANNING., DIVISION OF ENVIRONMENTAL MANAGEMENT NC DEPARTMENT OF ENVIRONMENT, HEAL , AND NATURAL RESOURCES :.�.•, P.O. BOX 29535 • ,/����'r1 ` 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 MANAGEMENT. PLEASE PRINT. 1. OWNERS NAME: N.C. D2p3r�rit of Transportation � 2. OWNERS ADDRESS: P.O. BOX 289 � ' Siler Citv, N.�. 27344 3. OWNERS PHONE NUMBER (FiQME): NA �woRx�: 919-742-5649 4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIe�L, ADDRESS,;. PHaNE NUMBER: D. L. Johnson P.O. Box 289 Si l�r Cit-�. N.'_'. 27344 5. LOCATION OF WORK (MUST ATTACH MAP). COUNTY: YdSWell NEAREST TOwN OR CSTY: �YanceWille SPECIFIC LOC�TION (ZNCLUDE ROAD NUMBERS, LANDMARKS, ETC.):_ Bridae No. 32 on SR 1100 across Benton �eek 6. NAME OF CLOSEST STREAM/RIVER: Benton �eek � 7. RIVER BASIN: y3T�2 Fear � - 8. IS THIS PROJECT LOCATED IN A WATERSFiED CLASSIFIED AS TROUT,; SA, HQW, ORW., _. - WS I. OR WS II? YES IXj NO [] 9. HAVE ANY ScCTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FO1� USE ON T:iIS _� - PROPERTY? . YES [ ] NO [� J ,: ZF YES, EXPLAIN. 10. ESTIMATED TOTAL NUMHER OF ACRES OF WATERS OF THE U.S., INGLUDIPIG WETLANDS, LOeATED ON PROJECT SITE: Unable to determine at prPSPnt _, . � _ 7/8/92 _. � � .:' -2- I1. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY _ THE PROPOSED PROJECT: . . ... FILLED: DRAINED: FLOODED: EXC�VATED: TOTAL'IMPACTED: 12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS): Bridge replacement with a cored slab bridae (3 �,p n���') 13. PURPOSE OF PROPOSED WORK: Replacement Of structurally deficient bridge. 14. STATE REASONS WHY TFiE AP?LIC�NT BELIEVES THAT THIS ACTIVITY MUST BE CARRIED OUT IN 4JETL�?.NDS. ALSO, NOTE MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS. Unable to determine if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVIC� (USFWS) AND/OR NATZONAL MARINE FISHERIcS ScRVICE (NMFS) REG?�RDING THE PREScNCE OR ANY FEDERALLY LISTED OR PROPOScD FOR LISTING ENDANGERED OR THREATENED � SPECIES OR CRITICAI, HABITAT IN THE PERMIT AREA THAT MAY BE AFFEC:i'D BY.TIiE PROPOSED PROJECT. HAVE YOU DONE SO? YES [X] NO (] � RESPONSES FROM THE USFWS AND/OR N2,L�'S SHOULD BE FORWARDED TO CORPS. 16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC P!ZEScRVATION OFFICER (SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES ZN THr PERMZT AREA WFiIC:i , MAY BE AFFECTED BY THE PROPOSED PRO,TEC'-'? HAVE YOU DONE SO? YES [}(] NO [ j RESPONSE FROM TFiE SHPO SFiOULD BE FORWARDED TO CORPS. 17. ADDITIONAL INFORMATZON REQUIRED BY DEM: A. WETLAND DELINEATION MAP SHOWING ?.LL WET?risNDS, STREriMS, :Ai1D LAi{ES Ot1 THE PROPERTY. B. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPT.? OF WETLANDS TO"BE ZMP�CTED BY - PROJECT. . C. IF DEiINEATIQN WAS PERFORMED HY A CDNSULTANT, INCLUDE ALL DATA SHEETS _, RELEVANT TO THE PLACEMENT OF THE DELINEATSON LINE. ' - D. IF A STORMWATER MANAGEMENT PLAN IS REQIIIRED FaR THZS PROJECT, ATTACH �, COPY. E. WHAT IS LAND USE OF SURROUNDING PROPERTY? ResidentiaT rural farmlanc� F. ZF APPLZCP.BLE, WHAT IS PROPOScD MET:iOD OF SEWAGE DISPOSAL? NA � .. � i� II:I � % • r,.', . . - . • : I , . ., * �. , _ , .. � � ' , ., � .. . . ,.'.�il¢ ;'..�:. � .� i . � � " � � r� - . ;u :� �� . ;.1 � � :. f ,�;�, �, . �l �x ` } ,w ° ` c.l Zk ;ti °, � i . . . . Q .f L1 . _ wt � ., `�� , ��• J' . . . � . . . . ' " ' ,1 �. Q ' . . .. .. . . ' �.- '� � ;. }{ ..lZ ti .. ' . . . ' ' • . { ..y t'1 : :ui �. � ' , . .. - .. t �,y.. *.�� , . . , . .. . . . . �N � ir`t ,;r... � ' A , � . .��� ` � e'' ?u . . �� ,w. �, 1, :o � o_ �.,: s � `.,. . ,, ,� � ;�y �r � Q . . ` t ; F /' . K�,w. . • �� J , , 7t . t 7 A. ,�j' r�� 1 . � . . . N . �� �{ �t, ��f �'� t • ' ' . ' . ' ' ' ' ,'` . ` ' . . . -, ��6�n :�,K � �u . 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"-7 I � t `'< y �' � � � i --f t . i � \ .i� 1. I . `; ! i , , t . �:. . � : `. .,, �` �f�] � .I ".� .. . _. I- � ; <_ <!= I �ti liii'gt�.n:-�1`-� r., A"" , _ , ->.: _ - ........ � DEM ID: ACTION ID: NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT �): JOINT FORM FOR HATIONWIDE PERMITS THAT REQUZRE NOTZFICATION TO THE CORPS OF ENGSNEERS NATIONWIDE PERMITS THAT REQIIIRE APPLZCATION FOR SECTION 4Q1 CERTIFICATION WILMINGTON DISTRICT ENGINEER CORPS OF ENGINEERS DEPARTMENT OF THE ARMY P.O. BOX 1890 WZLMINGTON, NC 28402-1890 ATTN: CESAW-CO-E Telephone (919) 251-4511 WATER QUALITY PLANNING.� DIVISION OF ENVIRONMENTAL.MANAGEMENT NC DEPARTMENT OF ENVIRONMENT, FiEALTH, AND NATURAL RESOURCES P.O. BOX 29535 RALEIGH, NC 27626-0535 ATTN: MR. JOHN DORNEY Telephone (919) 733-5083 ONE (1) COPY OF THTS COMPLETED APPLICATION SHOCTLD BE SENT TO THE CORPS OF ENGSNEERS. SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGcMENT. PLEASE PRINT. 1. OWNERS NAME: N.C. Dep3rtlTlerit of Transportation � 2. OWNERS ADDRESS: P.O. BOX 289 � Siler Citv, N.�. 27344 3. _OWNERS PHONE NUMBER (HOME): NA �woRx�: 919-742-5649 4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS;,, PHONE NUMBER: D. L. Johnson P.O. Box 289 Siler City. N."_ 27344 5. LOCATION OF WORK (MUST ATTACH MAP). COUNTY: �3SWe11 NEAREST TOwN oR CITY: •YaTlcei�Ville SPECIFIC LOC?.TION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.)e_ Bridae No. 32 on SR 1100 across Benton �eek 6. NAME OF CLOSEST STREAM/RIVER: BeritOIl �'eek 7. R2VER BASIN: �dA2 Fear ' -.- 8. IS THIS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROIIT,; SA, FiQW, ORW,, _ - ws z, oR ws zi� YES txl xo �� 9. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USc ON THIS _ •. PROPERTY? YES ( J NO (�r J ;: IF YES. EXPLAIN. 10. ESTZMATED TOTAL NUMBER OF ACRES OF WATERS OF THE U.S., INGLUDING - - WETLANDS, LOCATED ON PROJECT SZTE: Unable to determine at b�Prit . _ 7/8/92 . ;. ,.. . � Qe� 11. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY _ THE PROPOSED PROJECT: . ' - FILLED: DRAINED: � FLOODED: EXCAVATED: TOTAL'IMPACTED: -�- 12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS): Bridge replacement _with a cored slab bridae (3 sgan� la ,�') 13. PURPOSE OF PROPOSED WORK: Replacement Of structurally deficient bridqe. 14. STATE REASONS WHY THE AP?LIC�NT BELIE�IES THAT THIS ACTIVITY MUST BE CARRIED OUT IN WETLANDS. ALSO, NOTE MEASURES TAKEN TO MINIMIZE WETLAND ZMPACTS. Unable to determine if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE (USrWS) AND/OR NATIONAL MARINE FISHERZES SERVICE (NMFS} REG.�RDING TAE PREScNCE OR ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFEC�ED BY.THE PROPOSED PROJECT. HAVE YOU DONE SO? YES [Xj NO ( J � RESPONSES FROM THE USFWS AND/OR N2�LFS SHQULD BE FORWARDED TO CORPS. 16. YOU ARE REQUIRED TO COI�ITACT THE STATE HISTORIC PRESEc'�VATION OFFICER - (SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN THE PERMZT AREA WHICH " MAY BE AFFECTED BY THE PROPOSED PROJECT? HAVE YOU DONE SO? YES (}{] NO [ j RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS. 17. ADDITIONAL ZNFORMF�,TZ�N REQUIRED BY DEM: A. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS,:Pu�iD LP.KES ON THE PROPERTY. B. IF AVAILABLE, REPRESENTATIVE PHQTOGRAPH OF WETLANDS TO"BE IMPACTED BY - PROJECT. , C. IF DELINEAT20N WAS PERFORMED HY A CONSULTANT, INCLUDE ALL DATA SFiEETS __, RELEVANT TO TF� PLACEMENT OF THE DELINEATION LINE. ' � D�. IF A STORMWATER MANAGEMENT P7.AN IS REQUIRED FOR THIS PROJECT, ATTACH �, COPY . � .. E. WHAT ZS LAND USE OF SURROUNDING PROPERTY? ReSld2ritiaT rLlY'al farmlan�3 F. IF APPLICABLE, WHAT IS PROPOSED METFiOD OF SEWAGE DISPOSAL? . 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DEM ID: ACTION ID: , NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #): JOINT FORM FOR NATIONWIDE PERMITS THAT REQUIRE NOTIFZCATION TO THE CORPS OF ENGINEERS NATIONWIDE PERMZTS THAT REQUZRE APPLICATION FOR SECTION 4Q1 CERTIFICATION WILMINGTON DISTRICT ENGINEER CORPS OF ENGINEERS DEPARTMENT OF TFiE ARMY P.O. BOX 1890 WILMINGTON, NC 28402-1890 � ATTN: CESAW-CO-E Telephone (919) 251-4511 WATER QUALITY PLANNING. DIVISZON OF ENVIRONMENTAL.MANAGEMENT NC DEPARTMENT OF ENVIRONMENT, FiEALTFi, 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 MANAGEMENT. PLEASE PRINT. 1. OWNERS rr�E: N.C. Department of Transportation � 2. OWNERS ADDRESS: P•O. BOX 289 � , Siler Citv, N.�. 27344 3. OWNERS PHONE NUMBER (HaME): NA (WORK): 919-742-5649 4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAI., ADDRESS,; PHONE NUMBER: D. L. Johnson P.O. Box 289 Sil� Cit�. N.�_ 27344 5. LOCATION OF WORK.(MUST ATTACH MAP). COUNTY: YdSWell NEAREST TOWN OR CZTY: �Yance�7ville SPECIFIC LOC.�TION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):_ Bridge No. 32 on SR 1100 across Benton �eek 6. NAME OF CLOSEST STREAM/RIVER: B2ritAri '�'eek 7. RZVER BASSN: �at�e Fear ' - 8. IS THIS PROJECT LOCP.TED IN A WATERSHED CLASSIFIED AS TROUT,; SA, FiQW, ORW., _. _ WS I, OR WS II? YES [}{J NO (] 9. HAVE ANY SECTION 404 PERMITS HEEN PREVIOUSLY REQUESTED FO1x US^c ON THIS _ • PROPERTY? YES [ J NO (�.J IF YES, EXPLAIN. 10. ESTIMATED TOTAL NUMBER OF ACRES OF WATERS OF THE U_.5., INCLUDING ,•, WETLANDS, LOCATED ON PROJECT SITE: Unable to det�rmine at p_re�Pn+- 7/$/92 ,. � : .. : -2- . 11. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY _ THE PROPOSED PROJECT: . . .. FILLED: DRAINED: FLOODED: EXCAVATED: TOTAL' IMPACTED : -(1- 12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS): Bridge replacement with a cored slab bridae (3 spar�(� 5n') 13. PURPOSE OF PROPOSED WORK: ReplacemP_nt of structurally deficient bridge. 14. STATE REASONS WHY THE AP?7.IC�NT BELIEVES THAT THIS ACTIVITY MUST BE CARRIED OUT IN WETL�NDS. ALSO, NOTE.MEASURES TAKEN TO MINIMIZE FIETLAND IMPACTS. Unable to deterrr�ne if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOCT ARE REQUIRED TO CONTACT THE U.S. FISFI AND WILDLIrE SERVICE (UScWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) REG.�RDING THE PRESENCE OR ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFEC;y'D BY.THE PROPOSED PROJECT. HAVE YOU DONE SO? YES [X] NO ( J � RESPONSES FROM THE USFWS AND/OR Nt�LFS SHQULD BE FORWARDED TO CORPS. 16. YOL7 ARE REQUIRED TO CONTACT THE STATE HISTORIC PREScRVATION OFFICER (SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN TFiE PERMIT AREA WHIC:i ". MAY BE AFFECTED BY THE PROPOSED PROJECT? HAVE YOU DONE SO? YES [}{] NO ( J RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS. 17. ADDITIONAL INFORMATION REQUZRED BY DEM: A. WETLAND DELINEATION MAP SHOWING ALL WETL.�,NDS, STR�AMS,:AND LAKES ON THE PROPERTY. B. IF AVAILABLE, REPRESENTATIVE PHQTOGRAP.Ti OF WETLANDS TO'BE IMP�CTED BY - PROJECT. , C. IF DELINEATION WAS PFRFORMED HY A CONSULTANT, INCLIJDE ALL DATA SHEETS _, .. RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE. ' " D: IF A STORMWATER MANAGEMENT PLAN IS REQUIRED FaR TFiIS PROJECT, ATTACH �, COPY. � E. WHAT ZS LAND U5E OF SURROUNDING PROPERTY? ResidentiaT naral fa_rmlan�7 F. IF APPLICABLE, WHAT IS PROPOSED METHaD OF SEWAGE DISPOSAL? . NA � l r� II.'.I � . . � � �.�.� . � . . ��_ , � ��. , r . ' _ ;I' � ;� � �• ;� 1. ' _ ,k '•� W� .. Mr`.� � � ' . � 4 .:� � � . 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'� � ' ��} � •., • .'ti � � � �,:_C O\I�1�4".-! �'�@t � �-�=" ,v � �= � �; t �" ' -�-3.— �"_'�1' �• i r : � � , ' � ;y 1 � \ � ._. r� .� C.' � Lt � � :� �ic �� fT � �� �_-ti1r� _ '�� � ' .•': '� � �' � � �� .1 r'� i � �.� l�-`', y�T'�rv. r I I 1 `'r '�l'�-�-t`�.:� � "^ �' . �� �� 1 � �'I; i ,\� .� �j ,I . � r t._� � I �.- �' i ',�Ci '`� l, ti'�" 1 \ ] . .-'T'Y�'Tt�� �� �r� �' � `` � I � a� : . •• I .�. �� -� .. . `. � .. _? �� •( �.i..�, I. ;� .�y �1ii',�.1�'.`it:_. .-!. !., . '� a� _ . ' �. . , . � Y DEM ID: ' ACTION ID: NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #): JOINT FORM FOR HATZONWIDE PERMITS THAT REQUZRE NOTIFICATION TO THE CORPS OF ENGINEERS NATIONWIDE PERMITS THAT REQUIRE APPLICATION FOR SECTION 4Q1 CERTIFICATION WZLMINGTON DISTRICT ENGINEER CORPS OF ENGINEERS DEPART.'�SENT 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 RALEZGH, NC 27626-0535 ATTN: MR. JOHN DORNEY Telephone (919) 733-5083 ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS aF ENGINEERS. SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGcMENT. PLEASE PRINT. 1. owrrERS rr�: N.C. Department of Transportation � 2. OWNERS ADDRESS: P.O. BOX 289 ' , --- _ Siler City, N.�. 27344 . 3. OWNERS PHONE NUMBER (HOME): NA (WORK): 9I9-742-5649 - 4. IF APPLICABL�: AGENT'S NAME OR RESPONSZBLE CORPORATE OFFICIeiL, ADDRESS,, PHONE NUMBER: D. L. Johnson P.O. Box 289 Si 1_r Ci y. N. �. 27�44 5. LOCATION OF WORK (MUST ATTACfi MAPj. COUNTY: :dSW@11 NEAREST TOWN OR CZTY: �YanceWille SPECIFIC LOC�TION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):_ Bridqe No. 32 on SR 1100 across Benton �eek 6. NAME OF CLOSEST STREAM/RIVER: B2ri'tOri �'A2}C ' - 7. RIVER BASIN: ydA2 Fectr ' -,- 8. IS TFiIS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROII2,; SA, FiQW, ORW_, -..- WS I, OR WS II? YES (}{ J NO [ J 9. HAVE ANY ScCTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOEr.USE ON THIS _ . PROPERTY? YES [ j NO [�J . >, IF YES, EXPLAIN. 10. ESTIMATED T�TAL NUMBER OF ACRES OF WATERS OF THE U_.5., INCLUDZNG WETLANDS, LOC�TED ON PROJECT SITE: Unable to determine a�prP�Prit , . 7/8/92 , �:: g -2- " I1. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY _ THE PROPOSED PROJECT: . . FILLED: DRAINED: . FLOODED: EXC�VATED: TOTAL' IMPACTED : -(1- 12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS): Bridge replacement with a cored slab bridae (3 s�an� (a 50�� 13. PURPoSE OF PROPOSED WORK: Replacement of structurally deficient bridge. 14. STATE REASONS WHY THE APPLICANT BELIEVES THAT THIS ACTIVITY MUST BE CARRIED OUT IN WETL�NDS. ALSO, NOTE.MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS. Unable to determine if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICF. (USrWS) AND/OR NATIONAL MARINE FISHERZES SERVICE (NMFS} REGaRDZNG THE PREScNCc OR ANY FEDERALLY LISTED OR PROPOSED FOR LZSTING ENDANGERED �R THREATENED SPECIES OR CRZTICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFEC:r'D BY.THE PROPOSED PROJECT. HAVE YOU DONE SO? YES [X] NO ( J "� RESPONSES FROM TXE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS. 16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC P?tESERVATION OFFICER - (SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN � PERMIT AREA WHICH MAY BE AFFECTED BY THE PRaPOSED PROSECT? HAVE YOU DONE SO? YES [}{j NO (] RESPONSE FROM THE SHPO SHOULD HE FORWARDED TO CORPS. 17. ADDITIONAL INFORMATION REQUIRED BY DEM: A. WETLAND DELINEATZON MAP SAOWING ALL WETLiiNDS, STREAMS,:P.ND Le�KES �N THE PROPERTY. B. IF AVAILABLE, REPitESENTATIVE PHQTOGRAPi? OF WETLANDS TO"HE IbLD�CTED BY • PRaJECT_ � , C. IF DELINEATION WAS PERFORMED SY A CONSULTANT, INCLUDE ALL DATA SHEETS _, .. RELEVANT TO THE PLACEMENT OF THE DELINEATZON LINE. ' D. IF A STORMWATER MANAGEMENT PT..,AN IS REQUIRED FOR THIS PROJECT, ATTACH �, COPY. E. WHAT IS LAND USE oF SURROUNDING PRoPERTY? Residential naral farmlanc� F. IF APPLICABLE, WHAT ZS PROPOSED METHOD OF SEWAGE DISPOSAL? NA � � .. � i� II : � i = � • rr�• �• w - � - ' � � � . ;,1.' • E . - ^:�, '�: . � �' � 1 .. , Y �� � �` � . . � . � , . S ° {i �. � � . . � N �' � O .,( x . � } . . � . .. . . �� � � �., �� . � , � . . . o . . . � fl � O ; �� . . . .. a ,F c,i L� � „ " �. � w� �� Q r <�� ��. :� .:2 ti s �. ..y- —.j . . . ' — ,�H i6, r+�� �' �t 4 �}, _..A' I r. - tu µ� � .,� j . � _ � f.}� �?w,,. 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I _ �-'- ��i---�� - r-�-, _a � - _ - -- _ _ I r�,� r' _ � i� . - � � - _ _ _ _ _ �_ _ _ ' �- + \ `� -' -- � �� -- ,����� � ` _ _ � � _ _ _ �<-.,. I , _ � n. T _ _ .l � �:r--- - � . _ . i .. - � )r � - -- � - � � ---- � '' �� i ... �. :" 1��� // i/ �I I `I� \ _T_ .( �R /,._.�-.. . L - • _ �,Z Z�-i� -_ � __ __ � �.�`s.�:,. ---'=-+c�./ 1t ��� � � ' , `---!�-l_:_—_ '; � � ;�.-� / � _ �r ' �� ' i i _ ^ ��`. �� �� `/' _'—�i 1_-fil � V 4 �;�. `! >. � � _ 1 -``� ..,'�-r' ' i �� � :�.1 . � a�� � % I i �.. � f.y' ��__.,� � •'',.'" : `� _ . � *'_y�. �� �\ , i I�.�� _�' ._ ' � ±..... "'I. .�. >� � il -�S- �1.:." � � I � � � `�. J _�� 1 --_ � _ .�._ �.. T � (� � �/ 1 . . .... �.. T� � r T_ . _t \ i I : OQ ./+. �� ��i' f-ti . .! � 1 ' �� � ' F 5 T..+._ `, i � � �`.. � 1 � '"- �� • %.'NCrv1` . '-r;`+ , :c,-I �\ � l � �-+ r_� � � `i� �-+ � � : �-- .i,-.-T'^ i ' 4_.-- —� t ;-; 1 i �i� \�� � -ri, c� � � � � J, Lr: r ... . �, . . � ,�"� . -L— ,.`\--�t <';\� �� -�,; �,.�1 -! --- �;; -_ ' " `„� r . ' � - � ..��� s� - �_ r � � � / . � �; �i ; r� � � t � I . .� '�, , �.-- � . ..�,` , -„ a �.._c o�n-��+� .k , , ��- -� � {_ �� � V, _. � - �_' , , �_ �\ .:� ���,, �. \ +� .�--J��) S C.'' 1 W ���`., �r.,�_�.,•"'x �� i;,`S�' �l�-r'f-� - i� ��-.�.�r.�_,r�� �'a i � . . �� ..,\ �. � � _•' . u ' . f_". •�7J �i.' �i `� l� `,- Y i ���'y I I 'r� j' �i i . �_' �'r` ;t �,� � �� ;, .� �,�._ , : : ;. � r ,`� w R i � r f .. I ! ,ti � � . I f , � . _`` f _� , :, ( . . , r �' . : �. � t � \ , . ^� . ��, i' � ^,� �, � I . . ` , `•' ' . . .• : , � .•' � ; • '• ; ": _ I � " ,- j ti- �:i .�iii`g!.tv.�It:— -11' a . . . � _ _ ,.. . _. - , . M � DEM ID: ACTION ID: NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #): JOINT FORM FOR NIATIONWIDE PERMITS THAT REQUIRE NOTIFICATION TO THE CORPS OF ENGINEERS NATIONWIDE PERMITS THAT REQUIRE APPLICATION FOR SECTION 4Q1 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 DEPART.'�SENT OF ENVIRONMENT, HFALTFi, AND NATURAL RESOURC�S P.O. BOX 29535 RALEIGH, NC 27626-0535 ATTN: MR. JOHN DORNEY Teleohone (919) 733-5083 ONE (1) COPY OF THT_S COMPLETED APPLICATION S'riOULD BE SENT TO THE CORPS OF ENGINEERS. SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT. PLEASE PRINT. 1. OWNERS rr�: N.C. DepartmP�t of Transportation � 2. OWNERS ADDRESS: P•O. BOX 289 ' --- ; Siler Citv. N.�. 27344 � 3. OWNERS PHONE NUMBER (HOME): NA (WORK): 919-742-5649 4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS;. PHaNE NUMBER: D. L. Johnson P.O. Box 289 Si l�r City. N.''_ 27344 5. LOCATION OF WORK (MUST ATTACH MAP). COUNTY: YdSWell � NEAREST TOWN OR CZTY: �Yancewille SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):_ Bridqe No. 32 on SR 1100 across Benton �eek 6. NAME OF CLOSEST STREAM/RSVER: Benton '�'eek 7. R2VER BASIN: �pe Fear � -.- 8. IS THIS PROJECT LOCATED IN A WATERSHED CLASSZFIED AS TROUT„ SA, HQW, ORW., _ __ WS I. OR WS ZI? YES IX] I�IO [ j 9. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOFt USc ON T:iIS _ .. PROPERTY? YES [ J NO (� ] ;: IF YES, EXPLAIIV. 10. ESTZMATED TOTAL NUMBER OF ACRES OF WATERS OF THE U..S., INCLUDING - � WETLANDS, LOCATED ON PROJECT SITE: Unable to det�rmine at UreGPnt , _ 7/8/92 . , e:.. 0 -2- ' 11. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY , THE PROPOSED PROJECT: .. . .. FILLED: DRAINED: FLOODED: EXC�VATED: � TOTAL'IMPACTED: -�- 12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS): Bridge replacemPalt with a cored slab bridae (3 Gpan� (a �0' ) 13. PURPOSE OF PROPOSED WORK: Replacement of structurally deficient bridge. 14. STATE REASONS WHY THE APPLICP.NT BELIEVES THAT THIS ACTIVITY MUST BE CARRIED OIIT IN WETL�NDS. ALSO, NOTE MEASURES TAKEN TO MINIMIZE FTETLAND IMPACTS. Unable to determ�ne if wetlands are present, all efforts will be provided to minimize off-site erosion. � 15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE (UScWS) AND/OR NATIONAL MARINE FISHERZES ScRVICE (NMFS} REG.�RD2NG THE PREScNCE OR ANY FEDERALLY LISTED OR PROPOScD FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFEC':ED BY.THE -' PROPOSED PRaJECT. HAVE YQU DONE SO? YES [X] NO (•J , RESPONScS FROM THE USFWS AND/OR NM�S SHQULD BE FORWARDED TO CORPS. 16. YOLT ARE REQUIRED TO CONTACT THE STAT� HISTORIC PRESERVATION OFFICER ( SFiPO ) REG.�.RDING THE PRESENCE OF HZSTORIC PROP�'RTIES IN THy PERMIT AREA WHIC:i MAY BE AFFECTED BY THE PROPOSED PRO,TECT? HAVE YOU DONE SO? YES [}{] NO [] RESPONSE FROM THE SAPO SHQULD BE FORWARDED TO CORPS. 17. ADDITZONAL INFORMATION REQUIRED BY DEM: A. WETLAND DELINEATION MAP SHOWING ALL WETLe�NDS, STREIMS,:AND Lr'1FCES ON THE PROPERTY. B. IF AVAILABLE, REPRESENTATIVE PHQTOGRP.PTi OF WETLANDS TO"BE IMPACT�'D BY PROJECT. C. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SFiEETS _, .. RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE. ` ` D. ZF A STORMWATER MANAGEMENT P_T.AN IS REQUIRED FOR THIS PRaJECT, ATTACFi �, COPY. , E. WHAT ZS LAIVD QSE OF SURROUNDING PROPERTY? ResidelltiaT �al f�rmlanc� F. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? NA , 8-1�- aWNER'S SI ATURE DATE . ;;�, _ - - :.. _ � . , :�:: : _ ,fi ._ , � ; ,�¢ , - ��� �� , . . � �;_ :��: � � � .. � - 'Y � M� .''.. _ . . . " . . ° ri � , � _ . ' v� ` �. � ' � � ! rG . � � } . � � ; . � a w o . . .o. . � ., . ��p (L � � � . ., I . . . . � .. a r, I• L� �.nat '�W .. ' � . � ' ' � .�.� F J 1 � .:Q�. ti ,. . .. .. . . , • 5i �c�r '� ,,N I , ' s, i Cc It �k q , . , . . - �k 1:� , tU ' . ' . t� ,� j � ,� � `� �' �<.. s c, -y . � . �,• � �, � `� .4 ' #;t: '� ; `f . r ..i <..b� � y �O � . 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DEM ID: ACTION ID: NATIONWZDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT �): JOINT FORM FOR AiATIONWIDE PERMITS THAT REQUIRE NOTZFZCATION TO THE CORPS OF ENGINEERS NATIONWIDE PERMITS THAT REQUIRE APPLICATION FOR SECTION 4Q1 CERTIFICATION WILMINGTON DISTRICT ENGINEER CORPS OF ENGINEERS DEPARTMENT OF TFiE ARMY P.O. BOX 1890 WILMINGTON, NC 28402-1890 ATTN: CESAW-CO-E Telephone.(919) 251-4511 WATER QUALITY PLANNING.� DIVISIaN aF 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 TFiIS COMPLETED APPLICATION SiiOULD BE SENT TO T:iE CORPS OF ENGINEERS. SEVEN {7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT. PLEASE PRINT. 1. owrrE:ts rr� : N. C. Department of Transportation � 2. OWNERS ADDRESS: P.O. BOX 289 � Siler Citv, N.�. 27344 3. OWNERS PHONE NUMBER (HOME): NA (WORK): 919-742-5649 4. IF APPLICABLE: AGENT'S NAME OR RES20NSIBLE CORPORATE,OFFICIAL, ADDRESS,, PHONE NUMBER: D. L. Johnson P.O. Box 289 Si 1�r Ci t��, N. �. 27344 5. LOCATION OF WORK (MUST ATTACH MAP). COUNTY: :;aswell NEAREST TOWN OR CITY: •YanceWille SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):_ Bridge No. 32 on SR 1100 across Benton ',�eek 6. NAME OF CLOSEST STREAM/RIVER: BentOA �eek 7. RZVER BASIN: yciTX' Fear � -.- 8. IS THZS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROU2,; SA, HQW, ORW., _ _.._ WS I, OR WS ZI? YES [ j� ] NO [] 9. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FaR.USE ON T:iIS . - PROPERTY? YES [ ] NO (xr ] ;,: >, IF YES, EXPLAIN. 10. ESTIMATED TOTAL NUMBER OF ACRES OF WATERS OF THE U..S., INCLUDING. WETLANDS, LOCATED ON PROJECT SITE: Unable to determine at presPnt- . 7/8/92 , ��� .. .. i�:,: . :. _ .. _ . . . ... ' ..g ':- r�� 11. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY THE PROPOSED PROJECT: .. FILLED: DRAINED: FLOODED: EXCAVATED: TOTAL'IMPACTED: -�- 12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS): Bridge replacement with a cored slab bridae (3 s��n� (a �0�) 13. PURPOSE oF PROPOSED woRK: Replacement of structurally deficient bridge. 14. STATE REASONS WHY THE APPLICANT BELI�VES THAT THIS ACTIVITY MUST BE CARRIED OUT IN.WETLaNDS. ALSO, NOTE.MEASURES TAKEN TO MINIMIZE FIETLAND IMPACTS. Unable to determine if wetlands are present, all efforts will be provided to minimize off-site erosion. T5. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SE.�VICE (US'rWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) REG.iRDZNG THE PREScNCE , OR ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFF'CTED BY.TFiE PROPOSED PROJECT. HAVE YOU DONE SO? YES [X] NO (] RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO COR?S. 16. YOU ARE REQUIRED TO CONTACT THE STP.TE HISTORIC PREScRVATION OFFICER (SHPO) REGARDZNG THE PRESENCE OF HISTORIC PROP�'RTIES IN THr PERMIT AREA WHICH MAY BE AFFECTED BY THE PROPaSED PRaJECT? HAVE YOU DONE SO? YES [}{J NO ( j RESPONSE FROM THE SFiPO SHOULD BE FORWARDED TO CORPS. 17. ADDITZONAL INFORMATION REQUIRED BY DEM: A. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS,:Ai1D LAFCES GN THE PROPERTY. B. IF AVAILABLE, REPRESENTATIVE PHOTOGZAPH OF WETLANDS TO"BE I2LDACT_�'D gy PRaJECT. C. IF DELINEATION WAS PERFORMED SY A CONSULTANT, INCLUDE ALL DATA SiiEETS _, RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE. ' � D. ZF A STORMWATER MANAGEMENT PLAN IS REQUIRED FOR THIS PROJECT, ATT�CH �, - COPY. E. WHAT IS LAND USE OF SURROUNDING PROPERTY? Residential rural farmland F. IF APPLICABLE, WHAT IS PROPOSED METHaD OF SEWAGE DISPOSAL? NA . $-1�- OWNER'S SZ ATURE DATE ,� ! - -��.-� - . , - �:� _ - . � ;� fi � . � , _ .:.,.: , � - ;'; a � , � : _�- '1 , - . 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', `.. �_•T \ _�,f "`�`+1 �svl � r . � t�. K�� � F / _ . � i`� � � ! ± � ��i�`� . i '!`� L„ . F �� ? �� I .', ;� �. _.� � �`` � M � � 7't' � 1 � T"-� r �3T' `T � ' r . � V i kP . �, � .� � �. �t_ t ;.. L` _i J �i�f'�L. �� �J�y� ^';�ti --� � �- , I � i - „ _�---- . . , "�' ; � � '�w -; r � 11 ; � • �,..� . ., �� ' " �_ - ' �y_'�I-�. '•, � � \ ti` ' 't r ��� ; '` �._� O ! 1 '�81'7.`'� y , �'�. �� �'. } `'' - i _�''-_--I � � .'= � ' , - ' '- \ `•� �- �' �l � ' � �� _ �i, �' �-- ��`�-..�''� .•X � .t__�i� � �= %f= I -; 1I ;_.,ii—�- r:.--y:^�. �� i ' ••'. , .. , . - ,:," ` N, �'` � + �- .- � :,� �.r � ..�=' •, ;'. `� •i ,�-y11 $ ,1 � , " 6 •. , , ,, i --� . � �- .- , i � „ _ � F . I �(' �'� 1- : -i I ' �� , i.l --i- ��" L,,: fi �' � � � �. `. � i \�-. --I� r�� i � i;�i :.'�" ;� l � , I . � t � . ��, � _. `�- = ' ._ , �� � - � ' �"i� I12T'g �Q'.�Il �•_1 I.^ r -.. _ . .. . »� • - DEM ID: ACTION ID: NATIONWZDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT �): JOINT FORM FOR PIATIONWZDE PERMZTS THAT REQUIRE NOTIFICATION TO THE CORPS OF ENGINEERS NATIONWIDE PERMITS THAT REQUIRE APPLICATION FOR SECTION 4Q1 CERTZFICATION WZLMZNGTON 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 RESOURC�S P.O. BOX 29535 RALEIGS, 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 SHOCTLD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT. PLEASE PRINT. 1. owrrERS rr� : N. C. Department of Transportation � 2. OWNERS ADDRESS: P.O. BOX 289 � :--- ;. Siler Citv, N.�. 27344 3. OWNERS PHONE NUMBER (HOME): NA (WORK): 919-742-5649 -� 4. IF APPLICABLE: AGcNT'S NAME OR RESPONSIBLE CORPORATE OFFICIAI., ADDRESS;, PHONE NUMBER: D. L. Johnson P.O. Box 289 �i l�r Cit,y, N_''_ �7344 5. LOCATION OF WORK (MUST ATTACFi MAP). COUNTY: �dSW211 NEAREST TOwN OR CZTY: �Yance�lville SPECIFIC LOCATION (ZNCLUDE ROAD NUMBERS, LANDMARKS, ETC.):_ Bridge No. 32 on SR 1100 across Benton �eek , 6. NAME OF CZOSEST STREAM/RZVER: BP_71'tOri �2A}C 7. RI.VER BASIN: �dpe Fear � - 8. IS THIS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROUT,; SA, HQW, ORW., _. - WS I. OR WS II? YES IXJ N� � � 9. HAVE ANY ScCTION 404 PERMITS HEEN PREVIOUSLY REQUESTED FOR USc^, ON T:iIS _ � PROPERTY? YES [ j NO [x. J . ;, ;: IF YES, EXPLAIN. 10. ESTZMATED TOTAL NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING -• WETLANDS, LOCATED ON PROJECT SITE: Unable to determine at l�rP�Pnt _, . . 7/8/92 f :::; _ - ,. � e. , _ �'� I1. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY THE PROPOSED PROJECT: . ' FILLED: DRAINED: FLOODED: EXCAVATED: � TOTAL' IMPACTED : -fl- 12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS): Bridge replacemPazt with a cored slab bridae (3 sp n�2 Sn') 13. PURPOSE OF PROPOSED WORK: ReplacemPxit of structurally deficient bridqe. 14. STATE REASONS WHY THE APPLICANT BELIEVES THAT THIS ACTIVITY MUST BE CARRIED OUT IN WETI.�NDS. ALSO, NOTE MEASURES TAKEN TO MINIMIZE F7ETLAND IMPACTS. Unable to determ�ne if wetlands are present, all efforts will be provided to minimize off-site erosion. T5. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIcE SE.RVIC� (USrWS) AND/OR NATIONAL MARINE FISHERZES ScRVICE (NMFS) REG�IRDING THE PRESENCE OR ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED OR TFiREATENED SPECIES OR CRZTICAI. HABITAT IN THE P�'RMIT AREA THAT MAY BE AFFEC:'�'D BY. THE PROPOSED PROJECT. HAVE YOU DONE SO? YES [XJ NO [] RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS. 16. YOII ARE REQUIRED TO CONTACT TAE STATE HZSTORIC PRESeRVATION OFFICER (SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN TFiE PERMIT AREA WHIC:i . MAY BE AFFECTED BY THE PROPOSED PROJECT? FiAVE YOU DONE SO? YES [}{ ] NO ( J RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS. 17. ADDITIONAL INFOF2MATION REQUIRED BY DEM: - A. WETLAND DELINEATION MAP SHOWING ALL WETL.�YDS, STREAMS, A,YD LAFCES ON THE PROPERTY. B. IF AVAILABLE, REPRESENTATIVE P??OTOGRAPH OF WETLANDS TO"BE IMD�CTED BY • PROJECT_ . C. IF DELINEATI�N WAS PERFORMED EY 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? Residential rural farmlanc� F. IF APPLIC�BLE, WHAT IS PROPOScD METHaD OF SEWAGE DISPOSP.L? NA . � B-I�- OWNER'S SZ ATURE DATE . . . . � : ' . � � ,';�'.{n ; . . . . , , . . � � ' . � .. . . i . . . ' . �: � . � � � � � ,. .. ' . . ` . .. . '. .:.� .: � . . . . � . ,:. � .�. . .. . . . . . . �,' ._ . . . . � . >i' � _ , ; ":, , � �i _ ',� � � ; - .. ;u r�, o� ' , � . .. � � ' . ;�`'� M �` , . . . � . � � � � � . . . � . . ' S °O, i, �i � . � . . � } a • W� �`x o _.. , .w � .4 • �� ti .. � � � . ! . � . . � � . . . Q `f ��'�I .L1-; K,� '���.. � Q . .. � . .. �, r � `` , Q . � � . ' . . !� .4 � _ � ' . . . . . � � � ' . �. - � �� ( �S' Y �T L. .I- `N . 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'� <: �? �� / j. ci r" 4rT Y, t.4 , �� �l , � 1- : `� Y �y i ..x '` 'i.� r t F- -+ J z';-fi � i �� •-,y,� .___3 � � -r 1 � _��' -�1 : .-y-- •.\ '�'� I t ,� \� � s i-:; i I v,-% i� �-- \ .�i : . � � t � `1 ' r-_: -'r �J�C O n' �. 'r k'`-' ._�'� �� -11 ( �-- `_',--'"" r - _ `. . t � � � '�,._ i�.' S �, •k r -r i �' ---t-••,_�_-`/ ^ . ' � z :y � � n �� � i ��/ } -' c :� -1-v'; � ! ' •�� � ' �\ j . . , .� I �� � '� '� '`�^ r f\ L.• •' -�-L---- �-j r-• � �"lyi 1�• .; f= I 1 � �,yr—�+, Y-�-'-i:,r� :� i � . p \\ � ``� t '� -�1� tV' � � �`1 � �� �� `� ��~ +� :,�\��: �- ��� 1� ., �•��\���'-'Z'Fiii.� + � '" iii .�t�`�T ',l�T:. I i�'�� 1! g . '. �. � `. ' i i t.`.. I . ��,. .i �-i I:� l f � t: lt i i "f ^.`i; •.� � , � ' � : .. . _ ` ..--� ��--- t�}; `. �"ii .�12i'�!�@,�31 -'�-.-{ /, -a:._..t ; ' \: �� � y �.� J.4r�s B. Htn�rr Jx. GOVERNOR .\ � ; � ��o � e y' � � � ,+. s � �lo...+oo� STATE OF NORTH CAROLINA DEPART�NT OF TRANSPORTATION P.O. BOX 25201, RALEIGH, N.C. 27611-5201 P.O. BOx 289 Siler City, N.C. August 18, 1999 Division of Environmental Management John Hennesy, WQ Certification Unit P.O. Box 29535 Raleigh, N.C. 27626-0535 Dear Mr. Hennesy: DAVID MCCOY ACTII�TG SECRETARY Please find seven (7) copies of an application form attached for your review. If I can answer any questions you may have or if you have any comments, please call me at (919) 742-5649. Thank you for your assistance in this matter. Sincerely yours, �p,t,�,,,,,.� . Dennis L. Jo son Bridge Maintenance Superintendent Attachments ., a: DEM ID: ACTION ID: NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #): JOINT FORM FOR HATIONWIDE PERMITS THAT REQUIRE NOTIFICATION TO THE CORPS OF ENGINEERS NATIONWZDE PERMITS THAT REQUIRE APPLICATION FOR SECTION 4Q1 CERTIFIGATION WILIViINGTON DISTRICT ENGINEER CORPS OF ENGINEERS DEPARTMENT OF THE ARMY P.O. BOX 1890 WILMINGTON, NC 28402-189a ATTN: CESAW-CO-E Telephane (919) 251-451I WATER QUALITY PLANNING. DIVISION OF ENVIRONMENTAL.MANAGEMENT NC DEPART.'�1ENT OF ENVIRONMENT, FiEALTH, AND NATURAL RESOURC�S P.O. BOX 29535 - RALEIGH, NC 27626-0535 ATTN: MR. JOHN DORNEY � Teleohone (919) 733-5083 . ONE (1) COPY OF THIS COMPLETED AP?LICATION SnOULD BE SENT TO THE CORPS OF ENGINEERS. ScVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGcMENT. PLEASE ?RINT. 1. owrrERS rt�: N.C. Department of Transportation � 2. OWNERS ADDRESS: P.O. BOX 289 � Siler Citv, N.�. 27344 3. OWNERS PHONE NUMBER (HOME): NA (WORK): 919=742-5649 4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,;, PHONE NUMBER: D. L. Johnson P.O. Box 289 Siler City, N.'_'_ ?_7344 5. LOCP.TION OF WORK (MUST ATTAC:i MAP). COUNTY: Alan�ance NEAREST TOwN OR CZTY: Bt�'linqtOn SPECIFIC LOC�TION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):_ Bridge # 104 on N� 62 across Jordan's �eek , 6. NAME OF CiOSEST STREAM/RiVER: Jordan's 'Yeek - 7. RZVER BASIN: �3FJ2 F@d� � -.- 8. IS THZS PROJECT LOC.'�.TED IN A WATERSHED CLASSIFIED AS TROU2,; SA, HQW, ORW., _. -•.- WS I. OR WS II? YES IXl H� O 9. HAVE ANY ScCTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR.USE ON THIS . .. PROPERTY? YES [ ] NO [�J . IF YES, EXPLAIN. � - 1a. ESTIMATED TOTAL NUMHER OF ACRES OF WATERS OF THE U.S., INCLUDING ,., -. WETLANDS, LOCATED ON PROJECT SSTE: Unable to de rminP a� prPSPnt -. , . 7/8/92 . . . _ . .. . ��'1 .: 4 _2_ � I1. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY . . THE PROPOSED PRa.7FCT � FILLED: DRAINED: EZOODED: EXC�VATED: TOTAL' IMPACTED : -(1- 12. DESCRIPTION OF PROPOSED WORK (ATTACfi PLANS): Bridae replacerr�nt wi th a R� box GLl V�� 13. PURPOSE OF PROPOSED WORK: Replac2[T1P�lt of s�trllctl]r'711y defici2rit bridge. 14. STATE REASONS WHY THE APPLICANT BELIEVES THAT THIS ACTIVITY MUST BE CARRIED OUT IN WETL?.NDS. ALSO, NOTE.MEASURES TAKEN TO MINZMIZE WcTLAND IMPACTS. Unable to determine if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVIC� (USFWS) AND/OR NATIONAL MARINE FZSFiERZES SERVICE (NMFS} REG.�RDZNG THE PREScNCE OR ANY FEDERALLY LISTED OR PROPaSED FOR LISTING ENDANGERED OR THREATENED SPECZES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFEC:r'D BY.THE PROPOSED PROJECT. HAVE YOU DONE SO? YES [X] NO [ J , - RESPONSES FROM THE UScWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS. 16. YOU ARE REQUIRED TO CONTACT THE STATE iF2STORIC P?2EScRVATION OFFICER - (SFiPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN TFiE PERMIT AREA WFiICH MAY BE AFFECTED BY THE PROPOSED PROJECT? HAVE YOU DONE SO? YES (}{] NO [.] RESPONSc FROM THE SHPO SFiOULD BE FORWARDED TO CORPS. 17. ADDITIONAL INFORMATION REQUIRED BY DEM: A. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS,:AND LAiCES ON THE PROPERTY. B. IF AVAILABLE, REP�2ESENTATIVE PHOTOGRAPT.? OF WETLANDS TO"BE IMPACTED BY PROJECT. C_ IF DELINEATION WAS PERFORMED HY A CONSULTANT, INCLUDE ALL DATA SHEETS REI.c"VANT TO THE PLACEMENT OF THE DELINEATION LINE. D. I:' A STORMWATEFt MANAGEMENT PLAN IS REQUIRED FOR TFiIS PROJECT, ATTACIi COPY. E. WHAT ZS LAND U5E OF SURROUNDING PROPERTY? RPCir9c�ntial niral �ar�lar�d i, F. IF AP?LICASLE, WHAT ZS PROPOSED METHOD OF SEWAGE DISPaSAL? , NA � , . - _ 8 I OWNER'S SIGN RE DATE i e . , Tt� � ��. � r.� � h �� „ �� `i5le �� � - rr 62 � 119 � . � l.i� r �AII 161�.J ;61) � � � ; � � ti � I ) �Sn S�5 j• 7 :� - 'G���41 y ($�.(� \ -� � • '..+ IVO iv0� ��� ��r i��� 7 iei� q a���' JoMons �%�p�:oov � ��o ` o' _ � i .J .B ~ .3 � �a s 'ise� �r� ie� 36� 44 ��� i�e� i°ao ��4 v o 1� ivo: ��z i o r ,r 1. , � \. �' .^ 39 Se°"Y iaii ieov LAKE '�° �S i�ei � �=�� ivoz �� ivo. 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MORGAMOWN � � ;. furm+c.� � 10z� �., x 6Z �oo, � ? �ses v. i,s -_ _� � � 60 9iJ J 5'� ivi�] CLEN IL1vFN Mopadala �' '� � � CL7I O ) �(l1NIHC.I FAU � Q p,� '� iV�l �v1V 19�� POY.7,75 L Getk " � �6T Fs:' 7 ReS �i;f ,/^ �J1.� � �.:jl _^�' � �(� 5 � c f Iv�t ` IV]0 �/ `� ' \ � FAU .Q < '>'FA�.`O ::?;: �:�.::1. �Y o� 1� � Y 1 \ � . . �<#' ` 9�z � � I tv � i u 1 � ..a _ p � V >:. � Q 'V �:.,:::. _ ...,'(;.::::::: Q F .'�.^ .` fi;: ' � .:. - eDr. 62 ';;�R: . i::i i K . � � � ,� < '�� °» � �'S �'� i - i •,. > _: s:' �,. �... -� ; ;:.� I MC'BANE MU � .a'O �a _.,.: --- :. �� ...: .:a � 59 . 61 �� E7R. _ j . n ��+ / IO�. 7.781 c' ... 6 � . � ' '. } ' _ � ' �� ..:::�:::w. :: � �.% � � J • .J .J S � BURLINGTON ' {;.�? �:. ? ` '; - '° � � n`"'"""`e �•'°° ` � fA "`t�.�:::•. . fAU:., ' . � .. �.- 70 �04AHGf 779 � J Z ►Ot. 37.]ee , /4nw�r � ,_� ._; , ���~..::::. � t� a� �. :.. r :;.i:fr::: .: . .: .� •��� ��� /i:: .� J�. - � . � � �� Hl O J ...:.. ', ��... ;1... 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N iO11YlIi!'� Cr C'eek � a QI a 7Q i�s � puarter J 2 i� i D t MATd � �7 e S i.o ` z�ov e '-� �ieo 'w is 2 W ii�� ��v � �i � �' �i» i ^veF / A. iui -��� e � 1 ae� \e �ie ��o i� S m . 7 r�e� C. �J ti � nsa I��m 7�i1 ry J 9 �1 716.T � 71S] .1 165 � �0e � niv 17ie �4 ,��o h t � ; �z� Im 97 �s ?305� �„� y �,o �a��• c� . o �,be 9� 1 11J6 �� 7J09 67 �-"�.o. .9 �,� ��z, ��z�, � 84 , . � , , i ]]]I y B �t `b � �J 2791 n 1�` 2116 .� $, ]IS ' B i� v 7I��' 1_ .� ��� ��� � �� '' T �� � 96� S 85 z P204'�- ,' • « ]t9 y � � 0 �II� 11]0 �• 7�t1 �� ]]i7 � '1 i116 4 i�a 71sJ o IJO °��' U 1• i� p `� V�»o ?l2. Tr � �in � � �m� �»:gg ° x�.s �� 194 �25 ���b y - ,�., � � ° ,,,, 143 L �O e Yarna6 nz� 87 m i�� �� y N�ioi •c I �us Q ,�PIO e� �M, �- J ��oz ��� s�;, s ., I t .� < � 9 6 x]71 I7]I 9tL ' � `. .� ' . 1 'B ]1 2117 ' � ` I�� � V 'J ] dl o J�S�`aSIW� ��_ m� IIp , �� , P,. P,29 ,.n �23� ,i�o z�ez '�� �� `a��'� �,0 1 � y .s sa oe � � .� c � C21 , 253 m ° � . ' �� 144 �,. �-�2 ,, ,,,; >�, , 220 � ,�.�. . �� � Man� so.a '� }/ s ns� �� .�, _.. 7i�x Y �tii e �� n�� r`.. r, . , DEM ID: ACTION ID: , NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT �): JOINT FORM FOR NATIONW2DE PERMITS THAT REQUZRE NOTIFICATION TO THE CORPS OF ENGSNEERS NATIONWZDE PERMZTS THAT REQtJIRE APPLICATION FOR SECTION 4Q1 CERTIFZCATION WILMINGTON DISTRICT ENGINEER CORPS OF ENGINEERS DEPARTMENT OF THE ARMY P.O. BOX 1890 WZLMINGTON, NC 28402-1890 ATTN: CESAW-CO-E Telephane (919) 251-4511 WATER QUALITY PLANNING. DIVISION OF ENVIRaNMENTAL MANAGEMENT NC DEPART.�SENT OF ENVIRONMENT, FiEALTH, AND NATURAL RESOURC°S P.O. HOX 29535 RALEIGH, NC 27626-0535 ATTN: MR. JOHN DORNEY Telephone (919) 733-5083 ONE (1) COPY OF THT_S COMPLETED AP?LICATION SfiOULD BE ScNT TO Th"E CORPS OF ENGINEERS. SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGcMENT. PLEASE PRINT. 1. OWNERS rt�E: N.C. Department of Transportation � 2. OWNERS ADDRESS: P•O. BOX 289 � siler Citv, N.�. 27344 3. OWNERS PHONE NUMBER (AOME): NA �woRx�: 919-742-5649 � 4. IF APPLICABLE: AGcNT'S NAME OR RESPONSIBLc CORPORATS OFFICIAL, ADDRESS,� PuONE NUMBER: D. L. Johnson P.O. BoX 28�3 4i 1� Citv. N. "_'_ 77344 5. LOCATION OF WORK (MUST ATTACH MAP). COUNTY: Alamance NEAREST TOWN OR CZTY: Burlinaton SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):. Bridae # 104 on N� 62 across Jordan's '�-eek 6. NAME OF CLOSEST STREAM/RZVER: Jordan's "Yeek _. 7. RZVER BASIN: �dT�2 Fear � � - - S. IS THIS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROU2,; SA, HQW, ORW., -.- WS I, OR WS 2I? YES [}{ ] NO [] ' 9. HAVE ANY ScCTION 404 PE?tMITS BEEN PREVIOUSLY REQUESTED FOFt.USE aN THZS , • PROPERTY? YES ( ] NO (�. J ;; >. IF YES, EXPLP,IN. 10. ESTIMATED TOTAL NUMBER OF ACRES OF WATERS OF TFiE U.S., INCLUDING ,,, -- WETLANDS, LoCATED ON PROJECT SITE: Unable to d_ rminP a preGPnt _, . �/a/9z -- — - , _ �. . -2- 11. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS; IMPACTED BY THE PROPOSED PROJECT: . FZLLED: DRAINED: � FLOODED: EXCAVATED: TOTAL' IMPACTED : -(l- 12. DESCRIPTION OF PROPOSED WORK (ATTACfi PLANS): Bridge replacement __saith a R"' l�ox ct� 1 v�r't 13. PURPoSE OF PROPOSED WORK: Replacement Of structurally deficient bridge. 14. STATE REASONS WHY THE APPLZCANT BELIEVES THAT THIS ACTIVITY MUST BE CARRIED OUT IN WETL.�NDS. ALSO, NOTE.MEASURES TAKEN TO MINIMIZE WcTLAND IMPACTS. Unable to determine if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOLT ARE REQUZRED TO CONTACT THE U.S. FISH AND WILDLIrE SERVIC� (USFWS) AND/OR NATZONAL MARINE FISHERZES SERVICE (NMFS} REG.�RDZNG THE PRESENC� OR ANY FEDERALLY LISTED OR PROPOScD FOR LISTING ENDANGERED �R.TFiREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFEC:^�'D BY.THE PROPOSED PROJECT. HAVE YOU DONE SO? YES [XJ NO ( j , RESPO[�ISES FROM THE USFWS AND/OR NMFS SHQULD BE FORWARDED TO CORPS. 16. YOII ARE REQUIRED TO CONTACT THE STATE HISTORIC PT.tESERVATION OFFICER - (SHPO) REG2,RDING THE PRESENCE OF HISTORIC PROPERTIES IN TFL PERMIT AREA WHIC:: MAY BE AFFECTED BY THE PROPOSED PRa.TECT? HAVE YOU DONE SO? YES [}{] NO (] RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS. 17. ADDITZONAL INFORMATION REQUIRED BY DEM: A_ WETLAND DELINEATION MAP SHOWING ALL WETLANDS, ST�.AMS,:AND LAKcS ON THE PROPERTY. B. ZF AVAILABLE, REPRESENTATIVE PfiQTOGRAPH OF WETLANDS TO"BE IMPACTED BY PROJECT. C. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLIIDE ALL DATA SFiEETS RELEVANT TO TFiE PLACEMENT OF THE DELINEATION LINE. D. IF A STORMWATER MANAGEMENT PLAN IS REQUIRED FOR TIiIS PROJECT, ATTACEi COPY. E. WHAT IS LAND USE OF SURROUNDING PROPERTY? RPSI C�PTl1'l A'� n�ral far,rml and �, F. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? . NA � S -I . aWNER'S SZGN RE DATE O . i s . , � \ Ttr .��. �. y w� LQ h ^- 3!_ ' i�en �' ' "� 61 2 119 . -_ � . . 1Sl4. 1e�� ieu ieu' � _ Gk � -J h `k 1l�S � 1� l�'� l L.QQl� �_� � 190 1� ������ ' ` j - Ibid �1 � � �; - 7 ia�� y ,��'T� / JoNans C'e 4� � � �H�O .7 � .e ~ .7 � ` i �e � �o � ' ien 3 �.. �e�� ti' i�e� nn� ivo� I3�0 ,. ., ,. :,; 36, 44 '°-°° 104 `' �� � � �-� � ^ 39 . S�^y ieii ieov LAKE 'C°� is i�ai y.e �^.5�� ivoz �� ivo. I i YB '' Crs�k - BURL/NCTON b ��d� �. - �7 � is iCh. ° 'z RES. � Lo . i�ei N.� � o I .i� 1.2 rJ I610 - IA11.J y 19�1 V� Y� I161 y I)66 -_' ti �� 1 l IS�] . �D � � � 1:7 I76I .E G �- ? � 1901 �' 1906 �31 b� 28 e�,p � � ..'r� C46 ' `� s� �,Ma,,:,,� �� ,,: ' / � ' ,1 !Z '''�;4 i , '" 'l' •'� �.7� i�ei e acpa� A �SLi ,q j ��a. ! tu¢tt= 1766 _ IVW , I 1 ��flidl i •� r�n y ' � ��` '� � �/� Ridpe �!i " PC.7� �)6a I.D � � . 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C/NP'f � �O I]J 1 � QY4I}Cr r � �I J ]I�1 t MATdI "a �7 b Stt i.o ` a�ov e � �ie� � :.s 2 �ee4 ' �. iu� iioz_�� nas ae� ne �� � ao`� Z, S i��s W 9 v 7�e� � .0 �' 7 na� I Cr 1 ti �i�s ti ' 124. �•�� � � ° , ]I63 V l�lt l 5t� 7 .o, � : ���9 Z�ib Z,Si 5 � �b°00� �4 �,�o y ;��z m g7 �s P305� ,� c� . IIJb �� �J� 67 ��'�.o. .9 �,� 2��� �,��e ' 84 � , � , 9� :, � 1 0 ` ]7]I h 0 x \b � , � V ]]9] e f I116 i� p 715 • B 1� v 71��• 1� iT I]] �Y - .Q � 71A] S C� ��z..� �` �z9T "'a `?�-' 96 85 , z P204'.: ,: - y � � p� i I11� IIIO �• ]]!1 �� 1777 � '� ]116 G G�a 713� o I30 ���2 U 1• ii� `� V�»o �?2 • �in � �N� N;89 ? � � -,� ° ,�sz 143 194 �25 � .��„a - I , �Iw .B . L �O 0 Vama4s nz� 87 m i�� s S�x�oi �o I i� � Q ii�P�� e� »si �` -f z�oz tiva _ � y t v < x' � i 1Li a b n�l 717i ��i. .7 �� ' . 1 B , ]1] \ �a x e� .e o �25 e SP��S� �� ° � uv � � �.e , . r 6 1' � 1 ii�o ne� '� � OV� � '� P29 � ' u '-23 ,� �- c�'� ^ f'a�E '" C21 , 253 Z'` „ A '°� ' , �� 144 �. '-'° ,� ,,,� , , 220 � ,�.�. . : t�ei �� `... Ma+Vs 7in Y P�,.�.��� ._ Sa opahor �'� nN ���. ,. ..... � ....,.' . �,. � _ . .. U — i = i -- �;- i - - � . ,..__.,..._ ... _ __ , , . , -- -- ; � __ �� � �.'� = ;f, � � U 'Y�y�� _.__.. ==�`� _" ,��u v .= - ^, _ � � � , ,� L� _ ss-. ��� - _ J ' ._. ' . b'�! y� �Ci r- r,, i : , - _ -� " � : -- i, � _ _ _ --- -- �i ' --� _.-- ' �.' � c-: _;� -�; � �'.- -_- -- --!- - - - - i7,� �: � _ - _ :�� � _ ' ``� .,I.- �_ ,. i - -- ..1 _ - ' �'eo� __^/1 i _ . `.CI . :I., t.•i - -_' _. :`� � i '�� . -- � ----- _ i _ �� 1 � � . _.. _ Z __..-..._ y ' � ._ ' - '. ,..� �'.._. _ i . �� . � -_....... _ i :-.. � ' ' _ -- i � r " . ".� V � __ � � '-� - ," _ -- i - . � ' �,i _ - � -- -- �- -- � � �ti� � - - - -- _ , , - - -; - -- --. i , ;' , � - -- - � -- � , , � _ ; _. � _ - ���, . i -� ' i -'- - - , -- ,--- - -� ' ' - - — - _ , I _ � — ` __� `. �� �x n' �/'. t ' ;J` � �_ - - � I . . v � � �•� I - _ -_ _ � �' _ '- ' _ ._'- - _ _. ,. � � �i—_ 'I _ -- � _ . , -- ! � � � �I _ -� - ,. ti r _ ,. _ �- , � ,� r �: - ---- --- --- .-- ------------------,--��?._-_ - - - - � _ ._ - _ �. ; _ , _ _ -- �_�_ �--�: _ ' -+ - --- - - - - --- \ _ `�'- � _ - - �" _ i_' ,s �� --- �.-� �� .r i � C . � � DEM ID: ACTION ID: NATZONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #): JOINT FORM FOR PIATZONWIDE PERMITS THiiT REQUIRE NOTIFICATION TO THE CORPS OF ENGINEERS NATIONWZDE PERMITS THAT REQUIRE APPLZCATION FOR SECTION 4Q1 CERTZFICATION 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 ENVZRONMENT, HEALTFI, AND NATURAL RESOURCES P.O. BOX 29535 RALEIGH, NC 27626-Q535 ATTN: MR. JOHN DORNEY Telephone (919) 733-5083 ONE (1) COPY OF THIS COMPLETED AP?LICATION SHOULD BE SENT TO TFiE CORPS OF ENGINEERS. SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGcMENT. PTEASE ?RINT. 1. OWNERS NAME- N.C. Dep3L'�rit of Transportation � 2. OWNERS ADDRESS: P.O. BOX 289 � Siler Citv. N.�. 27344 3. OWNERS PHONE NUMBER (HOME): NA (WORK): 919-742-5649 � 4. IF APPLICASLE: AGcNT'S NAME OR RESPONSIBLr. CORPORATE OFFICIAI., ADDRESS,;. PHONE NUMBER: D. L. JoYLnSOn P.O. Box 289 Si_1 r Cit-v, N.''_ 27�4d 5. LOCATION OF WORK (MUST ATTACH MAP). COUNTY: Alamance NEAREST TOWN OR CZTY: Burlinaton SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):. Bridqe # 104 on N� 62 across Jordan's �e�k , 6. NAME OF �.OSEST STREAM/RIVER: Jordan's °'r'P?k 7. RIVER BASiN: ,al�e Fedr , _ _ 8. IS THIS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROIIT,; SA, HQW, ORW., -•.- WS I, OR WS ZI? YES (}{J NO [ J ' 4. HAVE ANY SECTION 404 PE.TtMITS BEEN PREVIOUSLY REQUESTED FOR.USE ON THIS -_ PROPERTY? YES ( ] NO (� ] ;; >.: ZF YE'S, EXPLr�IN. 10. ESTZMATED TOTAL NUMBER OF ACRES OF WATERS OF TXE U.S., INCLUDING ,�, WETLANDS, LOC�TED ON PROJECT SiTE: Unable to det�mine at p_resent , . �/a/92 _ .. -2- 11. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY THE PROPOSED PROJECT: .. FZLLED: DRAINED: � FLOODED: EXCAVATED: TOTAL'IMPACTED: -�- 12. DESCRIPT20N OF PROPOSED WORK (ATTACH PLANS): Bridqe replacement wi th a R"_' box cLl v�r't 13. PURPOSE oF PROPOSED WORK: ReplacemPx�t of structurally deficient bridge. 14. STATE REASONS WHY THE APPLICANT BELIEVES THAT THIS ACTZVITY MUST BE CARRIED OUT IN WETL?.NDS. ALSO, NOTE.MEASURES TAKEN TO MINZMIZE WcTLAND IMPACTS. Unable to deterrr�ne if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU ARE REQUIRED TO CONTACT THE U.S. FZSH AND WILDLIFE SERVICE (US'rW5) AND/OR NATIONAL MARINE FZSFiERIES SERVICE (NMFS) REG�RDING THE PREScNCE ; OR ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFEC:�'D BY.THE PROPOSED PROJECT. HAVE YQU DONE SO? YES [X] NO ( j � RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS. 16. YOU ARE REQUIRED TO CONTACT THE STATE KISTORIC PRESERVATION OFFICER • (SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES ZN TFiE PERMIT AREA WHIC:i ., MAY BE AFFECTED BY THE PROPOSED PRO�CT? HAVE YOU DONE SO? YES (}{] NO [ J RESPONSc FROM THE SHPO SHOULD BE FaRWARDED TO CORPS. 17. ADDITIONAL INFORMATION REQUIRED BY DEM: A. WETLAND DELINEATION MAP SHOWING ALL WETLP.NDS, STREAMS,:AND LAKES aN THE PROPERTY. B. IF AVAILABLE, REPRESENTATIVE PHCTOGRAPI? OF WETT..ANDS TO"BE IMPACT_ED BY PROJECT. . C. ZF DELINEATION WAS PERFORMED HY A CONSULTANT, INCLUDE ALL DATA SHEETS _, ,. RELEVANT TO TF� PLACEMENT OF THE DELINEATION LINE. ' � D. IF A STORMWATER MANAGEMENT PLAN IS REQUIRED FOR THIS PROJECT, ATTACFi ;�, COPY. E. WHAT ZS LAND USE OF SURROUND ING PROP�'RTY? Rc�si c3c�nt i a l n ira l �FarY'mi nnd F. IF APPLIC�SLE, WHAT IS PROPOSED METHOD aF SEWAGE DISPOSAI,? . NA � , - - - S I aWNER'S SIGN DATE IS � � \ _ _ = n �5�0 • � •isse � tr bZ � 119 � � �� r 16I1 161� J 161] � � � ' ;� � (w / � �\ If�3 . 1� .. tY�' � t�41� \ IV�I • ��\� ���� Q ` n ' _ '�. p ) '.+ 190 �PO� � IS�� � I613 q �r �� � ��bRStf Cip �,]WV � �9. 1 �v .7 .D M .] � . ♦ � � Il�7 3 -.. Ibl] �1 '�', 1]64 Ilb] D i eo r,r 1. .'r: �y 36! T4 ivoo 104 0 � ivoz ��1 y � y � 1 � ii 39 . S�r ieii i'°° L.tlfE 'C° �J i�ei -� _� ivoz �� I � Yeh � Crssk - BURLlNGTON b 176� � .6 .s �°-°i %. � is iO�. : '� RES. 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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, HEALTIi, AND NATURAL RESOURCES P.O. BOX 29535 RALEIGH, NC 27626-a535 ATTN: MR. JOHN DORNEY Telepnone (919) 733-5Q83 ONE (1) COPY OF TXIS COMPLETFD APPLICATZON SfiOULD BE SENT TO THE CORPS OF ENGINEERS. SEVEN {7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT. PLEASE ?RINT. 1. OWNERS rr�: N.C. De artment of Transportation � 2. OWNERS ADDRESS: P.O. BOX 289 ' Siler Citv, N.�. 27344 3. OWNERS PHONE NUMBER (HOME): NA (WORK): 919-742-5649 � 4. IF APPLICABLE: AGr.NT'S NAME OR RESPONSIBLE CORPORATE OFFICIr'1L, ADDRESS,, PHONE NUMBER: D. L. Jol'Ln�On P.O. Box 289 Si l�r Cityf N.''_ �7344 5. LOCATZON OF WORK ( MUST ATTAC:i MAP ). COUNTY : ti1cui�u1�C NEAREST TOwN OR CITY: Burlinaton SPECIFIC LOCATT_ON (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):_ Bridae # 104 on N � 62 across Jordan' s'�-eek 6. NAME OF CiOSEST STREAM/RZVER: Jordan'S "_"reek 7. R2VER BASiN: yape Fe �! , 8. IS THIS PROJECT LOCATED IN A WATERSAED CLASSIFIED AS TROU2,; SA, HQW, ORW., -.- WS I, OR WS II? YES [}{j NO (] . 9. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FaR U5c ON THIS • PROPERTY? YES ( ] NO (x. ] ;; ,: IF YES, EXPLAIN. . 10. ESTZMATED TOTAL NUMBER OF ACRES OF WATERS OF THE U.S., INGLUDZNG ,,, WETLANDS, LOeATED ON PROJECT SITE: Unable to det�mine at bresenf- -. ,: • . 7/8/92 ;_ .: � _ -2- . I1. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY THE PROPOSED PROJECT: . . .. FILLED: DRAINED: � FLOODED: EXC�VATED: TOTAL' IMPACTED : -(1- 12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS): Bridqe replacemPazt wi th a R� box cul v�rt 13. PURPOSE OF PROPOSED WORK: ReplacemP_nt Of structurally deficient bridge. 14. STATE REASONS WHY THE AP?LICANT BELIEVES THAT THIS ACTIVITY MUST BE CARRIED OIIT IN WETL�NDS. ALSO, NOTE.MEASURES TAKEN TO MINIMIZE F7ETLAND iMPACTS. Unable to determine if wetlands are present, all efforts will be provided to minimize off-site erosion. ' 15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVIC� (US'rWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS} REG.�RDING THE PRESENCE ; OR ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFEC�'D BY.THE PROPOSED PROJECT. HAVE YOU DONE SO? YES [X] NO [] RESPONSES FROM THE USFWS AND/OR NMFS SHQULD BE FORWARDED TO CORPS. 16. YOU ARE REQLJIRED TO CONTACT THE STATE FiISTORIC P:�ESERVATION OFFICER , (SHPO) REG.�RDING THE PRESENCE OF AISTORIC PROPERTIES IN TFiE PERMIT AREA WHICH ., MAY BE AFFECTED BY THE PROPOSED PROJECT? HAVE YOU DONE SO? YES [X] NO [ j RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS. 17. ADDITIONAL ZNFORMATION REQUIRED BY DEM: , � A. WETLAND DELINEATIO(�1 MAP SHOWING ALL WETLANDS, STREAMS, AND LAFCES ON THE PROPERTY. B. IF AVAILABLE, REPRESENTATIVE PECTOGRAP?? OF WETLANDS TO"BE IMPACTED BY - PROJECT. C. IF DELZNEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SFiEETS _, , REI.r."VANT TO THE PLACEMENT OF THE DELINEATION LINE. ` � D. IF A STORMWATER MANAGEMENT PLAN ZS REQUIRED FOR TEiZS PROJECT, ATTACH �, - COPY. i, E. WHAT IS LAND USE OF SURROUNDING PROPERTY? ��SidPntia'1 riiral farmland F. ZF APPLIC.�BLE, WHAT IS PROPOSED METHaD OF SEWAGE DISPOSAL? , NA � 1 . - - S I aWNER'S SIGN RE DATE �,. -� � ,---- -- " .J h rits� � � � o , ` � -- � � ��� r � 119 �� M Y�-+��- ` Isee Ie11 IGI� lel] � ; _ 63 � � ♦ � ��as 7,• 4 � 142I, \-9 Ivo �i o� ��� : �� C 7oov ,C i��� 7 ''iai.t y ,��4��/ loNans 'e.f- � � i�° .� � .a ^ .7� : D ueo r,, r isn 3 t. .'r.' ie� 36� � 44 ti nee ve� '°-°° ��4 ��a 1� rooz ive_7 ii ^ 39 5�°"y ieii ieov LAKE 'C° �J ��ei y.6 �^.5 �, ivoz �-90�- ivoa � ,i ,YB " Crssk '- BURLlNCTON b 176J .S % . � is i� � '� RES. � i.o - . i�ei N .1 i.1 r.� ieio {- �nix,s ? �w �,°'.t45 i�ei y ��es ~ I ' 2 a i� �so . 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' 124. 165 � �.,�.a. �' � z�;o z��b `� � z„z � ���o • , ; - , P305- �„� y a 36°00' i4 h Y ��� m 97 s %o ��� �� �. ��� 9� 1 67 ��"�.o. .o � „�e `� z��� „z� " 84 , . � , � l h �y. ;_ � �� V nvz »zi g Q t� tiie �is • B � �� i� �T, in �n ','Y � .Q ? v�e� s u � -' � ��� �i:�v S� T x� � � P204'... ,' „9Y -3 � 96 � 85 z , ��:� ., % 4 s� d nn it�o � v�v ! 1 viie �c° xin � iso �'IU2 ci 1Li ii� s �43 �` vi»o i�vi .�, � �in �r 7 N:89 _" � I - .. ° „r 194 �25 87 �„b ,, - 71�, u , 'O ° yamals x�z� m i�� 1e S ltoi �o � � I Q ���PIO bt� r�.� �- .� z�o� �, ��� x� � i � :, 9 b ]]11 1]]I +• �.£ 7 '. .� ' 1 B 11 �' � .� : ei o �25 c g " � � i�v � � , . � i e �O ' t P�t� 14Qt r� °� t b �231 ii�o r�ei ' � �x �� GQE�,� MpJ� 7 �� PG9 r � � e y��o � .� c � ,,,, C2I , 253 � � � �� � � 144 �» <, z»J ' , , 220 � ,�.�. . � - � , Ma� ,.,, �.a� �_��� '' '�, DEM ID: ACTION ID: NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #): JOINT FORM FOR HATIONWIDE PERMZTS THAT REQUIRE NOTIFICATION TO THE CORPS OF ENGINEERS NATIONWIDE PERMITS TH7�T REQUZRE APPLICATION FOR SECTION 4Q1 CERTIFICATZON WILMINGTON DISTRICT ENGINEER CORPS OF ENGINEERS DEPARTMENT OF THE ARMY P.O. BOX 1890 WZLMINGTON, NC 28402-1890 ATTN: CESAW-CO-E Telephane (919) 251-4511 WATER QUALITY PLANNING. DIVISION OF ENVIRONMENTAL MANAGEMENT NC DEPARTMENT OF ENVZRONMENT, HEALTFi, AND NATURAL RESOURCES P.O. BOX 29535 RALEIGH, NC 27626-a535 ATTN: MR. JOHN DORNEY � Telephone (919) 733-5083 ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE SENT TO Th'E CORPS OF ENGINEERS. SEVEN (7) COPIcS SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRaNMENTAL MANAGEMENT. PLEASE ??tINT. 1. owrrERS rr� : N. C. Department of Transportation � 2. OWNERS ADDRESS: P.O. BOX 289 � Siler Citv, N.�. 27344 3. OWNERS PHONE NUMBER (FiOME): NA �woRx�: 919-742-5649 � 4. IF APPLICABLE: AG�.NT'S NAME OR RESPONSIBLE CORPORATE OFFICIAI., ADDRESS,;. PHONE NUMBER: D L Johnson P.O. Box 89 �i 1_____ r�City. N.^_ �7�44 5. LOCATION OF WORK (MUST ATTACS MAP). COUNTY: Alamance NEAREST TOwN OR cZTY: Burlinaton SPECIFIC LOC�TION (ZNCLUDE ROAD NUMBERS, LANDMARKS, ETC.):. Bridge # 104 on N"' 62 across Jordan's "'re�k , 6. NAME OF CLOSEST STREAM/RiVER: Jord n's "YPPk . 7. R2VER BASZN: ydF.� Fear � -.:.. 8. IS THIS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROU2„ SA, IiQW, ORW., -- WS I, OR WS II? YES (}{] NO [ J 4. HAVE ANY ScCTION 404 PERMITS BEEN PREVIOQSLY REQUESTED FOR,USE ON THIS .. . PROPERTY? YES ( J NO [� ] . ;: '.; IF YES, EXPLe�IN. " , 10. ESTIMATED TOTAL NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING ,•, - WETLANDS, LOC�TED ON PROJECT SITE: Unable to de �rmine at pr SPnt- -. , 7/8/92 . . . . .. . .. . . . . ,,j : : �.. � -2- 11. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY THE PROPOSED PR�JECT: .. . ... FILLED: DRAINED: " FLOODED: EXCAVATED: TOTAL'IMPACTED: -�- 12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS) : Br1C�CJ� r'eX�laC2ITl�i1_t _snzith a R'_' box ct� 1 v�rt 13. PURPOSE OF PROPOSED WORK: ReplacP_ment of structurally deficient •bridge. 14. STATE REASaNS WHY THE APPLICANT BELIEVES TN.AT THIS ACTIVITY MUST BE CARRIED �IIT ZN WETL�NDS. ALSO, NOTE.MEASURES TAKEN TO MINIMIZE FIETLAND IMPACTS. Unable to determ:ne if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIrE SERVIC� (USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) REG�RDING THE PRESENC^c ; OR ANY FEDERALLY LISTED OR PROPaSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFEC�'D BY.THE - PROPOSED PROJECT. HAVE YOU DONE SO? YES [XJ NO [] RESPONSES FROM THE USFWS AND/OR NMFS SFiOULD BE FORWARDED TO CORPS. 16. YOU ARE REQUIRED TO COPITACT THE STATE HISTORIC PRESERVATION OFFICER �- (SHPO) REG?.RDZNG THE PRESENCE OF AISTORIC PROPERTIES IN TFL PERMZT AREA WEiIC:i ., MAY BE AFFECTED BY THE PROPOSED PRO.TECT? HAVE YOU DONE SO? YES (}{j NO (] RESPONSE FROM THE SFiPO SHOULD BE FORWARDED TO CORPS. 17. ADDITIONAL INFORMATION REQUIRED BY DEM: A. WETLAND DELINEATION MAP SHOWING ALL WET.T.ANDS, STREriMS, AND LAFCES ON THE PROPERTY. B. IF AVAILABLE, REPRESENTATIVE PHQTOGRAPE? OF WETLANDS TO"HE IMPACTED BY � PROJECT. , C. IF DELINEATION WAS PERFORMED HY A CONSLTLTP.NT, INCLUDE ALL DATA SHEETS _, .. RELEVANT TO TF� PLACEMENT OF THE DELINEATION LINE. D. IF A STORMWATER MANAGEMENT PLAN IS REQUIRED FaR TFiIS PROJECT, ATTACH �, COPY. E. WHAT IS LAND USE OF SURROUNDING PROPERTY? RPGic3Pntial r��ral far,rmland •.. F. IF APPLIC.�HLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPaSAL? . NA � � 1 - - 8 I OWNER'S SIGN RE DATE J n -�� Zi Ci \� p' IS 1 � 1 n ��' � .�� � ] �� - � � - tr � 119 � `! ,r 13�� ! IS/d 161t Idl� lell ' � � 63 Q� . 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'O �.a,,,�„ '� J/ �s, DEM ID: ACTION ID: NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWZDE PERMIT �): JOINT FORM FOR HATIONWIDE PERMITS THAT REQUIRE NOTIFICATION TO THE CORPS OF ENGINEERS NATIONWIDE PERMITS THAT REQUZRE APPLICATION FOR SECTION 4Q1 CERTIFZCATION WILMINGTON DISTRICT ENGINEER CORPS OF ENGINEERS DEPARTMENT OF THE ARMY P.O. BOX 1890 WILMZNGTON, NC 28402-1890 ATTN: CESAW-CO-E Telephone (919) 251-4511 WATER QUALITY PLANNING.. DIVISION OF ENVIRONMENTAL.MANAGEMENT NC DEPARTMENT OF ENVIRONMENT, fiEALTH, AND NATURAL RESOURC�S P.O. BOX 29535 RALEIGH, NC 27626-0535 ATTN: MR. JOHN DORNEY Teleohone (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 MANAGEMENT. PLEASE ?RINT. 1. OWNERS rr�: N.C. De artment of Transportation � 2. OWNERS ADDRESS: P.O. BOX 289 � siler Citv, N.�. 27344 3. OWNERS PHONE NUMBER (HOME): NA (WORK): 919-742-5649 � 4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFZCIAL, ADDRESS,�. PHONE NUMBER: D L JoYLnson P O Box 89 Si l�r Cit-� N_ �_ ?7�44 5. LOCATION OF WORK (MUST ATTAC:i MAP). COUNTY: AlaITiariCe NEAREST TOWN OR CZTY: Burlinaton SPECIFZC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):. Bridge # 104 on N, 62 across Jordan' s�ePk , 6. NAME OF CLOSEST STREAM/RivER: Jord n'� "Yeek . 7. R2VER BASIN: �A2 Fear ' - .-.:.. 8. IS T$IS PROJECT LOCATED ZN A WAT�RSHED CLASSIFIED AS TROO2,;SA, HQW, ORW., _ -- WS I, OR WS II? YES (j{] NO [ j 9. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS . , PROPERTY? YES [ ] NO (�.J , IF YES, EXPLAIN. . 10. ESTZMATED TOTAL NUMBER OF ACRES OF WATERS OF TFiE U..S., INCLUDING �,, .• WETLANDS, LOCATED ON PROJECT SiTE: Unable to dete_rmine at,�resent , . 7/a/92 -z- I1. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY THE PROPOSED PROJECT: . FILLED: DRAINED: � FLOODED: EXCAVATED: � TOTAL'IMPACTED: -�- 12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS): Bridae replacement wi t-h a F2 � boX Gti 1 V�rt 13. PURPoSE OF PROPOSED WORK: Replacement Of structurally deficient bridge. 14. STATE REASONS WHY THE APPLICANT BELIEVES THAT THIS ACTIVZTY MUST BE CARRIED OUT IN WETL�NDS. ALSO, NOTE.MEASURES TAKEN TO MINZMIZE F1aTLAND IMPACTS. Unable to determ�ne if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU ARE REQLTZRED TO CONTACT TEiE U.S. FISFi AND WILDLIFE SERVIC� (USFWS) AND/OR NATIONAL MARINE FZSfiERZES SERVICE (NMFS} REG?.RDZNG THE PREScNCc ; OR ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFEC:�'D BY.THE -' PROPOSED PROJECT. HAVE YOU DONE SO? YES [X] NO O � RESPONSES FROM THE USrWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS. 16. YOII ARE REQUIRED TO CONTACT THE STATE HISTORIC P?ZEScRVATION OFFICER � ( SHPO ) REG.�RDING THE PRESENCE OF HISTORIC PROP�'RTIES IN TFiE PERMIT AREA WHIC:i . , MAY BE AFFECTED BY THE PROPOSED PROJECT? HAVE YOTJ DONE SO? YES [}{ ] NO [ j RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS. 17. ADDITIONAL INFORMATION REQUIRED BY DEM: � A. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, AND LAKES ON THE PROPERTY. B. IF AVAILABLE, REPRESENTATIVE PHQTOGRAPEi OF WETLANDS TO"BE I2�.PACTED BY PROJECT_ , C. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEETS _. RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE. ' � D. ZF A STORMWATER MANAGEMENT PLAN IS REQUIRED FOR THIS PROJECT, ATTACH �, - COPY . �� .. E. WFiAT IS LAND USE OF SURROUNDING PROPERTY? Rr��� �Pnt-i al ri�ral farml and •. F. IF APPLIC?.BLE, WHAT IS PRaPOSED METHOD OF SEWAGE DISPOSAL? . 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' _------; _ -� - - � :ti.� - -. _- v ;. _. __., , ; _ , , , , � _ � � z�� __ ` �- �� Ci� -- � - . - _;-.-.- - ' - �. � _ i , � ; � _ - . , -_ -'. ., ' ' '". _ j _ .� . ___ � � � i � �_.._._. _ _' . ��" .I , � ^� " .. . i � . \'� �', . y' � . - . _ _ r ."__�--��. .,.{� i . f ti� __ � � � 3�-'p � r� i . v .. . � ' � � � � . , l I � , ��� `�� ' . '- . �_" '__ ' �. � � � -1 � ���� _'__" - .. . _ 'I _ - �- -__ . � W -� ' ' - ,,. �.__. � � �r _ � _�.�_�, ____,�' �Ci� � i i i _'�, i; ,_ � _ _ ----- i�, -� ' _'. � __ 7'j,' - i �,r+,, ; � -'� "'' !,, ''� -.� — �_�-.�..___,_�. _- - - �:... � } � . ? , _- -� ' _ \ i- � I I � �rLP�, , 4 _ ,,I _ 1 - " I �'.L ��y `_, i _ -'I : •i •�"�'-- ``� i ' �.• .r : 1 � I - I '_ , '__ . " � �' _' -r� I. . • ,- ��- / 1 ' � ' ,.�� �- - _ � ., � . I � � � � _ �J ' • J � • �• ' J �.. r , - , _ — - _ ', - '- - - - _ � � -- � � � � � — � � � — � � � � � % �� , � �—.,�,: ����� ��� � �� ! �,�_ �o' - - .� .."�. � 'ese��` ��',, �e � � � � �� � � �n, - - � ��� _ �� . : ' '" DEM ID: ACTION ID: NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT �): JOINT FORM FOR HATIONWIDE PERMITS THAT REQUIRE NOTIFICATION TO THE CORPS OF ENGINEERS NATIONWIDE PERMITS THAT REQUIRE APPLICATION FOR SECTION 4Q1 CERTIFICATION WZLMINGTON DISTRICT ENGINEER CORPS OF ENGINEERS DEPARTMENT aF THE ARMY P.O. BOX 1890 WILMINGTON, NC 28402-1890 ATTN: CESAW-CO-E Telephane (919) 251-4511 WATER QUALITY PLANNING.. DIVISION OF ENVIRONMENTAL.MANAGEMENT NC DEPARTMENT OF ENVIRONMENT, fiEALTH, 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 Th'E CORPS OF ENGINEERS. SEVEN (7) COPT_cS SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRaNMENTAL MANAGcMENT. PLEASE ?RINT. 1. owrrERS NArtE • N. C. Department of Transportation � 2. OWNERS ADDRESS: P.O. BOX 289 � Siler Citv, N.�. 27344 � 3. OWNERS PHONE NUMBER (FiOME): NA (WORK): 919-742-5649 � 4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLc. CORPORATE OFFICIr�L, ADDRESS,., PHONE NUMBER: D. L. JoYLn�on .O. Box 289 �il�r City. N_"'_ �7�4d 5. LOCATION OF WORK (MUST ATTACH MAP). COUNTY: Alamance NEAREST TOwN OR cZTY: Burlinaton SPECZFIC LOC?,TION (INC7.UDE ROAD NUMBERS, LANDMARKS, ETC.):_ Bridge # 104 on N� 62 across Jordan's �e�k 6. NAME OF CLOSEST STREAM/RIVER: Jordan's 'rPek _ 7. RIVER BASZN: �T�2 Fear � - - - .: .. 8. IS TAIS PROJECT LOCATED IN A WATERSHED CLASSZ:IED AS TRO[J2,; SA, HQW, ORW., -�- WS I. OR WS II? YES IX� N� �� ' 9. HAVE ANY SECTION 404 PE.�2MITS BEEN PREVIOUSLY REQUESTED FaFt USE ON THIS - PROPERTY? YES ( j NO (y. J :; >.; IF YES, EXPLAIN. . 10. ESTIMATED TOTAL NUMHER OF ACRES OF WATERS OF THE U.S., INCLUDING r, - - WETLANDS, LOC�TED ON PROJECT SITE: Unable t0 det�mine dt iJr Sc�nt ,: 7/8/92 :t.: � ; ,. , -2- I1. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY THE PROPOSED PROJECT: . FILLED: DRAINED: FLOODED: EXCAVATED: TOTAL' IMPACTED : -fl- 12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS): Bridqe replacement wi t-h a R� box cLl v��+ 13. PURPOSE OF PROPOSED WORK: Replacement Of St�tlCtLirally deflCiellt bridge. 14. STATE REASONS WHY THE APPLICANT BELIEVES THAT THIS ACTIVITY MUST BE CARRIED OUT IN WETL?.NDS. ALSO, NOTE.MEASURES TAKEN TO MINZMIZE FIETLAND IMPACTS. Unable to determine if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVIC� (USFWS) AND/OR NATIONAL MARINE FISHERZES SERVICE (NMFS) REG.�RDING THE PREScNCE OR ANY FEDERALLY.LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA TFiAT MAY BE AFFEC�'D BY.T_HE PROPOSED PROJECT. FiAVE YOU DONE SO? YES [XJ NO ( j RESPONSES FROM THE USFWS AND/OR NMFS SHaULD BE FORWARDED TO CORPS. 16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC P:tESERVATION OFFICER �- (SHPO) REG�RDING TFiE PRESENCE OF HISTORIC PROPERTIES IN TFiE PERMIT AREA WHICH , MAY BE AFFECTED BY THE PRaPOSED PRaJECT? HAVE YOU DONE SO? YES (}{] NO (] RESPONSE FROM THE SHPO SHOULD BE FaRWARDED TO CORPS. 17. ADDITIONAL ZNFORMATION REQUIRED BY DEM: ' A. WETLAND DELINEATION MAP SHOWING ALL WETLisNDS, ST�.�MS, :AND LAI{ES QDI THE PROPERTY. B. IF AVAILABLE, REP?iESENTATIVE PHQTOGRAPH OF WETLANDS TO'BE IMPACTED BY � PROJECT. C. IF DELINEATION WAS PERFORMED HY A CONSULTANT, INCLIIDE ALL DATA SFiEETS _, RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE. - D. ZF A STORMWATER MANAGEMENT PLAN IS REQUZRED FOR TFiIS PROJECT, ATTACH �, . COPY. E. WHAT IS LAND USE OF SURROUNDING PROPE.'RTY? RP4� (�PTI�"l a'� t-��ral �a�,Y'ml and F. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DZSPOSAL? NA � � 1 8 -I OWNER'S SIGN RE DATE „ � ,� ��)3't .isse �' ' tr 6l � 719 ^ . 13� . ieii �ei. iei� ' � � � � __J ^ 'k IS/3 1'� 4 �dy { �-�' -� ' IDO 190i ��� 1 + � - -� P � " � i � r � 7 ,'I613 . 161� �` A�' lordans �'�4�oov � e ' T ` r � u �, � a .e .7' n � Y . �„� , �. :r;°�9 'o�; 36� 44 � �� ��a� �� 104 0 1 � ��� ,_, �? � � ]01 V � � %` 39 S�°"y isi� L.4KE �C rJ i�ei � ivoz '-�- ivo. 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' i-• / eor. ^' �- � 'e x�es;� ror. �zo �,:.; : :r';:;. \ t, � 7 .� . ��, �(����`���.:` : ' ..i R - to ' �oi�s � ` ° ::j B� R�oTo . ^ . >:� �� ^ `3:�,:.; .,;•i� �S t O { � � 'ii Bellemone ...:�, a7 sa ° n9 ? �a P78 . c� r�s �� � z izo� .s N y Y � �2 �ZI $� ]I 0 � I C�� � wmill��� � Gf. �� f J �O I]I Ill '• - b \ � � 1 1.0 � �. ��4 �. II]I II]] � b 37I3 � � C, ni ' I 24 . � t� 7 .oa ° �4 ���o ; h 67 �'�.o. ., �,� ,��b a ��� � 91 ,., , �, �iea �� 1.5 2 W � apJ� �, } 1�1s I 7 71J] iise `1 � zist xisz � .7 �s P,305�. �. ,a �6��- ,^ 0 It66 []/�° 1 v . 84 , � �v � � , ,. ��b� s w � z�� ' �. �..� ,r, � _� ° P204'�' ,' „9�=' � -�- s`;' 96 85 z �? � � � i 0 111� 11]0 �, ]]}I �� 7 I7 � 1 ]I16 4 G�a 7131 o I30 P iL�i V 311 ii� p `� V�»o � s G � :in �` �m� F�i89 � x�as � 194 �25 ���b - � � »b� 143 ti ��.. PIO b `° ° �'= ���. °' � �.� 71�9 .5 "iio� .0 � � I Q i�� t'y i�e� -f z�oz .� rivo � .y � i � fl ] '3 9 b �]]1 �]]I 9� ' � `. .� � . ' �B 71 il�l , . �� I�]� e �j " 2t� � t.v ^ 'a � ei� .s o L \t� 1e2t �.a ii�° '� J �P , � P29 �� � .6 � �231 ii�o i�si �.�: �E L0.Ei'� M� � ` rC2� 7 i 253 n�•/] " A ��� �y 77]1 /� 1]l7 � / � LGO � Ab�o� � CS1� � �k G p , � 144 `°^. Ma� '�� � L sa.apa+,,,, '� � Y��, ��ei �� , . _ _ � nn Y ti� e n . n ,_ : ' ti / s ,� . JaMES B. Hurrr JR. GOVERNOR ,ry�g�; t ����-,,, STATE OF NORTH CAROLINA DEPART'MENT OF TRANSPORTATION P.O. BOX 25201, RALEIGH, N.C. 27611-5201 P.O. Box 289 Siler City, N.C. August 18, 1999 Division of Environmental Management John Hennesy, WQ Certification Unit P.O. Box 29535 Raleigh, N.C. 27626-0535 Dear Mr. Hennesy: DAVID MCCOY ACTING SECRETARY Please find seven (7) copies of an application form attached for your review. If I can answer any questions you may have or if you have any comments, please call me at (919) 742-5649. Thank you for your assistance in this matter. Attachments Sincerely yours, �J9vvw� d- , Dennis L. Jo son Bridge Maintenance Superintendent R1 � DEM ID: ACTZON ID: NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWZDE PERMIT #): JOINT FORM FOR HATIONWIDE PERMITS THAT REQUIRE NOTIFZCATION TO THE CORPS OF ENGZNEERS NAT20NWIDE PERMITS THAT REQUIRE APPLICATION FOR SECTION 4Q1 CERTIFICATZON 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 APPLZCATION SHOULD BE SENT TO THE CORPS OF ENGINEERS. SEVEN {7) COPIES SFiOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT. PLEASE PRINT. l. 2. 3. OWNERS NAME: N.C. D2 3rtTile.IIt of Transportation � � OWNERS ADDRESS: P.O. BOX 289 � Siler Citv, N.�. 27344 OWNERS PHONE NUMBER (FiOME): NA (woRx�: 919-742-5649 4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLc CORPORATE OFFICIs�L, e�DDRESS,� PHONE NUMBER: D L JO nsOn P O BoX 89 Si 1 r Ci _y. N. �_ ?7�t14 5. LOCATZON OF WORK (MUST ATTACH MAP). COUNTY: �a�a 11 NEAREST TowN oR CITY: Yancewille SPECIFIC LOCATION (ZNCLUDE ROAD NUMBERS, LANDMARKS, ETC.):_ Bridge # 14 on N� 62 across Jordan's �eek 6. NAME OF CLOScST STREAM/RIVER: �7orc1 n' �'Y�k - _ 7. RIVER BASIN: ��' Faar � � : 8. IS THIS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROUT,; SA, FiQ�^1. ORW., _ - WS I, OR WS I I? YES (}{ ] NO [ J 9. FiAVE ANY ScCTION 404 PERMZTS BEEN PREVIOUSLY REQUESTED FOR,USE ON THIS _ � PROPERTY? YES ( ] � NO [�rJ >; IF Y.z.'S. EXPLAIN. . . 10. ESTIMATED TOTAL NUMBER OF ACRES OF WATERS OF TIiE U.S.,•INCLUDING WETLANDS, LOeATED ON PROJECT SITE: Unable to de rmine a pre�Pnt ,: , �/a/gz : � ._ , . -2= 11. NUMBER OF ACRES OF WATERS OF THE U.S., THE PROPOSED PROJECT: . INCLUDING WETLANDS, IMPACTED BY FILLED: DRAINED: FLOODED: EXCAVATED: TOTAL' IMPACTED : -(1- 12. DESCRIPTION OF PROPoSED WORK (ATTACH PLANS}: Bridg�r�lacement with a R� box culbert 13. PURPOSc oF PROPOSED woxx: ReplacP�r�ent of structurally deficient bridqe. 14. STATE REASONS WHY THE AP?LICANT BELIEVES THAT THIS ACTIVITY MUST BE CARRIED OUT IN WETLANDS. ALSO, NOTE.MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS. Uridb1C� to determine if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU ARE REQUIRED TO CONTACT TAE U.S. FISH AND WILDLIrE SERVZC� (US'rWS) AND/OR NATIONAL MARINE FZSHERZES SERVICE (NMFS} REG.�RDING THE PREScNCE , OR ANY FEDERALLY LISTED OR PROPOScD FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRZTICAL HABZTAT IN THE PERMIT AREA THAT MAY BE AFFEC:ED BY.THE PROPOSED PROJECT. HAVE YOU DONE SO? YES [X] NO [ J � RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS. 16. YOU ARE REQUIRED TO COAITACT THE STATE HISTORIC PRESERVATION OFFZCER - (SHPO) REG?.RDZNG THE PRESENCE OF HISTORIC PROP�RTIES IN T:i� PERMIT AREA WHICH ., MAY BE AFFECTED BY THE PROPOSED PROJECT? HAVE YOU DONE SO? YES [j{] NO (] RESPONSE FROM THE SFiPO SHOULD BE FORWP.RDED TO CORPS. 17. ADDIT20NAL INFORMATION REQUIRED BY DEM: A. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STR�3MS,:AND LAKES ON THE PROPERTY. B. IF AVAILABLE, REPRESENTATIVE PHOTOGRP.PH OF WETLANDS TO"BE Z2�.PACTED BY - PROJECT. C. IF DELINEATION WAS PERFORMED BY A CONSULTANT, INCLUDE ALL DATA SFiEETS _, RELEVANT TO TFiE PLACEMENT OF THE DELINEATION LINE. D. ZF A STORMWATER MANAGEMENT PLAN IS REQUIRED FOR THZS PROJECT, ATTACS �, COPY. � E. WHAT ZS LAND USE OF SURROUNDING PROPERTY? RP�i�3r�ntial niral �armlanrl F. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? NA � �. $- I$- aWNER'S SI ATURE DATE !\� 7 �l �au C�4 � iA� ' - isi� ��xz �.o � V'� rn... 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I ' . � � ' ."'_._' .-' � , _ _ _ • I =� - . � . �' " _.' � - _ _ _ . _Y'_'_` . _ _ _ - _�_ - -'__ � _ - �`� � . , — , x '� --- . -' Y i � - _ ` � � . ,�,�'� - , ; , _ ,' �,, _ . , � `�� , °-----•.— 'TG , . - , -. ��ip ---- , � , - -. i _ _ { `F , _ ,. . - - _. _ � -� � � � -- � � � � -- -- � � - , -:_, : � _ - . _ W � , i � � � ' c� - - � �----. � � -� ` - �' �-� � ' J � ---- "__ - - � - _- _ - _ - • � � - � � - -- � : , ', , � ; ' . _ �_ . ��,e -- " - - - _- � �. . . , _ ' ' _. , - " � �, _ ,; _ _ j ; -- - -.�� __ i.i,.i I� _. � _ . __ _ -.� i - -� � - - � ,-7 . . � -- ` ..__I. � �� ,; �� '� _ � --- -- --- . , .---- -- - . . , ' - - -- ---- - _ -.. . .� �� • . . , - - ------ - - -- -- - � „ + -- --- , . �. . ., � . , --- ; � . .:�� . , � . ,� �,.� _ , i , . i , ,i , : � � . �„ �� �.: : . ' ;' 1 �'.,.i ;, ';�,: �. i' i . " . � ... ��. � �� . � -� �r.�a }.,� � � � �L . ' , ��. -�::� I J ( — / , � -_ � __' I 1 � \�, _ � _ I \\ \ i —_ '_' - ' i' 1 - - 1 " 'V� . . . .�. .. . � _ _ - r .. � .. _ . - . . --J� ' iC � _ '� - � �� � � �i � �• or T I ♦ DEM ID: ACTION ID: NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #): JOINT FORM FOR HATZONWIDE PERMITS THAT REQUIRE NOTIFICATION TO THE CORPS OF ENGINEERS NATIONWZDE PERMITS THAT REQUZRE APPLICATION FOR SECTION 4Q1 CERTIFICATION WZLMINGTON 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 Teleohone (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 MANAGEMENT. PLEASE ??2ZNT. 1. owrrE?ts rra�sE • N.C. Department of Transportation � 2. OWNERS ADDRESS: P.O. BOX 289 � Siler City, N.�. 27344 3. OWNERS PHONE NUMBER (HOME): NA (WORK): 919=742-5649 4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIaI., ADDRESS;, PHONE NUMBER: D. L. J011nSOn P.O. Box ?89 Sil_____�ity, N.�_ �7344 5. LOCATION OF WORK (MUST ATTACH MAP). COUNTY: �a�_well NEAREST TOWN OR CZTY: YanCeWille SPECIFIC LOC�TION (ZNCLUDE ROAD NUMBERS, LANDMARKS, ETC.);_ Bridge # 14 on N� 62 across Jordan's �eek 6. NAME OF CLOSEST STREAM/RZ`IER: Jordan'� "Y�k � --._ 7. RIVER BASIN: �ane F �r - 8. IS THIS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROQ2„ SA, HQF7. ORW., _. - WS I, OR WS II? YES (XJ Na ( J 9. HAVE ANY SECTZON 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR,USc ON THIS .- PROPERTY? YES ( j NO [�.J >; IF YES, EXPLAIN. .' , 10. ESTIMATED TOTAL NUMBER OF ACRES OF WATERS OF TIiE U.S., INCLUDING ,�, - - WETLANDS, LOCaTED ON PRoJECT SITE: Unable to de rmin at�prP�Pnt .,: • 7/8/92 � � .. -2- I1. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY - THE PRaPOSED PROJECT: , . .. FIZ�LED : DRAINED: FLOODED: EXC�VATED: TOTAL' IMPACTED : -(1- 12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS): Brid e replacement with a R� box culbert 13. PURPOSE OF PROPOSED WORK: Replacement of structurally deficient bridge. 14. STATE REASONS WHY THE AP?LICANT BELIEVES TF.AT THT_S ACTIVITY MUST BE CARRIED OUT IN WETLANDS. ALSO, NOTE MEASURES TAFCEN TO MINIMIZE 47ETLAND ZMPACTS. Unable to determine if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVIC° (USFWS} AND/OR NATIONAL MARINE FISHERZES ScRVICE (NMFS) REG?,RDING THE PRESENCE OR ANY FEDERALLY LISTED OR PROPOScD FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT ZN THE PERMIT AREA THAT MAY BE AFFEC2`ED BY.THE � PROPOSED PROJECT. HAVE YOU DONE SO? YES [X] NO [ J RESPONScS FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS. 16. YOU ARE REQUIRED TO CONTACT THE STATE FiISTORIC PRESERVATION OFFICER - (SHPO) REG�RDING THE PRESENCE OF HISTORIC PROPERTZES IN T:iE PERMIT AREA WHICH ,� MAY BE AFFECTED BY TFiE PRaPOSED PROJECT? HAVE YOU DONE SO? YES [}{] NO [] RESPONSE FROM THE SHPO SHOLTLD BE FORWARDED TO CORPS. 17. ADDITIONAL INFORMATION REQUIRED BY DEM: A. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, AND L,PiFCr�S ON THE PROPERTY. B. IF AVAZLABLE, REPRESENTATIVE PECTOGRAP:i OF WETLANDS TO"HE I2�D�CTED BY - PROJECT. � C_ IF DELINEATION WAS PERFORMED HY A CONSULTANT, INCLUDE ALL DATA SHEETS , RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE. D. IF A STORMWATER MANAGEMENT PLAN IS REQUIRED FOR TFiIS PROJECT, ATTACH �, COPY. � E. WHAT IS LAND QSE OF SURROUNDING PR�Pz'RTY? Re�id ntiai rnral �armlanr� F. IF APPLICABLE, WHAT IS PROPOSED METHOD OF ScWAGE DISPOSr'iL? NA D � �. 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U N - ��: - , , — '�--�_� : , ,�: ��:.�E� �� � ; ., �' o _ - - �� � � � �,= �. o . �} _ _ � � . _ _ . _ . __ . � �� . , � . , �.,. ... ,� . . ., ; .. � , _ 1 � - � , I i � _ -' ---, � m t . ., Y�' � i - - � 'i i - � � - ` ,Y n c = ��:i e `1 � j ` � ` �.t-, i ; �,;�-� ... - � , . . .., --/% � �, `�_� ' �� . � � , �' �!, - -- � . _ -. :.� - , � °G' - ' � ^'� —_ - - � � `r: � . ---,- � I �� _ .. . _ -.,_-�_'_ - - .-- ��_i--.. `_- , •, � •. .. . .� • _ - . - . _, i _ _ J� _ ; _ � _ - ---- - - - ----- - ---- - — ------- �:' - � _ _ _ :-_------------ ---- _ _. � , , , __-_ - -- - ---- _ - ' ;. " �� ` ' , - _-- _ _ _- _ � _. - ---- � � '` ` - - , - - �', �� _ _ ,, - - � � �y�� � � "�� ��� o; / --- i - -� _. - i - _.�--' _ - _ = — __ � _, c:i . . , ; � � -- -- ;�� . z : ,� _; ' , � _ . ry -� � - � � �1 . \ � - - - I .. \ �\ .''��i / � �- . `• y_ _� _" i � / �' � � �. ' � � . _ _ " _ -.. ' I I . � I , _ ' _ ' " � .. I . . i. .� 1 ' i � , . /�J _ ' �____'_. • ,_ ' - " '�, _ . _I�:_�- . . - � ._. • _` ` ' � . � �� � I � '- � , - . � . _ . . _ ' I'. . - _�r�4mP'__Ql� �____ � _ _ -__�-` ' • - �_ _ i i��`n ' - _p _ .. . "- . - .� � ' _ . . ' . ' . � I ' ,. __ , - i . .�,� .�. . -.. � ;� ,ti . - ' I . . ' � I . . 1�� � � I ' _ • - " ' ��'p ----- � � - � � � `� . _. r -- - - -- ' � ' _ _ � - ,� � I - . _ �- i `, � ,- • .Y � � _ - �' `� ___-- _ � c� --- -' � �' ' -, - J � " _ =- ; - ---_ ___ , _ - - , __ , 2ce V � � �. � � - _ -- - ; - - -- � -� - ,`�, � � - __ _ _ - - I / _ _� _ , ,, _ _ _ �; ' , - ---r"� � ' ir �� -- ------- ---- � � � -- -- -- - - ---------- - - ----------- --=F- - ` - -- - --- . _ _ � � = � -, - ; '. �. _ . , ,. _ , _ : - � v , ; , i , i ,i _ -- , --�.. _....�_I `� 1_ i . , � , _. � , . . . .. , , , . . /, -r"�o +— - �-,-.�'� , � .... , ,� �' ' . : _ w - , �. ' . . .� ,- _, � - : � _ '� i � '' , , - — - -- � I � `_ , _ = � A `� .. : ._. _ - --- - . _ - J ' 1''� ' � - ,, , � _ , _ . . - d . DEM ID: ACTZON ID: , NATZONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #): JOINT FORM FOR NATIONWZDE PERMITS THAT REQUIRE NOTIFZCATION TO THE CORPS OF ENG2NEERS NATIONWIDE PERMITS Z'HAT REQUIRE APPLICATION FOR SECTION 4Q1 CERTIFZCATION WZLMINGTON DISTRICT ENGINEER CORPS OF ENGINEERS DEPARTMENT OF THE ARMY p.O. BOX 189a WILMINGTON, NC 28402-1890 ATTN: CESAW-CO-E Teleohone (919) 251-4511 WATER QUALITY PLANNING. DIVISION OF ENVIRONMENTAL.MANAGEMENT NC DEPARTMENT OF ENVIRONMENT, FiEALTH, AND NATURAL RESOURCES P.O. BOX 29535 RALEIGH, NC 27626-a535 ATTN: MR. JOHN DORNEY Telephone (919) 733-5083 ONE (1) COPY OF TIiIS COMPLETED AP?LICATION SHOULD BE SENT TO THE CORPS aF ENGINEERS. SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT. PLEASE PRINT. 1. OWNERS rrArtE • N.C. De artment of Transi?ortation � 2. OWNERS ADDRESS: P.O. BOX 289 � Siler Citv, N.�. 27344 3. OWNERS PHONE NUMBER (HOME): NA (W�RK): 919-742-5649 - 4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORAT� OFFICZ?.L, ADDRESS,, PHONE NUMSER: D L Jo nson O Box 289 Si 1__��t-y. N. ^. �7�4a 5. LOC?.TION OF WORK (MUST ATTACH MAP). COUNTY: ''��w 11 NEAREST TOwN oR CZTY: YanceWille SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.);. Bridge # 14 on N� 62 across Jordan's �eek 6. NAME OF CLOSEST STREAM/RIVER: 7ordan'� 'Y�k _ 7. RIVER BASIN: ��e Fe� -._:. 8. IS THIS PROJECT LOCATED IN A WATERSAED CLASSIFIED AS TROII2„ SA, HQW, ORW,, _ -•._ WS I, OR WS II? YES (}{ ] NO [] 9. HAVE ANY SECTION 404 PE:�MITS BEEN PREVIOUSLY REQUESTED FaFt ,USc ON TFiIS _ • PROPERTY? YES [ ] NO (�] , ZF YES, EXPLAIN. ' ' , 10. ESTIMATED TOTAL NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, LOCATED ON PROJECT SITE: Unable to de rminP at t�r � nt , . 7/8/92 ♦ :, w : _ . ' . � . . . -2- 11. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY THE PROPOSED PROJECT: . FILLED: DRAINED: FLOODED: EXCAVATED: TOTAL'IMPACTED: -�- 12. DESCRIPTION OF PROPOSED WoRK (ATTACH PLANS): Bxidc{Y replacement with a R� box culbert 13. PURPOSE OF PROPOSED WORK: ReplacemPxit of stsucturally deficient bridge. 14. STATE REASONS WHY THS APPLICANT BELIEVES TFiAT THIS ACTIVITY MUST BE CARRIED OUT IN WETLP.NDS. ALSO, NOTE.MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS. Unable to deterrr�ne if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU ARE REQUIRED TO CONTACT THE U.S. FISA AND WILDLI.E SERVICE (USrWS) AND/OR NATZONAL MARINE FISHERZES SERVICE (NMFS} REG?,RDZNG THE PRESENCE OR ANY FEDERALLY LZSTED OR PROPOScD FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY SE AFFEC:ED BY.THE PROPOSED PROJECT. HAVE YOU DONE SO? YES [X] NO [ J RESPONSES FROM THE USFWS AND/OR NMFS SHaULD BE FORWARDED TO CORPS. 16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER - (SHPO) REGARDING THE PRESENCE OF HISTORIC PROP�RTIES IN THy PERMIT AREA WHIC:i . MAY BE AFFECTED BY THE PROPOSED PRO.TECT? HAVE YOU DONE SO? YES [}{] NO ( j RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS. 17. ADDITIONAL INFORMATION REQUIRED BY DEM: A. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, ST�AMS,:AND LAKES ON THE PROPERTY. ' B. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO"BE 22-LDACTED BY PROJECT. C. IF DELINEAT20N WAS P�RFORMED BY A CONSULTANT, INC.r.WE ALL DATA SHEETS _, RELEVANT TO THE PLACEMENT OF THE DELINEATZON LINE. ` - D. ZF A STORMWATER MANAGEMENT PLAN IS REQUIRED FOR TFiIS PROJECT, ATTACH �, COPY. E. WHAT IS LAND USE OF SURROUNDING PROPERTY? R SiC3 ni-i�3i t��ral farml�n� F. IF APPLICABLE, WHAT IS PROPOSED METHaD OF ScWAGE DISPOSAL? • NA � �. 8- I$- OWNER'S SI ATURE DATE � �-0 � 1799. 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STONY 33 n�a D 3 0�]63 F�. 4' ne� I[] tn z.. — � - - , � �,�� � 14 ; ��b� , 17 � � 'J IlQ4 MM — s 1]6I - e COrbefl 1101 .t1AI 11 11� 11 ^ I�OA .._ p p f': 11�� 'a � 61 1T10 'V� � y �� I10] �, i I -�._ ' 111] h y� i.3 I7= .� �. � � � �• • ~I �L � �' ' '��� ' / 62 t�9 � � n�•✓ r�. p � rO � ^ A L A M A N C E C O U N T Y � �'�� �� I � O R A � Z _ o \ � 0 z � � _. ___ — , ,� � ,,, - — , _. � � ► , ; . -- — ' , '- � , `; ; � _� , -- _ ; � --- , -- - _ ; � _ -; � — -- � _ _� ; ° - � -.%' , r (� - . ;� � i h� - �. _ J� �-------- � _ � _ - _ . — ; _ ;� - � , —.—__ i _ '' i r1G -- _i . - � % � % �-�---' � '`'-� � _-," i ,1 ��'s _ — - - � �-- �:r ��A ��:�:-E L ; �` ��.0 N � ,,,_� o�� _ � �`� :����,_�J� �a�� _ _ ; , � — , W� , T , , y;' ,. , _ ;- , y fi c u'i e ; ; � `. c ;ti.���=i. � � .. - , i ,: ' ,,� . ` ,' - ; � � : '� ' , � ^��, -_ - -- � � �,�,: � , . -- ; _ � -- � ` - __. - - � -- - ;-- . � - ' -- ._ _ ; -- -� _.: ; � _-: .., ,_ , _ _ , ;" ��---.'--_ ----- - -------------�:--------- -- _;.---, -------- -=_- --� -- - ___ � � ., - `_ -. - , , , � , _. - _ ,,_- ' ' ---7' _` _—� - � ---- � _- , . _ - � � � � - � - - _ ' � �4• . _ - ,r � � r -- � _. - --��. , ` _ _ -. , _ , . � _. , . , _ . , _ -, _-- -- ,. �� _. >. , _- , -�' ; _ _. _ . - . - _ _ ' z - __ '� � _ , __ ., , __ --�:�- , = � �� �ry __., , - _ - � � \ _ `� c, � -. _ � - �� ' %i= �. „ " - � _ _. � _ � : : .� � �_ __ , j _ � � ' I _ • -�-�-sri / - � _ .. I . , � i "�- ' � i'"_ � :. 1'J - __�_�__'. I ``• _ , �I.:_,._ i _. � -_• . — ' •�� ' � . ' � _ � • �-....: ' . ' ' ___" _ . ' - � I�� .- . . • _ "___-� _ . _ I /� - � �`� --- ; _ _ - _. - ' --_- �1a . - � = - - — - � , -- - � .� - _. - _.. � � = ' '`^� _ �. � � � .,�` , � ' C� . - � , - �� _„__. � � '� . _ -. I - - ' ��% r,' ` : ` � . I _ � -I _ - _ • . , � � -' � �' -� — _ ' / l� `' . ,--j � . ' , __ - ; r i I' . . '�, i � � _ � %' � r � _._��s ,f . V . ..� _ /, �'I J � � __ ' I / ` . • � -• _ _ , _ - - - - , __ � s � � � �, � - I � , -- � � � _-_ � ' I i _ _ . _ .� � li _ 1 � I � � . . � � � :.1 - _ .`\ ' I .� _ _.,__� ____. _ ' f ' ` -_'._'r ( I' �� . ' . � 1 � _ _ _ _ - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 - _ _ _ _ _ �- �� � �� ';. �I _ _ _ __ :i_____" �; /,' � � j �� � 1�ti� �.i..r.� � G T �� � — � I �' / _- ___ /1 � � � \ � ` ' � __ - j ' I 1 _ . ... ___ . � , . . _ .. J v �� a • DEM ID: ACTION ID: , NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT �): JOINT FORM FOR HATZONWIDE PERMITS THAT REQUIRE NOTIFICATZON TO THE CORPS OF ENGINEERS NATIONWIDE PERMITS THAT REQUIRE APPLICATION FOR SECTION 4Q1 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.. DZVISION OF ENVIRONMENTAL.MANAGEMENT NC DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES P.O. BOX 29535 RALEIGH, NC 27626-a535 ATTN: MR. JOHN DORNEY Telephone (919) 733-5083 : ONE (1) COPY OF THIS COMPLETED APPLICATZON SHOULD BE SENT TO THE CORPS OF ENGINEERS. SEVEN (7) COPIES SHOULD HE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT. PLEASc PEiINT. 1. OWNERS rr�tE: N.C. Departln�nt of Transportation • 2. OWNERS ADDRESS: P.O. BOx 289 � � Siler Citv, 1V. �. 27344 3. OWNERS PHONE NUMBER (FiOME): NA (WORK): 919=742-5649 4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLc CORPORAT� OFFICIAL, ADDRESS,, PHONE NUMBER: D. L. Jo son P.O. Box 289 Sil r Ci y. N.�. �7344 5. LOCATION OF WORK (MUST ATTACH MAP). COUNTY: '_'aswc�ll NEAREST TOWN OR CITY: Yancewille SPECIFIC LOC?.TION (ZNCLUDE ROAD NUMBERS, LANDMARKS, ETC.):. Bridge # 14 on N� 62 across Jordan's �eek 6. NAME OF CLOSEST STREAM/RIVER: Jordan'� "'r�k - 7. R2VER BASIN: rape Fear_' - 8. IS THIS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROII2„ SA, HQW, ORW., _ - WS I, OR WS II? YES (XJ NO [] 9. HAVE ANY SECTIQN 404 PERMITS HEEN PREVIOUSLY REQUESTED FOR,USE ON THIS ._ PROPERTY? YES [ j NO [� J :; >.; IF YES, EXPLAIN. , 10. ESTIMATED TOTAL NUMHER OF ACRES OF WATERS OF TEiE U.S., I13CLUDING : WETLANDS, LOCATED ON PROJECT SITE: Unable to det�rmine a�,prP�Pnt ,: , 7/8/92 � . . . � . .. . .,. . ;i,. i , : y - � -2- 11. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY _" THE PROPOSED PROJECT: . . ... FILLED: DRAINED: FLOODED: EXC�VATED: TOTAL' IMPACTED : -(1- 12. DESCRIPTION OF PROPOSED WORIC (ATTACH PLANS): BX'idqe replacement with a R� box culbert 13. PURPOSE OF PROPOSED woxxc: Replacement Of structurally deficient bridge. 14. STATE REASONS WHY THE APPLICANT BELIEVES THAT THIS ACTIVITY MUST BE CARRIED OUT IN WETL?.NDS. ALSO, NOTE MEASURES TAKEN TO MINZMIZE WcTLAND IMPACTS. Unable to determine if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIcE SERVIC� (USrWS) AND/OR NATIONAL MARINE FZSHERZES SERVICE (NMFS} REG�RDZNG THE PRESENCE , OR ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED OR THR�'ATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFEC�'D BY.THE - PROPOSED PROJECT. HAVE YOU DONE SO? YES [XJ NO ( J RESPONSES FROM THE USFWS AND/OR NMFS SHQULD BE FORWARDED TO CORPS. 16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORZC PREScRVATION OFFZCER (SHPO) REGARDZNG THE PRESENCE OF HISTORIC PROPERTZES IN � PERMIT AREA WHICH . MAY BE AFFECTED BY THE PROPOSED PRO,TECT? HAVE YOU DONE SO? YES [}{] NO ( j RESPONSE FROM THE SfiPO SHOULD BE FORWARDED TO CORPS. 17. ADDITIONAL INFORMATION REQUIRED BY DEM: • A. WETLAND DELINEATZON MAP SHOWING ALL WETLANDS, STREAMS,.AND LAICES ON THE PROPERTY. B. IF AVAILABLE, REPRESENTATIVE PHQTOGRAP:i OF WETLANDS TO'BE II�D�CTED BY - PROJECT. . C. IF DELINEATION WAS PERFORMED HY A CONSULTANT, INCLI7DE ALL DAT� SiiEETS _. RELEVANT TO TF� PLACEMENT OF TfiE DELINEATION LINE. D. IF A STORMWATER MANAGEMENT PLAN IS REQUIRED FOR THIS PROJECT, ATTACH �, COPY. � E. WHAT IS LAND USE OF SURROQNDING PROPERTY? RPSid ntial t7�ra1 farmlan� F. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPaSAL? 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I� G � , ,i . � /'/ I `� �i� '�r.0 {...►. �.1 �...�f�_�� � � .'�.: � I J � � . 1 l _ ' � . ., '� '�\ � '\ l i 1 J / i� �� � • - � � -- � � � � DEM ID: ACTION ID: NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT �): JOINT FORM FOR HATIONWIDE PERMITS THAT REQUIRE NOTIFICATION TO THE CORPS OF ENGINEERS NATIONWIDE PERMITS THAT REQUIRE APPLICATION FOR SECTION 4Q1 CERTZFICATION WILMINGTON DISTRICT ENGINEER CORPS OF ENGINEERS DEPARTMENT OF THE ARMY P.O. BOX 1890 WZLMINGTON, NC 28402-1890 ATTN: CESAW-CO-E Telephone (919) 251-4511 WATER QUALITY PLANNING., DIVISION OF ENVIRONMENTAL.MANAGEMENT NC DEPARTMENT OF ENVIRONMENT, HEALTFi, 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 AP?LICATION SHOULD BE SENT TO THE CORPS OF ENGINEERS. SEVEN (7) COPIES SHOULD BE ScNT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT. PLEASE PRINT. 1. OWNERS NAME: N.C. D2 3r'�i1P_rit of Transportation • 2. OWNERS ADDRESS: P.O. BOX 289 � Siler Citv, N.�. 27344 3. OWNERS PHONE NUMBER (FiOME): NA �woRx�: 919-742-5649 4. ZF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAI., ADDRESS,; PHONE NUMBER: D L Jo nsOn P O Box 89 Si1Pr Ci y N_"_ ?7�44 5. LOCATION OF WORK (MUST ATTACH MAP). COUNTY: �aswPll NEAREST TOWN OR CITY: Yancewill SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.);_ Bridge # 14 on N� 62 across Jordan's �eek 6. NAME OF CZOSEST STREAM/RIVER: �7 rdan's "Y�k _, . 7. RIVER BASIN: �ai�e e� - :.. 8. IS TAIS PROJECT LOCATED IN A WATERSFiED, CLASSIFZED AS TROUT,� SA, HQF1. ORW,, - WS I, OR WS II? YES (}{J NO [ J 9. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR:.USE aN THIS . . PROPERTY? YES ( j NO (xr J . ;: >.: ZF Y.�.'S, EXPLAIN. .. 10. ESTIMATED TOTAL NUMBER OF ACRES OF WATERS OF THE U..S., INCLUDING ,•, WETLANDS, LOCATED ON PROJECT SITE: Unable o d rmine a pr �Pnt — -. ,: . 7/8/92 � -2- I1. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDZNG WETLANDS, IMPACTED BY _ THE PROPOSED PROJECT: . FILLED: DRAINED: FLOODED: EXCAVATED: TOTAL'IMPACTED: -�- 12. DESCRIPT2oN oF PROPOSED WoRK (ATTACH PLANS): Bridge replacement with a R� box culbert 13. PURPOSc^. OF PROPOSED WORK: ReplacP_ment of structutally deficient bridge. 14. STATE REASaNS WHY THE AP?LICANT BELIEVES TI�.AT THIS ACTIVITY MUST BE CARRIED OUT IN WETI.�.NDS. ALSO, NOTE MEASURES TAKEN TO MINIMIZE WETLAND IMPACTS. Unable to deterrr�ne if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE (USFWS} AND/OR NATIONAL MARINE FZSHERIES SERVICE (NMFS) REG?RDING THE PRESENCE OR ANY FEDERALLY LISTED OR PROPOScD FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAI. HABITAT IN THE PERMIT AREA THAT MAY BE AFFfi'C'�ED BY. THE PROPOSED PROJECT. HAVE YOU DONE SO? YES [X] NO ( J RESPaNSES FROM TH� QSFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS. 16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC P�SERVATION OFFZCER (SHPO) REGARDING TFiE PRESENCE OF HZSTORIC PROPERTIES IN TFiE PERMIT AREA WHIC:i . MAY BE AFFECTED BY TFiE PROPOSED PROJECT? HAVE YOU DONE SO? YES [}{] NO ( j RESPONSE FROM THE SHPO SAOULD BE FORWARDED TO CORPS. 17. ADDITSONAL INFORMATION REQUIRED BY DEM: A. WETLAND DELINEATION MAP SHaWING ALL WETLANDS, STREAMS,:AND LAFCES ON THE PROPERTY. B. IF AVAILABLE, REPRESENTATIVE PHOTOGRAPH OF WETLANDS TO"HE IMPACTED BY PROJECT. � C_ IF DELINEATION WAS P�RFORMED HY A CONSULTANT, INCLUDE ALL DATA SiiEETS _, .. RELEVANT TO TFIE PLACEMENT OF THE DELINEATZON LINE. D. IF A STORMWATER MANAGEMENT PLAN IS REQUIRED FOR THIS PROJECT, ATTACH �, COPY. �. E. WHAT IS LAND USE OF SURROUNDING PROPERTY? RP�i�3Pnf-iai Y��ral farmlan� F. IF AP?LICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? 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DEM ID: ACTION ID: NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT �): JOZNT FORM FOR HATIONWZDE PERMITS TSAT REQUIRE NOTIFICATION TO THE CORPS OF ENGINEERS NATIONWIDE PERMITS THAT REQUIRE APPLICATION FOR SECTION 4Q1 CERTIFICATION WILMINGTON DISTRICT ENGINEER CORPS OF ENGINEERS DEPARTMENT OF TFiE 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, FiEALTH, AND NATURAL RESOURCES P.O. BOX 29535 RALEIGH, NC 27626-0535 ATTN: MR. JOHN DORNEY Telephone (919) 733-5083 ONE (1) COPY OF TFiIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS OF ENGINEERS. SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT. PLEASE PRINT. 1. OWNERS N�E: N.C. Department of Transportation � 2. OWNERS ADDRESS: P•0. BOX 289 --- � Siler Citv, N.�. 27344 3. OWNERS PHONE NUMBER (HOME): NA �woRx�: 919-742-5649 - 4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLc CORPORATE OFFICI�iL, tiDDRESS,. PHONE NUMBER: D. L. JOhiLOil , P.O. Box 289 Sil�r City. N.^__ �73d4 5. LOCATION OF WORK (MUST ATTACH MAP). COUNTY: '_"a�wc�ll NEAREST TOWN OR CZTY: Yancewille SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):_ Bridge # 14 on N � 62 across Jordan' s�eek 6. NAME OF CLOSEST STREAM/RIVER: Jordan'� "Y�k 7. RIVER BASIN: �i�e Fe� � - 8. IS TFiIS PROJECT LOCATED IN A WATERSAED CLASSIFZED AS TROQ2,; SA, HQW, ORW., -•.- WS I, OR WS I I? YES (}{ ] NO (] 9. HA�TE ANY ScCTION 404 PE.RMITS BEEN PREVIOUSLY REQIIESTED FOFt.USE ON THIS _ - PROPERTY? YES ( j NO [�. ] . :: >; ZF YES, EXPLAIN. - 10. ESTIMATED TOTAL NUMHER OF ACRES OF WATERS OF TFiE U_.S., ZNCLUDZNG - WETLANDS, LOCATED ON PROJECT SSTE: Unable to det�mine 3 T�r �Pnt -.. , . . 7/8/92 _ ,��. R. -2- 11. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDZNG WETLANDS, IMPACTED BY _" THE PROPOSED PROJECT: . . FILLED: DRAINED: FLOODED: EXC�VATED: TOTAL'IMPACTED: -�- 12. DESCRZPTION OF PROPOSED WORK (ATTACH PLANS}: Bridg��r�placement with a R� box culbert 13. PURPOSE OF PROPOSED WORK: Replacement of structurally deficient bridge. 14. STATE REASONS WHY THE APPLICANT BELIEVES TFiAT THIS ACTIVITY MUST BE CARRIED OUT IN WETLANDS. ALSO, NOTE MEASURES TAKEN TO MINZMIZE �TLAND ZMPACTS. Unable to determine if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE (USrWS) AND/OR NATZONAL MARINE FISHERZES SERVICE (NMFS) REG.�RDING THE PREScNCE , OR ANY FEDERALLY LISTED OR PROPOScD FOR LZSTING ENDANGERED OR THREATENED SPECIES OR CRITZCAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFEC'�D BY.THE PROPOSED PROJECT. HAVE YOU DONE SO? YES [X] NO [ j RESPONSES FROM THE USFWS AND/OR NMFS SHOULD HE FORWARDED TO CORPS. 16. YOU ARE REQLTIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) REGARDING THE PRESENCE OF HISTORZC PROP�'RTIES IN TFiE PERMZT AREA WHIC:: MAY BE AFFECTED BY THE PROPOSED PROJECT? FiAVE YOU DONE SO? YES [ j{ j NO (] RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS. 17. ADDITZONAL INFORMATION REQUIRED BY DEM: A. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS,:AND LAKES ON THE PROPERTY. B. IF AVAILABLE, REPEtESENTATIVE PHOTOGRAPIi OF WETLANDS TO"BE IMPACTED BY - PROJECT. C. IF DELINEATION WAS PERFORMED HY A CONSULTANT, INCLUDE ALL DATA SHEETS ,. RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE. D. ZF A STORMWATER MANAGEMENT PLAN IS REQUIRED FOR TEiIS PROJECT, ATTACH �, COPY. � E. WHAT ZS LAND USE OF SURROUNDING PROPERTY? R�idPni-ial rtiral farmlanr� F. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? . NA � �, $- I$- OWNER'S SI ATURE DATE �.7 !t_ iw ��ee,f ^ fAS �Ji� i�iz o d i�s� G(� , � . 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'. �. . . .. . .. . .. il ,\\ `.\ � ` i' - ' I i . .,. � � '� . . , � . . .� . , � -.. . : . y I �`1 ". - �� �- , i ' Iy -J � ! � � � .5�� �n =��—� ����� � 1 DEM ID: ACTION ID: ; NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT �'): JOINT FORM FOR HATZONWIDE PERMITS THAT REQUIRE NOTIFZCATION TO THE CORPS OF ENGINEERS NAT20NWZDE PERMITS THAT REQUIRE APPLICATION FOR SECTION 4Q1 CERTIFICATION WZLMINGTON DISTRICT ENGINEER CORPS OF ENGINEERS DEPARTMENT OF THE ARMY P.O. BOX 189a WILMINGTON, NC 28402-1890 ATTN: CESAW-CO-E Teleohone (919) 251-4511 WATER QUALITY PLANNING. DIVISION OF ENVIRONMENTAL.MANAGEMENT NC DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURC�S P.O. BOX 29535 RALEIGH, NC 27626-0535 ATTN: MR. JOHN DORNEY Telephone (919) 733-5083 : ONE (1) COPY OF TEiIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORYS OF ENGINEERS. SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT. PT.EASE PRINT. 1. owrrE?�s rr�E : N. C. De artment of Transportation • 2. OWNERS ADDRESS: P.O. BOX 289 � Siler Citv, N.�. 27344 3. OWNERS PHONE NUMBER (FiOME): NA (WORK): 919-742-5649 4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICZAI„ eiDDRESS,, PHONE NUMBER: D. L. JoYLn�on P.O. Box 289 Si 1 er Ci ty1 N. �_ ?7344 5. LOCATION OF WORK (MUST ATTACA MAP). COUNTY: �a�well NEAREST TOWN OR cZTY: Yancewille SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):_ Bridge # 14 on N� 62 across Jordan's �eek , 6. NAME OF CLOSEST STREAM/RIVER: Jord�n'� "'r�k 7. RZVER BASIN: �ape e�r - 8. IS THIS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROIIT,; SA, HQ�^1. ORW., _ WS I, OR WS ZI? YES IX� H� �� 9. HAVE ANY SECTION 404 PERMITS BEEN PREVZOIJSLY REQUESTED FaR;USE ON THIS _ .. PROPERTY? YES ( J NO (� J :; ,, IF YES, EXPLAIN. 10. ESTIMATED TOTAL NUMBER OF ACRES �F WATERS OF TF3E U.S., INCLUDING WETLANDS, LOeATED ON PROJECT SITE: Unable to det�rmi_ne at r_�rP�Pnt : , . 7/8/92 �.: t . -2- I1. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY _ THE PRaPOSED PROJECT: . FILLED: DRAINED: FLOODED: EXCAVATED: TOTAL'IMPACTED: -�- ' 12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS): Bridae replace n with a R� box culbert 13. PURPOSE OF PROPOSED wORK: ReplacemP_nt of structurally deficient bridge. 14. STATE REASONS WHY THE APPLICANT BELIEVES THAT THIS ACTIVZTY MUST BE CARRIED �UT IN WETL?.NDS. ALSO, NOTE.MEASURES TAKEN TO MI:IIMIZE FIETLAND ZMPACTS. Unable to determi.ne if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIrE SERVICE. (US'rW5} AND/OR NATIONAL MARINE FISHERZES SERVICE (NMFS} REG?,RDING THE PRESENCE , OR ANY FEDERALLY LISTED OR PROPOScD FOR LISTING ENDANGcRED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFECT'ED BY.THE � PROPOSED PROJECT. HAVE YOU DONE SO? YES [Xj NO [ J RESPONSES FROM THE USFWS AND/OR NMFS SHQULD BE FaRWARDED TO CORPS. 16. YOII ARE REQUIRED TO CONTACT THE STATE HISTORIC P:3EScRVATION OFFICER (SHPa) REGARDING THE PRESENCE OF HISTORIC PRaPERTIES IN TFiE PERMIT AREA WHIC:i MAY BE AFFECTED BY THE PROPOSED PROJECT? HA�IE YOU DONE SO? YES [}{ J NO (] RESPONSE FROM THE SHP� SAOLTLD BE FaRWARDED TO CORPS. 17. ADDITIONAL INFOFtMATION REQUIRED BY DEM: A. WETLAND DELINEATSON MAP SHOWING ALL WETLANDS, STREAMS,;AND LAFCES ON THE PROPERTY. B. IF AVAILABLE, REP?tESENTATIVE PHQTOGF�P.PH OF WETL.�NDS TO' HE II�DACTED BY � PROJECT. C. IF DELINEATION WAS P�RFORMED HY A CONSULTANT, INCLIIDE ALL DATA SHEETS _, .. RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE. D. ZF A STORMWATER MANAGEMENT PLAN IS REQUIRED FOR THIS PRO�CT, ATTACH �, COPY. E. WHAT IS LAND USE OF SURROUNDING PROPERTY? RPGI(�Pl'1�'lr'3�I rilYal farmlan� F. IF APPLICABLE, WEiAT IS PROPOSED METFiOD OF SEWAGE DISP�SAL? . 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J..: � �.. �� - _ _ � _� � , � j ; " - — ' � � i `� . ,. , , . • ,. . ,. _ ,. _ _- , . , . _ f . , , ., - , " .. . . . � , , , - . _. � ,. . , . � � :. .. • -.J C ���- � �`'� �� � ���i . ��� �:� , , � �� � 4 JaMES B. HuNr JR. GOVER��IOR .�v � dy'^� � �� � .���. STATE OF NORTH CAROLiNA DEPARTMENT OF TRANSPORTATION P.O. BOX 25201, RALEIGH, N.C. 276 1 1-520 1 P.O. BOX 289 Siler City, N.C. August 18, 1999 Division of Environmental Management John Hennesy, WQ Certification Unit P.O. Box 29535 Raleigh, N.C. 27626-0535 Dear Mr. Hennesy: DAVID MCCOY ACl'L�lG SECRETARY Please find seven (7) copies of an application form attached for your review. If I can answer any questions you may have or if you have any comments, please call me at (919) 742-5649. Thank you for your assistance in this matter. Attachments Sincerely yours, �,4w�w c� . Dennis L. Jo son Bridge Maintenance Superintendent - � DEM ID: ACTION ID: , ' NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT �): JOINT FORM FOR NATIONWIDE PERMITS TSAT REQUIRE NOTIFICATION TO THE CORPS OF ENGINEERS NATIONWZDE PERMITS THAT REQUIRE APPLICATION FOR SECTION 4Q1 CERTZFICATION WILMINGTON DISTRICT ENGINEER CORPS OF ENGINEERS DEPART."3ENT OF TFiE ARMY P.O. BOX 1890 WILMINGTON, NC 28402-1890 ATTN: CESAW-CO-E Telephone (919) 251-4511 WATER QUALITY PLANNING.� DZVISION OF ENVIRaNMENTAL.MANAGEMENT NC DEPARTMENT OF ENVIRONMENT, FiEALTFI, AND NATURAL RESOURC°S P.O. BOX 29535 RALEIGH, NC 27626-0535 ATTN: MR. JOHN DORNEY Telephone (919) 733-5083 ONE (1) COPY OF THIS COMPLETED APPLICATION SFiOULD BE SENT TO TFiE CORPS OF ENGINEERS. SEVEN (7) COPZES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT. PLEASE PRINT. 1. OWNERS NArtE: N.C. Department of Transportation � 2. OWNERS ADDRESS: P-O. BOX 289 � Siler Citv, N.�. 27344 3. OWNERS PHONE NUMBER (HOME): NA (WORK): 919-742-5649 � -- 4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, r1DDRESS,�, PHONE NUMBER: D. L. Johnson , P.O. Box 289 Sil�r City, N_�_ �7344 5. LOCATiON OF WORK (MUST ATTACH MAP) . COLINTY: .a�ell NEAREST TOWN OR ciTY: YanceWille SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):_ Bridge # 28 on N � 62 across Jordan' s�eek 6. NAME OF CLOSEST STREAM/RIVER: Jordan's "'rPPk 7. RZVER BAS2N: =ape Fear - - 8. IS THIS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROII2,; SA, HQf^1. ORW., -- WS I, OR WS II? YES IX� H� � � 9. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS _ • PROPERTY? YES ( j NO [xr ] . ;; ,>.; ZF YES. EXPLAIN. 10. ESTIMATED TOTAL NUMHER OF ACRES OF WATERS OF THE U.S., INC.LUDING ,� WETLANDS, LOCATED ON PROJECT SITE: Unable to det�rmine at pr �Pnt -.�, : , 7/8/92 ���� ;. *.. I a' . -2- 11. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY THE PROPaSED PROJECT: FILLED: DRAINED: ' FLOODED: EXC��7ATED : TOTAL'IMPACTED: -�- 12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS): Brldc72 replacement wi th nnP 1 i nP nf 1 �R" }�' f�'�" ''M �i � arc�h 13. PURPOSE OF PROPOSED WORK: Replacement of structurally deficient bridge. 14. STATE REASONS WHY THE AP?LIC?.NT BELIEVES THAT THIS ACTIVITY MUST BE CARRIED OUT IN WETL�NDS. ALSO, NOTE MEASURES TAKEN TO MINZMIZE FIETLAND IMPAC:s. Unable to determine if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SE.RVIC� (USFWS) AND/OR NATIONAL MARINE FZSHERIES.SERVICE (NMFS} REG.�RDING TfiE PREScNCE OR ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED QR THRE.3T�NED SPECZES OR CRZTICAL HABITAT ZN THE PERMIT AREA THAT MAY HE AFFEC:'E'D BY.THE PROPOSED PROJECT. HAVE YOU DONE SO? YES [X] NO [ j RESPONSES FROM THE USFWS AND/OR NMFS SHQULD BE FORWARDED TO COR?S. 16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION aFFZCER (SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN � P�RMZT AREA WHICH MAY BE AFFECTED BY THE PRaPOSED PROJECT? HAVE YOU DONE SO? YES [}{] NO (] RESPONSE FRaM THE SHPO SHOULD BE FORWARDED TO CORPS. 17. ADDITZONAL INFORMATION REQUIRED BY DEM: � A. WETLAND DELINEATION MAP SEiOWING ALL WETLANDS, ST�AMS, AND LAKES ON ` TFi�' PROPERTY. B. IF AVAILABLE, REP?tESENTATIVE PHOTOGRAPH OF WETL.�NDS TO"BE IZLpACTED BY • PROJECT. C_ IF DELINEATION WAS P�'RFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEETS _, RELEVANT TO TF� PLACEMENT OF THE DELINEATION LINE. ' D. ZF A STORMWATER MANAGEMENT PLAN IS REQLTIRED FOR THZS PROJEC'�, ATTACH �, COPY . i . E. WHAT IS LAND USE OF SURROUNDING PROPERTY? Besidential rl�rai farmlanc3 F. IF APPLICABLE, WHAT IS PROPOScD METHaD aF SEWAGE DISPOSAL? . 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I 17 � — n» , ' i�o. 1. � � 84 � t� ; ° —r— ,e,° , m ,,,� y .7 ' y;� � 1167 O , � 6 .� ' .:i, � � \, �' �QO s�:' ��� �� C62/. \l i] ri� ��05'. , ., iwo�` .e i�v 7 : "'_><zi , .:;�.._.il'� / ', •;y . t� I , u,� % – r,, CASWELL GAME , 1� v�.o.o�n 1 s ,� +uoe � � ) j� ` �,°� .� t iiii �11`�nae� i�� .Wo„� I _ • LAND !r� J "� •• % 73 � �i .e , esU' i � ' �� Coy� ^ � f�r � / i��e G�K 67 / \ . / 'e /i»7 � -/ � / - / �.1 ° 7l �:. \ �106 „y� ,T �. i ,4 (� � \ \ �»s i�� � � ��z: i � a _ `� . i �-� � , � se � TO?"O' �\ i� B�h , �. iso) �75 � ti.` im : - � � v�i �) y� _ 1 :' � � � r:y 1 �, � _ \� � ��v� 9 it3s W� 1.9 �i'S ii�e �� iixs / -` � i� �� �" .��Y��/ ,�i�ae �/ ' �\ / Gr'b \\ Owo.� i \\ �a` ,�""a — q � ��z� � _ , �^% 103 - I \�./�/ C � • ..,. - F, J, .. ,no o � ,'� /J t�\Y 76 �/ nx� I � (� . n]o.y i� '_:� �r� 21 j' i nov in: ,�:o �, � � C�J4�`' .;;: i S -/ �S �� � \� II ' .b � _ ���10 �(� J'y-? � l05 � f 1•1`. / � � ` I _ nu i� v p � �C ,yy �1 ., a s M1. �� . �: i B 22 ' ���o,:' � 107 �_ .. r�`� 71 r �,� , 70 i�.o I , p�^� ,1 ��, J i�w / _,.!v1, �� �� �� � .4�� S �uo nxe / 'r e'� B�'CJ� '�''.�il � � L � e6� Q'; �,c �i» '' i��v i.e 56 �- «s t, � �Z , ' �� ��7� �a iive . � .t n�r , i3� .e��" `� "_' � 1 � Hi� b 1'=' qee 1?, b �� 1130 � � ' 11��'O� �O .1 I)31 1]l� �_ l .1 a ,'1\ _ �`)�� - ) .J 'S � tleo / //'"�'��14 7 1� I S8 ' p -T� - uu � � .5 �� / � �) // ) J i�SV � .' y �100� :o e ��oo "�°- iies nn /^ t�5 /` �� U �v�e t' J �i21-'r , � .e Milw.iil� � �a u ��fz P / v% � � �� i�i� 111] S]y� Ila . 63 .J � ! '0 11C� djll�s 111� �iIV�� � 11]� ^ ti � 1 �� _, ' 1]J]� \ ' � 1)A3� U� i109 7 " � � II]] 113] I]36 Q �l e �� ;�� 99 > ,�;5 J' '' � S 1 1 e � � ' .�/ i � ��b,; 9 . � �; i.y �3 (\ � o�. s �"'d'° i�e. � � I o ,. `y � �CwnP \ o �l ?° - 0` i � w ,� ` -�-- i � � ,�,. 8� I% P I I 4 � jprTp� _ n e v�v neo i `' - ��.� / \� '\1 i iio�^� � — �� 1 t� . �3_ , i�ti Y515 7 / 7 ` ' � 1 M1 �., , ��» P, „» D64\ ��a P � ��y� - ��.s j � 25 � 1— 30 e �JJ ` I ,� tIW: ,Q �3 � —�J' '. 1 � c �� t170 �9 Li 1IOA U / y '► 3 �°7'^Of , i)ee 'J � ` , 39- �: �'I � \� �i e t •s -3 [� � � �,r iooiL ,�5 � �,� o �O� � �mi,A. ��o�� e �0 7' J� F�s ^. i�ev �i Ila7 >>b � �,R J��.� -� -0 ii„ �B�r� Giio� � `'�~ E': �', i.e 1.441 Md�nai . 28 � '� P�t � I � l3 ��_ i�.o G6 � 5�w�.h ,L t] iioo _� �� � ��aa � ��e� P � 9 3 Pi�as ,C, a �7 �. �es ��' „�9 , _�. _- n«+. 33 y � D ,�a� - , �. �.- s «� ,��� � 14 : s _ - ��w � MM — i�e� CabeM iioi .nei no i� i� �ioe _ s �' �i ��2 .1 �'10 �T�. L11 �° •.�!"_�iii. 2.7 I�, �' ve7 - - �=� .` �'� � y_�. ; . �� .^3 2 � / t� ` "�� 63 �J 119 I ,. - � � � � o O p ° O � ^ A L A M A N C E � C O U N T Y � �;� �� � O R A � � � � 0 z � _ . .. .. , ___ �� - - � ._ - N�' ; , : , . � - -� -- - � - __ �,�.�; _ . � __ _- : , ��A 5���� � � � U, N � �..�' � ..�� - --- _ ' :� ` ., �;=;._ 5°�'`� _ _ ; � , _ ... � - , , - --- -- - ....---�_ . . _: _� - _ � _. _. � � n � -- Y�'i. e � = , , � � ; _ .. , . l� � �� -- _.. ,�. . - _ . � ` � —. — � � , _ ---,- -- ._. , . .; _,. - c " " .. _ -- -.- _ � -- - - - . � -�; g ' -- - i_' - ^� • __ ' Jc�� - - � -- _ - -- ._- _ - _ ' " _ � -- — _. - _ _ - -"- C,��" _ - - � —_:._-. __ , ,. � _ _ .. . z �^�- --- - __ -- . ` � � . _ z_.. - _ - — — . .�_ ._ .,� _ . -- _ ----. . - — — .- _ - �� • -- '�'+ — — ' ' — , `�;� � _ � _.. �;. � - - � ` - r „ G � -- - . . . ' ��r�,� __. '--� . � , -- - _ � � �� e � � 1 ` C� - _'c � _ - -- - v � i. _.. _ ".J . - �� .�-�--^ _ ___ I — r - �..-.' � ' . � � - � - _ _ _ _ _ _ _ _ _ _ _ . _ _ . i _ - _ _ _ _ _._ _ _ _;_ _'_ _ _ I � � � � � � � 1" '.. �" _ . � j � "� � � � � � �� � � i " � _' _ __' _ \ � . . . , ., - _ � . � + DEM ID: ACTION ID: NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT �): JOINT FORM FOR IZATIONWIDE PERMITS THAT REQUIRE NOTIFZCATION TO TSE CORPS OF ENGINEERS NATZONWIDE PERMZTS THAT REQUIRE APPLICATION FOR SECTION 4Q1 CERTIFICATION WZLMINGTON DISTRICT ENGINEER CORPS OF ENGINEERS DEPARTMENT OF THE ARMY P.O. BOX 1890 WILMINGTON, NC 28402-1890 ATTN: CESAW-CO-E Teleahone (919) 251-4511 WATER QUALZTY PLANNING. DIVISION OF ENVIRONMENTAL.MANAGEMENT NC DEPARTMENT OF ENVIRONMENT, FiEALTH, AND NATURAL RESOURC�S P.O. BOX 29535 RALEIGH, NC 27626-0535 ATTN: MR. JOHN DORNEY Telephane (919) 733-5083 ONE (1) COPY OF THIS COMPLETED APPLICATION SHOULD BE ScNT TO THE CORPS OF ENGINEERS. SEVEN {7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRaNMENTAL MANAGEMENT. PLEASE PRZNT. 1. OWNERS rrartE • N.C. De artment of Transportation � 2. OWNERS ADDRESS: P-O. BOX 289 Siler Citv, N.�. 27344 3. OWNERS PHONE NUMBER (HOME): NA (WORK): 919-742-5649 4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, eiDDRESS,� PHONE NUMBER: D. L. JO n�On P.O. Box 89 4i 1 r Ci ,X,, N_ �_ 27344 5. LOCATION OF WORK (MUST ATTACH MAP). COUNTY: �aswell NEAREST TOWN OR C2TY: YanceWille SPECZFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):. Bridge # 28 on N� 62 across Jordan's �eek 6. NAME OF CLOSEST STREAM/RIVER: Jord n's �T'PPjf - 7. RZVER BASIN: .%ai�e Fear - - ,:.. 8. IS THIS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROII2,; SA, HQ�^1. ORW., - WS I, OR WS II? YES (XJ NO ( j 9. HA�7E ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR US^c ON THIS , PROPERTY? YES ( J NO [x. ] . ;: ,- IF YES, EXPLAIN. . 10. ESTIMATED TOTAL NUMBER OF ACRES OF WATERS OF THE U.S., ZNCLUDZNG „ _ WETLANDS, LOCATED ON PROJECT SITE: Unable to det rminP a pre�Pnt -. ,: . . �/a/92 � — _ -z- ,. 11. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY THE PROPOSED PR�JECT: . FILLED: DRAINED: FLOODED: EXC?,VATED : TOTAL' IMPACTED : -fl- 12. DESCRIPTION OF PRoPOSED WORK (ATTACH PLANS): Bridcre replacement ��i th nnP 1 i nP nf 1 78" X A"�" ''M �� arc�h 13. PURPOSE OF PROPOSED WORK: Replacement Of structurally deficient bridge. 14. STATE REASONS WfiY THE AP?LIC�NT BELI�VES THAT THIS ACTIVITY MUST HE CARRIED OUT IN WETL?.NDS. ALSO, NOTE MEASURES TAKEN TO MZNIMIZE WETLAND IMPACTS. Unable to determine if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU ARE REQUIRED TO CONTACT TEiE II.S. FZSH AND WILDLI?E SE.�VIC� (USrWS) AND/OR NATIONAL MARINE FISHERZES ScRVICE (NMFS} REG.�RDING THE PRESENCE , OR ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGcRED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY HE AFFEC�D BY.THE PROPOSED PROJECT. HAVE YOU DONE SO? YES [X] NO () RESPONScS FROM THE IISFWS AND/OR NMFS SHQULD BE FORWARDED TO COR?S. 16. YOU ARE REQUIRED TO CONTACT THE STATE HISTORIC PRESERVATION OFFICER (SHPO) REGARDING THE PRESENCE OF AISTORIC PROPERTIES IN TXE PERMIT AREA WHIC:i , MAY BE AFFECTED BY THE PROPOSED PRO.TECT? HAVE YOU DONE SO? YES [}{] NO ( j RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS. 17. ADDITZONAL INFORMAT20N REQUIRED BY DEM: � A. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STR�AMS,:AND I,AKs.S ON ` THE PROPERTY. B. IF AVAILABLE, REP?tESENTATIVE PAQ:OGRAPH OF WETLANDS TO"BE IM°ACTED BY PROJECT. C. IF DELINEATION WAS P�RFORMED BY A CONSULTANT, INCLUDE ALL DATA SFiEETS _, ,. RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE. D. IF A STORMWATER MANAGEMENT PLAN IS REQUIRED FOR THIS PROJECT, ATTACH �, . COPY . . '� .. E. WHAT ZS LAND USE OF SURROUNDING PROPERTY? RP�identia ri�ra� farmlan� F. IF APPLICASLE, WHAT IS PROPOSED METHaD OF SEWAGE DISPOSe�L? . NA � � f3-I�-qR OWNER'S SI ATQRE DATE �, w „�,�, . j,� S °`.1�' 60 e is`. , .—cy's 6 7 i�s� > > . � a - � '- `� � � � r,,,,� �s�� i5�+ . e � G adt' i»o ? � — , . y,y� � � '' o / � isoo �, i!i• 1 s � ifeo�� � .5 isee tr7 1 3i2 � �a 9 � _ Q�(, � � ! ,_z, � T y� y,�� „z� P3� ° � y ' , p � . .e:� � R��S�.� � � '� i»sPoh�dk ieov � �ew o �no � ise� � , . � „_ 41 , sp,;,o � - �,,,� �A �7 � � e �� V tfi�. _ °• F- ., i77� .6 ; lo ! Z b�� J '� • 111] ] 344 Ill� CwnQ E b�`:�' K � . ., � � 43 H�` u �». ., � `y `' 45 , � � „� 0 36, �.e , ,-: „� - y � e �.a � J.p �eve ' n .r.B.M�.I � .a � o p i.n� ` ini � �.y �. / S'. n uoe� �h � �� ! isvs �sv� _ � ��a �- as� � 1544 T�0 y �n� I.V I I� "'39) 1ili.� �' ped�rrell '� t _j� y C�,K 1.0 � . y e t. � � :. ins y \ .t F' � // q L M1 ...o� 39 �1. �i0 ��. � ',h `� h ` . '� �v 94 s r `� [7 ine � inz �h ,t� sa � �se. j/ 7 �.� : i�i E" `� ' � � F q �.:. . ..� `2 ,, `a i�oe , - � � (� Z� �..�� YANCEYVILLE ii, bZ . ieoo .5 leox / i ISOV ��, �.1 � 11lt F�,t SB \� � rW. 1.511 �� I , I 111 ` �1 ` � �O ' /�(` ` ' -"P44 � .� — e � �, :�� �, o �8 'TV � � � I)tl � 1� t Z � �16] �:� FI✓ � .7�. .7 Oi,� � 1./ �� Atf / u�. a ni� ` r:y� 'y..:\ � � . SB / fv i��� 1 _��/ .� Cawdl 5l.tz� 's �' ., � . . ��*��f. � . '`�� .. 1 ieoi ? � � � \ \ _ � l�} �aiz ,�,� �}, 1 \�: .;i' • _ ^ 69 � I';� ; �.: �� 117 �/; `'�: . �,» „' 1. � , ,,n a 84 0 „�� t.\ , ,� �e�o ' " , : ; „o� L �� � � � ' � i ��ez O — :� :� , r� ioa � ��O s. LL�3!1 m r C6L���� \ ���1 6 �� vos ,� , e iwo .a j � i�n ` ? ;. �:;:;:;:<l , :.<l:?.-i� � . '.y � t�� _ 1 v + � o u,� , o � �;, 3 CASWELL� GAME ^ �� ( s � uos � c� .� i�z� ` vae ( LAND L y,• L�� , � ' � t 73 ,� . s _ �� CobM '.: fM � i�in� � � `� a3� , i/\ / � "e /i»7 �� . : ' ' F�' ` ) ♦ \ 9wP ^ �-� '° � �i G ' " .: — , 1.1 % �\ 11]S I\� I]06 � \ / ' 1 7 1� ,T �'� �, '� n:z i � � ` %� r�� \ :y ' �7 � ,iise B� .�. iso) i 75 � ti-� �m 1 v�� � . � ( �\ _ \ ) y �1 � 119� :y " ,` ' � �) / � �. /^ \ 9 t�75 �.9 �r5 l.4 / \\ p� � w'. / 'i�ae G. / \ t,os��� ii�e ii�s % � � _:� u`�"��3 - J . Qwv!� l°°'a Mi q , \ irn � �� =�� o . ',y, 1 F `'' t ��Y 76 �/ iinl ` ;� n7o�y � ���_.,. �^ �no z1 /� � �� i�,� ,��< ,;, �� C54.5 � % - �' j 21 � � 6 , . ,., � - `," ' ) � �,' ��..1� `�� /� �� � 105 �� . P ' ' : � ry �� � / ss 5 a � 22 � ,��o.:� � 107 _ 71 ,' =� .. ,Q — j � ~J „�� � � � 70 �,.� J _ K� � , � . s ii.v // , s �� � c� '.\ � �� 7 �. iuo ii7e / '' ii�v i.e � � � C5� 56 ��.�. . � � B6� �.t . — t�is ! l Hiphio.ran s.!� iiL'. � I�sa f l� ' 1)�� �Z� . �. _ �' b .l!�..' (� e� / �,� n� t�7e nee ? C� b �: e It1e IISO j'' � lil� I0�/ F� �� ` � illl 1 I)t� /� QO .' N � �� o, /1 O J� . l 00 Y _ (f, - ) .S -S > iieo � � 7 ' � o F . �� - .s �� , �i� J y � 1 -0 ii�� y� �i» '�6 iies �ti� t�5 ' ^ a� �.ne t � �i i" ,� .s Mil.s+iil� Y �o u i�fz P. /` �° ° �� ��i. It�] Qy� ��y 63 .J ' , 'Q �\` r�lles N- ' ♦ )i s1u Cxow y � \I�]� Iloa .7 ~ J �1�7 ` , Vs] ��� �4 vs1� / �0 UI 56 /' � � -� .y` ves o ` �.--.� �—�^ g g :, „�, � � ; g � 1 , , � r % ��e� � g 1J � � • � � �:t.�. 1177 � \J S bk JMidw 1 � . ° 8� � � ; t]S� rY b'3" 1�� � ''o �� I � � �o �� � _ � `�G�. /� �� P I I 4 � ` ��3 \'iaa^ , ii e ;� � ��sv i�eo � ' - /I � t ��: ��� 1 � �iii Ur'� 7 � � � i I ! %` �„�� , t,v \ a64\ ,o. � _�,t� , �—.�'� vu _ � Y `9 �e,� `� . � �� i =1 25 Y \ 1— ��a, 30 ��,� � _ ,.. „�v Y/ 9 ' � ioe V , y �,y S' Bay^°* /�� �,s ` n I q I!34'_ _:; j iTr .! I11 e /!� > I I]eA !p/ ' _. 1 \ r _ „„ v �i .� L .. / , 0 1 �w� p F�5 • . ^. nev �ni � i a7 i i.o , a .> _ M� 7~ 3 � �1 Md�ISa� i' L ,� �J U ���r e�"r��` �7 0`�i ,,,, �.e � ZS 7 a� �� � L6 _ iio� o �� E'; fitl tioo � �� , �ax1 i� P a nee � P I� ir. S P n6s � F:. I� M1 i�e� �1]v q �_ STON� 3 3 a 1��� ilb] �. , „o0 7.. — �,- ' S «�c ii,i e �! / 14 ` 3 � - MM i]na Corben no� .1�e� no n n ^ noe �o .., �n �p e� �'i ni. ].7 .t � Ve1 inp � J 100� h __ `I ��- "� _�. �'�� _� .— _— • � --- � --- �—� -- � — ' % '— ' / t�5 ` :� � � 32 ) 6z „ v � _ 719 1 � �/ r O O P ^ O � ^ A L A M A N C E C O U N T Y ��`� �� o O R A � � � � 0 z � ' ' ---- �- • .:, NG�� ' ~ _ -- - � /�l � � �� � . - �- -- , _ �N � � � � 11 N T,.� ���-_ . ; . _ : : �, . ��i� � � -- - _ : �. _ - , 5°� � - - , , � , , , __ - ---- '. ....--s- � ; _. ---� n �. _ �;;i e i `. - ; � _- , - ---- .. , ��, , - _, , , _ - . -- �. � ��, -- � � � —' �- � - `� y _ ' . , i '_. � � " - � _ � . _ ' - --�. _ ..l'- .. . ^'J - • ._._ _ ' I _ J� - � �- _ . l _ _ - -"- �� _ -- � �, - �^ - --.. c; � - � < _ � .__ — _ - _ 1`� - �- � �= - _ , � ` _ �. �'�� _ �--- �' -- -- ,- . �_ - ' V i I � . _ I'. ._'_'_� _._ I � _ - . I. - ' . i _ _ _ �._ _ _ _ _._ _ _ _._ _'_ _ _ I - _ � � _ j �,: � - � � � � � ' ' 1 ! _ _ _"' � ✓ : ♦ � � • . ' � � - _-- .—� y _ z -- __ - � ti� t � f.� C � DEM ID: ACTION ID: NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #): JOINT FORM FOR NATIONWIDE PERMITS THAT REQUIRE NOTZFZCATION TO THE CORPS OF ENGINEERS NATIONWIDE PERMITS THAT REQUIRE APPLICATION FaR SECTION 4Q1 CERTZFZCATION WILMINGTON DISTRICT ENGINEER CORPS OF ENGINEERS DEPARTMENT OF THE ARMY P.O. BOX 1890 WZLMINGTON, NC 28402-1890 ATTN: CESAW-CO-E Telephone.(919) 251-4511 WATER QUALITY PLANNING. DIVISIaN OF ENVIRONMENTAL.MANAGEMENT NC DEPARTMENT OF ENVIRONMENT, FiEALTEi, AND NATURAL RESOURCES P.O. BOX 29535 RALEIGH, NC 27626-0535 ATTN: MR. JOHN DORNEY Telephone (919) 733-5083 ONE (1) COPY OF TXIS COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS OF ENGINEERS. SEVEN {7) COPIES SHOULD BE SENT TO TAE N.C. DIVISION OF ENVIRONMENTAL MANAGcMENT. PLEASE PRZNT. 1. owrrERS r7AME • N.C. De artment of Transportation 2. OWNERS ADDRESS: P•�• �OX 289 ' Siler Citv, N.�. 27344 3. OWNERS PHONE NUMBER (HOME): NA �woRx�: 919-742-5649 4. IF APPL2CABLE: AGENT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,�. PHaNE NUMBER: D L Jo nson P O Box 89 — �i 1 er Ci ty1 N� �7�44 � 5. LOCATION oF WoRK (MUST ATTACx MAP). CoUNTY: -aSWell NEAREST TOwN OR CITY: YanceWille SPECIEIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):_ Bridge # 28 on N"' 62 across Jordan' s'�-e�k 6. NAME OF CLOSEST STREAM/RIVER: Jord n's �'Y'PP1C . 7. R2VER BASIN: :.�i�e Fear � - - . _ .. 8. IS THIS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROUT,; SA, HQ6'1. ORW., . -- WS I, OR WS ZI? YES (y,J NO [ J 9. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FaFr USE ON THIS _ � PROPERTY? YES ( j N� [� I , �' ZF YES, EXPLAIN. ` . 10. ESTZMATED TOTAL NUMBER OF ACRES OF WATERS OF THE U..S., INCLUDING r, , WETLANDS, LOC�TED ON PROJECT SiTE: Unable O de rmiri2 at t�r �Pnt -, : 7/8/92 , -2= 11. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY THE PROPOSED PROJECT: . FILLED: DRAINED: FLOODED: EXC�VATED: TOTAL'IMPACTED: -�- 12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS): Bridqe replacerr�nt ��; +-h nnP 1 i nP nf 1 7R" �: �3"�" "M �i_� arch 13. PURPOSE OF PROPOSED wORK: Replacement of structurally deficient bridqe. 14. STATE REASONS WHY THE APPLICANT BELIE�IES THAT THIS ACTIVITY MUST BE CARRIED OUT IN WETL?.NDS. ALSO, NOTE MEASURES TAFCEN TO MINIMIZE FIETLAND IMPACTS. Unable to determine if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU ARE REQUIRED TO COIVTACT THE U.S. FISH AND WILDLIcE SE.TtVZC� (USFWS) AND/OR NATIONAL MARINE FISHERIES SERVICE (NMFS) REGaRDZNG TFiE PRESENCE OR ANY FEDERALLY LISTED OR PROPOScD FOR LISTING ENDANGERED �R TFiREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFEC:r'D BY.THE PROPOSED PROJECT. HAVE YOU DONE SO? YES [X] NO [ J RESPONSES FROM THE USFWS AND/OR NMFS SHaULD BE FORWARDED TO CORPS. 16. YOII ARE REQ(JIRED TO CONTACT THE ST�TE fiISTORIC PRESERVATION OFFICER � (SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES IN TH� PERMIT AREA WHICH , MAY BE AFFECTED BY THE PROPOSED PROJECT? FiAVE YOU DONE SO? YES [X] NO [ J RESPONSE FRaM THE SHPO SHOULD BE FORWARDED TO CORPS. 17. ADDITZONAL INFORMATION REQUIRED BY DEM: ' A. WETLAND DELINEATION MAP SIiOWING riLL WETT..tiNDS, ST?WeiMS,:AND LAKES ON THE PROPERTY. B. IF AVAILABLE, REPFtESENTATIVE P�:QTOGRP.PH OF WETLANDS TO"BE IMPACTED BY - PROJECT. C. IF DELINEATION WAS P�RFORMED SY A CONSULTANT, INCLUDE ALL DATA SFiEETS _, RELEVANT TO TF� PLACEMENT OF THE DELINEATION LINE. D. ZF A STORMWATER MANAGEMENT PLAN IS REQUIRED FOR THZS PROJECT, ATTACH �, COPY . �� ` E. WHAT IS LAND USE OF SURROUNDING PROPERTY? Re�identia rural farmland F. 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U N � -,,X . 4a��_ --- : ^ � - - . �o � _ _ ; � , . --_ _- - � _ -�. � — - � � n � -- �;•1. e , _ , � � _ � --- , ` _ , _, � - - - , . � , � .__ . • � �� -- - �' . ... . � . � � v � i L , . .. _ _ . i Nv ' _'!' ��' _� _' '�C - _" '- _ . . �-- _�. - i . . � � _ ...1" .. . � _ " -- _ . � ' J`' - ' � - � -- __ � -. - - - -" - � C.�� � _ - � - ^ _. .. - _ - . z — -- ' , - -- _ _ __ , ` - _ � --- � � - - - z. _. - _ - -- . ,�,._.— _ .. � ,..� ----.. ---- -_ - �� ._.. , -�-__ ---- — --- -- — - _ -- . �i�. ___ ,a _ - - � �" " _ , _ . ` r . _ � r� �j � n— �� -_ — - ---� ,p� _ �--- 1' . C^ � � �_ ■ ! � ' :C - � - V I j ,. J ' I � ..�� _'__'_� � � r _ 1 - � � _ _ ' . I _ , i _ _ _ _ _ - _ _ . _ _'_ - _ •I � �� � �� � �. � � _ � �'� � �. � � � �� � _ � _ ' I ! ___ _'_ � ✓ . ->-� c � DEM ID: ACTION ID: NATZONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT #): JOINT FORM FOR NATIONWIDE PERMITS THAT REQUIRE NOTZFZCATION TO THE CORPS OF ENGINEERS NATIONWIDE PERMITS THAT REQUIRE APPLICATION FOR SECTION 4Q1 CERTIFZCATION WZLMINGTON 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.� DIVZSION OF ENVIRONMENTAL MANAGEMENT NC DEPARTMENT OF ENVIRONMENT, FiEALTFi, AND NATURAL RESOi7RCES 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 Th�. CORPS OF ENGINEERS. SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISiON OF ENVIRONMENTAL MANAGEMENT. PLEASE PRZNT. ' 1. owrrE:ts rr� : N. C. Department of Transportation � 2. OWNERS ADDRESS: P.O. BOX 289 � Siler Citv, N.�. 27344 3. OWNERS PHONE NUMBER (HOME): NA (WORK): 919-742-5649 � 4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLc. CORPORAT° OFFICI?,L, ADDRESS,; PHaNE NUMBER: D. L. Johnson P.O. Box 289 Sil�r Cit,y, N.�_ �7344 5. LOCATION OF WORK (MUST ATTACFi MAP). COUNTY: =aswell NEAREST TOWN OR CITY: YanceWille SPECZFIC LOCATION (ZNCLUDE ROAD NUMBERS, LANDMARKS, ETC.):_. Bridge # 28 on N� 62 across Jordan's �eek � 6. NAME OF CLOSEST STREAM/RIVER: Jor'd3n'G "Y�k 7. RZVER BASiN: �pe Fear - - 8. IS THIS PROJECT LOCATED ZN A WATERSHED CLASSIFIED AS TROQ2,; SA, HQ�^1. ORW., - WS Ir OR WS II? YES (XJ NO (] . 9. HAVE ANY ScCTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FOFt USE aN THIS _ . PROPERTY? YES ( j NO [x. j . ;;: IF YES, EXPLAIN. 10. ESTIMATED TOTAL NUMBER OF ACRES OF WATERS OF THE U.S., ZNCLUDING ,•, WETLANDS, LOCATED ON PROJECT SITE: Unable to det�rmine dt Dr_�Pni- ,. , . 7/8/92 �►� . 11. NUMBER OF ACRES OF WATERS OF SHE U.S., INCLUDING WETLANDS, ZMPACTED BY THE PROPOSED PROJECT: . • . FILLED: � DRAINED: ' FLOODED: EXC�VATED: TOTAL'IMPACTED: -�- 12. DESCRIPTION OF PROPOSED WORIC (ATTACH PLANS): Bridcfe replacement �� th nnP 1 i nP nf 1 7R" X �3"�" �NI �t� ar�h 13. PURPOSE OF PROPOSED WORK: Replacement of structurally deficient bridge. 14. STATE REASONS WHY THE APPLICANT BELIEVES THAT THIS ACTIVITY MUST BE CARRIED OIIT IN WETLANDS. AL50, NOTE.MEASURES TAKcN TO MINIMIZE WETLAND IMPACTS. Unable to determ�ne if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SE.RVIC� (USFWS) AND/OR NATIONAL MARINE FISHERZES SERVICE (NMFS} REGaRDING TFiE PREScNCE OR ANY FEDERALLY LISTED OR PROPOScD FOR LISTING ENDANGERED �R THRrATENED S?ECIES OR CRITICAL HABI?AT IN THE PERMIT AREA THAT MAY BE AFFEC:'.5'D BY.THE � PROPOSED PROJECT. HAVE YOU DONE SO? YES [X] NO [) RESPONSES FROM THE USrWS AND/OR NMFS SEiOULD BE FORWARDED TO CORPS. 16. YOU ARE REQUIRED TO CONTACT TAE ST?.TE HISTORZC PRESERVATION OFFICER � (SHPO) REGARDING THE PRESENCE OF HISTORIC PROPERTIES ZN THE PERMIT AREA WHIC:i MAY BE AFFECTED BY THE PROPaSED PROJECT? HAVE YOU DONE SO? YES (}{] Na () RESPONSE FROM THE SHPO SHOULD BE F�RWARDED TO CORPS. 17. ADDITZONAL INFORMATZON REQUIRED BY DEM: - A. WETLAND DELINEATION MAP SHOWING ALL WETLANDS, STREAMS, AND LAKES ON THE PROPERTY. S. ZF AVAILABLE, REP:iESENTATIVE PHQ:OGRAPH OF WETLANDS TO'BE IMPACTED SY PROJECT. , C. IF DELINEATION WAS PERFORMED SY A CONSULTANT, INCLIIDE ALL DATA SFiEETS _, RELEVANT TO TFFE PLACEMENT OF THE DELINEATZON LINE. ' D. ZF A STORMWATER MANAGEMENT PLAN I5 REQIIIRED FOR TIiIS PROJECT, ATTACH �, COPY . i . E. WHAT IS LAND USE OF SURROUNDING PROPERTY? Besiden idT rt�ral farmlanc3 .. F. IF APPLICABLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSPiL? , NA � ` �-I`3-99 OWNER' S SZ AT[JRE DATE Cn � i V .�� x s� '� � JV c' '1 > �'1'3-�-'- si� Ml.a is�s ' tse� 7 L d� ��oo � � Q' � / �� v �' is�a ' J3.i3� � o iseoj .5 ^ LS isee t� 1.i9II � y�/ 0 �2 � - ��(-' � � ��17 7 '.�1.7 - if]� S y , '�'� R115 � ' � ���, cd` �.�. . ��� � P3�'; � �` �no . .��1 ��� i�n L}� Park 7.'If44. u!�3; - �sn � � �se� � . • • �� — � 1 �1 ��... L7ffi � � 1lL �S�Caviplan F: ., is]i IA .6 • IO 7G � � �o�. 43 e b�,,;,- . � .n •;y, � cMc^"c' � ino .� �' 45 ' . e � 'e , ��iv ` 3Che�s s �� �sv� �.7 _ �. r ♦ isa� i '! ,.Mr� � •a � 9 in� � `inz � e i � ": n — � , � � � S • �we� �h ^ j � isvs isv� ,L � \ ,� ��' as� '� � li4£ tj0 .� in� ~ a � � � �Yodo.dl � ^ i.v � c, - �"'sv� �7 �,F 7.0 � '':1 e y t , ; � .1 � G � ('' .. 1TJ3 q � 1 Iv �] 1310 � �� h J �-0 � 94 �~ 1 � � :; is�e h t • �7 — ? 151i l I]V � 156� Q�� 7 �� i,oi � F;: :. 5°� oc F i �oe Q T; ^ lt�: " ti' .:... 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' - � C - , _, � - - . c - — -- - - -- — ,� � , : .. : _ — , - ,`�, _ ' -- - - ; ._ - Jo; _ -- - , - - ` , - _ ! --- —. , _ - �{ _ _ � _ � ��.`. - _ __ ; . ,. _. _ _ _ . � _ _ -- _ � '- � ` -- - _ � �'' -- _ -- -- ,L - _ ti � , ---- - -- — _. _ - _ ,��• � ---.. Y �md 7 .._._. _ . . . - _ -__ . ��y�n = - �. - . . ' " _._ � ' t`. � .. . . _ � ` - ' r,� ^ _ - r=� ' �,y ' v _ r - �,Q� ---. - .. — __ . � � ` C� __ - ' � � � - - . i . -_ ..- -- J . ' j . __'_'_�_'_ � _ � � � � _ —_ - __- I, ' ' _ _ _ _ _ _ _ _ _ �. _ _ _ _ _ _ _ _ _ _ _ _ _ _ ' _ _ —J`^-' . i - _ _ - _ _ _,_ _ _ _ _ _'_ _ _ � � - � � � �� � ,� � � � � � � � � � ~ � I � " DEM ID: ACTION ID: , NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT �): JOINT FORM FOR NATIONWZDE PERMITS THAT REQUIRE NOTIFICATION TO THE CORPS OF ENGINEERS NATIONWIDE PERMITS THAT REQUIRE APPLICATION F�R SECTION 4Q1 CERTZFICATION WZLMINGTON DISTRICT ENGINEER CORPS OF ENGINEERS DEPARTMENT OF THE ARMY P.O. BOX 189Q WILMINGTON, NC 28402-1890 ATTN: CESAW-CO-E Telephone (919) 251-4511 WATER Q[JALITY PLANNING . : DIVISION OF ENVIRONMENTAL.MANAGEMENT NC DEPARTMENT OF ENVIRONMENT, FiEALTFi, 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 ScNT TO TFiE CORPS OF ENGINEERS. SEVEN (7) COPIES SHOULD BE ScNT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT. PLEASE PRINT. 1. owtvE:ts rt�: N.C. DeAartment of Transportation � 2. OWNERS ADDRESS: P.O. BOX 289 � Siler Citv, N.�. 27344 3. OWNERS PHONE NUMBER (HOME): NA (wa�tx�: 919-742-5649 � 4. IF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORAT� OFFICIAL, ADDRESS,; P??aNE NUMBER: D. L. JoYLnson P.O. Box 289 Si l�r Ci{-y, N_''_ �7344 5. LOC?.TSON OF WoRK (MUST ATTACH MAP). COIINTY: =aSWe11 NEAREST TOWN OR cZTY: YanceWille SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):_ Bridge # 28 on N� 62 across Jordan's �eek 6. NAME OF CLOSEST STREAM/RIVER: Jord�n's �"PP�C 7. RLVER BASIN: ,aAe Fear ' -. .- 8. IS THIS PROJECT LOCATED IN A WATERSHED CLPaSSIFIED AS TROII2,; SA, HQ�^1, ORW,, -_ WS I, OR WS II? YES (XJ NO [ J 9. HAV£ ANY SECTZON 404 PERMITS BEEN PREVIOUSLY REQUESTED FOR USE ON THIS ._ • PROP�RTY? YES ( J NO [xr] >; IF YES, EXPLAIN. '' 10. ESTIMATED TOTAL NUMBER OF AC:tES OF WATERS OF THE U.S., ZNCLUDING ,; � WETLANDS, LOCATED ON PROJECT SITE: Unable to detPrmine at presPnt �-. ,: . �/a/92 -2- . 11. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY _ THE PROPOSED PROJECT: . . . FILLED: DRAINED: FLOODED: EXC�VATED: TOTAL'IMPACTED: -�- 12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS): Br'dae r placement w; th nnP 1 i nP nf 1 �R" �' f��" ''M �i r�e arnh I3. PURPOSE OF PROPOSED WoRK: ReplacemPxit of structurally deficient bridge. 14. STATE REASONS WHY THE APPLIC�NT BELIEVES THAT THIS ACTIVITY MUST BE CARRIED aiJT ZN WETL.�NDS. ALSO, NOTE MEASURES TAKc.N TO MINIMIZE WETLAND IMPACTS. Unable to determine if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLZcE SERVIC� (UScWS) AND/OR NATZONAL MARINE FISHERZES SERVZCE (NMFS) REG�iRDZNG THE PRESENCE OR ANY FEDERALLY LISTED OR PROPdSED FOR LISTING ENDANGERED OR THRrAT°NED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFECT`.�.'D BY.THE PROPOSED PROJECT. HAVE YOU DONE SO? YES [XJ NO [ J RESPONSES FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO COR?S. 16. YOU ARE REQIIIRED TO CONTACT THE STATE HISTORIC P�ScRVATION OFF'ICER - (SHPO) REG.�RDING THE PRESENCE OF HISTORIC PROPERTIES IN � PERMIT AREA WFiIC:i MAY BE AFFECTED BY THE PROPOSED PROJECT? HAVE YOU DONE SO? YES [}{] NO (] RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS. 17. ADDITZONAL INFOF2MATION REQUIRED BY DEM: - A. WETLAND DELINEATION MAP SHOWING ALL WETT..ANDS, ST?WAMS, AND LAKES ON THE PROPERTY. B. IF AVAILABLE, REPRESENTATIVE PHQTOGRP.P:i OF WETLANDS TO"BE IM°ACTED BY PROJECT. , C. IF DELINEATION WAS P�RFORMED BY A CONSULTANT, INC:.UDE ALL DATA SHEETS _, ,. RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE. D. IF A STORMWATER MANAGEMENT PLAN IS REQUIRED FOR TEiIS PROJECT, ATTACH �, COPY. , E. WHAT ZS LAND USE OF SURROUNDING PROPERTY? gesidential n�ra� farmlanc� -. F. IF APPLICASLE, WHAT IS PROPOSED METHaD OF SEWAGE DISPOSe'�L? . NA � \ f3-I�-qQ aWNER'S SI ATURE DATE G^ 7 j �/' �• � � �•` w L C �� _ �� � � .JV � � ��A ?''1_7?3i, si� nu�.ye i�i��� . � tsa� i^�i i�oo .7 r1 .7 / �� ; T��is 1 S � i�ea, S u �see �� � � LL'� `� ��n 7 "�-? . �sxo �szi . � � .S �M1 °�.' i a� ` x � pZ � � °t:! 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' .. - " I , ; .. -. , ." _ . . _ _.- . _.. . _ . . . � ,. . -..... . . . ��. _ � . - _ _, - • _ t� ,_`� . . . ... ..__ . i. �- .. � �. - . ... _ ,� : - . . .._ _, ... � __ _ � ` C: � .'"����`✓:... � 1 ._. �_ ... . . G �r1+' � ,--.. _ ��.� ,- � � \ . _ �\ Ia. - y`_ ' \ � 1` � r� n sc� 1 �� O \ 1� - _._ �t. __ - � � � -.. � . - i ----^ - --_ '. t � - "- b - ' � - _ - .�._ _ _ _ _._ _ _ _'_ _'_ _ ' � , � �--+-{� � � _ � '� � � � � � ��_ � �. . - I � � DEM ID: ACTION ZD: , NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT �): JOINT FORM FOR HATZONWIDE PERMITS THAT REQUIRE NOTIFZCATION TO THE CORPS OF ENGINEERS NATIONWIDE PERMITS THAT REQUIRE APPLICATION FOR SECTION 4Q1 CERTIFICATZON 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, FiEALTH, AND NATURAL RESOURCES P.O. BOX 29535 RALEIGH, NC 27626-a535 ATTN: MR. JOHN DORNEY Telephone (919) 733-5083 ONE (1) COPY OF TH2S COMPLETED APPLICATION SHOULD BE SENT TO THE CORPS OF ENGINEERS. SEVEN (7) COPIES SHOULD BE SENT TO THE N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT. PLEASE PRINT. 1. OWNERS NAME: N.C. D2p3r�At of Transportation � 2. OWNERS ADDRESS: P.O. BOX 289 , -_� ; Siler Citv, N.�. 27344 � 3. OWNERS PHONE NUMBER (HOME): NA �woRx�: 919=742-5649 4. ZF APPLICABLE: AGENT'S NAME OR RESPONSIBLE CORPORAT� OFFZCIr'1L, ADDRESS,; PHONE NUMBER: D. L. Johnson P. O. F3c-�x � 8 9 Siler City, N_"_ �7�44 5. LOCAT2oN oF WORK (MUST ATTACH MAP). COUNTY: =asWe11 NE�.REST TOwN OR CSTY: YailceyVille SPECIFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):_ Bridge # 28 on N: 62 across Jordan's "�-ePk 6. NAME OF CLOSEST STREAM/RIVER: Jordan'� �'_Y'PP�f 7. RZVER BASIN: �ape Fe3r ; � __.._- .. 8. IS T$IS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROi72,; SA, HQW. ORW., -- WS I.,OR WS II? YES (Xj NO (] 9. HAVE ANY ScCTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FaFt USE ON THIS . • PROPERTY? YES ( ] NO (k. J , >, IF YES, EXPLAIN. 10. ESTIMATED TOTAL NUMBER OF ACRES OF WATERS OF THE U..S., INCLUDING �•, WETLANDS, LOCP,TED ON PROJECT SITE: Unable to det�rmine a pr �Pnt- : • . 7/8/92 :. . -2- . I1. NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING WETLANDS, IMPACTED BY THE PROPOSED PROJECT: . FILLED: DRAINED: � FLOODED: EXC?.VATED : TOTAL' IMPACTED : -(1- 12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS): Bri�ge _replace�nt �h nnr� 1 i nP nf 1 7R" },' �'�" '�M �pp ar-c-h i3. PURPOSE OF PRoPOSED WORK: Replacement of structurally deficient bridge. 14. STATE REASONS WHY THE APPLICANT BELIEVES THAT THIS ACTIVITY MUST BE CARRZED OUT IN WETI.�NDS. ALSO, NOTE MEASURES TAKEN TO MINIMZZE WETLAND IMPACTS. Unable to determine if wetlands are present all efforts will be provided to minimize off-site erosion 15. YOU ARE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIrE SERVIC� (USFWS) AND/OR NATIONAL MARINE FISHERZES SERVICE (NMFS} REG?RDING TFiE PREScNCE OR ANY FEDERALLY LISTED OR PROPOScD FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFEC�'D BY.THE � PROPaSED PROJECT. HAVE YOU DONE SO? YES [X] NO [] ` RESPONSES FROM THE UScWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS. 16. YOU ARE REQUIRED TO CONTACT THE ST�TE HISTORIC PRESERVATIOfI OFFICER (SHPO) REGARDING THE PRESENCE OF AISTORIC PROPERTIES IN THE PERMIT AREA WHIC:i MAY BE AFFECTED BY THE PROPOSED PRaJECT? HAVE YOU DONE SO? YES [X] NO (] RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS. 17. ADDITIONAL INFORMATION REQUIRED BY DEM: , A. WETLAND DELINEATION MAP SAOWING ALL WET.T.ANDS, STREAMS,:AND LAKES QN THE PRGPERTY. B. IF AVAILABLE, REP?�ESENTATIVE PHQTOGRAPH OF WETLANDS TO"BE I2�DACTED BY - PROJECT_ C. IF DELINEATION WAS P�RFORMED BY A CONSULTANT, INCLUDE ALL DATA SFiEETS , .. RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE. D. IF A STORMWATER MANAGEMENT PLAN IS REQUIRED FaR THIS PROJECT, ATTACFI �, COPY. �.. E. WHAT IS LAND USE OF SURROUNDING PROPERTY? Residentia7 n�ra1 farmlan�3 F. IF APPLICASLE, WHAT IS PROPOSED METHOD OF SEWAGE DISPOSAL? NA � \ _ _ f3 I � q9 aWNER'S SI ATURE DATE � (`�'� t� � '! '����� �� � . . is�s � w L� a ' � � p / �no .7 -� �i� Mi. o tss� t7 13a � �`� 1� - lill t � � s 9 � ' � V � '� �ISI• } o iseo i .5 �see � ` � R��S � °�1 �� ��n � � � .rl.�? . � �szi � � � ti ''(, � � � �0 1° o '� � �i"1 1��� i�.i 41 � iaxe Pah � iew T ri�m ;,,, P3� �0 1L � y ise� � � � �yp � ' un — �� j]� ? 1]]I V ISI O '6 ' �L �1 1].il ] 349: i�t� � f? � ., isii b'`i;� lo ., : 43 - J, < <i ' .� ; „�o ��= U� � �» 45 � _ 36�,.e e —3 , —� � 1591 y 8 .d . � J.7 1lv� ^ _.B.M�.+ .a � in� • i � ;: — :-�e /' ^' .9 .� ino 1� t �• �ia� `th � �'° i� i�v� i�W �-�- _�r7 e 1�49. 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'gr°n�' �% ° �,,,; �.e 1441 Md�"°' �j p � - i � es .y / � �a ti7 ,�., ' ��w � 26 _ ��o. �� �: ,y,� „� , � _ • GO ne7^ f � P�Y nne p . iiov ,y _l. - SiONY 33 na D s Pi�as� 6:. 4' i�e� p �7 in � � ZJ �," " } Ot�C �iii ��9.! �4 ` isa� ,s �7 _ no� i i � i �� �� :o MM .s nea e Cwbatl . L ii .iiai �° n �. . � � h� F=.- iiia z.7 � i�s� �� �v� � ti ,-(- ' --_� ---� .,,I' 32 � ---1-- '�� - � — - / _1— 62 - �� -- �- - --- � y J , . i19 � ✓ � ✓ n r�i p n � I �n S Q � ^ A L A M A N C E � C O U N T Y ~; 3g �o R A r Z 24 '�r o � � z 1 � --- _ - --- , , '_ :, � Nc�V �� . . - , , �. __ ._.__. ' � � � p � �, � . . . - , .,; , ,. ; - - T ._ --,_� - � �� � _ - - - ......� ;.. :; � - �o�� N �o��. —, � � - -- - _ - ; —_-; - ; --, - - - -� - � � � � , _ , n c u�i• e � c. - 1 , �.:--- .. ' _ �/ -- - � ,��, 1 ... � _ . � c�; � -- -- �- � ,c - _ . ' - , � " "_ _ -:; � � — - - - _ ,. _ � �,h _ _ / ._ i-- ._ J - � -- - _ � - '' G'� - - . ^ - .. � -- ` _ a' -- - - 5 -. � - " -- - _ - _ �?� �" /. _. r �, G ; ���' ----.. _ ��,�-. �_ la, � � V -- � C� A... -'__ ._"._ � ' � ;i __/ _" z -- __ . �`l� n. ;, _ � ,�G ---- _ V � . i � _., v . - . . ,. i .. _' _ .-Y ---_ - i i r ` i. - ��" � - . i - - - - - - - - - -.- - - _ - - - - ' --'-i�, ;� _ i �?:���-1.�•� .� .� � � � � � _ _. � I -- _ ` . _ . i .. . . . . ... '� , _ , s '. DEM ID: ACTION ID: NATIONWIDE PERMIT REQUESTED (PROVIDE NATIONWIDE PERMIT �): JOINT FORM FOR NATIONWIDE PERMITS THAT REQUIRE NOTZFICATION TO THE CORPS OF ENGINEERS NATIONWIDE PERMZTS THAT REQUZRE APPLICATION FOR SECTION 4Q1 CERTIFICATZON 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 ENVZRONMENT, FiEALTH, AND NATURAL RESOURC�S 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 MANAGEMENT. PLEASE PRINT. 1. OWNERS NAME: N.C. Depdrt[T1Erit of Transportation � � 2. OWNERS ADDRESS: P.O. BOX 289 � , -- - Siler Citv, N.�. 27344 ,. , 3. OWNERS PHONE NUMBER (FFaME): NA (WORK): 919=742-5649 � -- 4. IF APPLICABLc: AGcNT'S NAME OR RESPONSIBLE CORPORATE OFFICIAL, ADDRESS,; � PHONE NUMBER: D. L. Johnson P.O. Box 289 Siler City. N_''_ �7344 5. LOCATION OF WORK (MUST ATTACH MAP). COUNTY: -��Wel1 NEAREST TOwN OR CITY: Yanceyville SPECZFIC LOCATION (INCLUDE ROAD NUMBERS, LANDMARKS, ETC.):_ Bridge # 28 on N� 62 across Jordan's �eek 6. NAME OF CLOSEST STREAM/RIVER: Jordan's �_'Y'PPlC 7. RZVER BASiN: ya�7e Feaz' ' 8. IS THZS PROJECT LOCATED IN A WATERSHED CLASSIFIED AS TROIIT,; SA, HQ�^1. ORW., -- WS Z, OR WS ZI? YES (}{] NO (. J 9. HAVE ANY SECTION 404 PERMITS BEEN PREVIOUSLY REQUESTED FaR USE ON THIS . • PROPERTY? YES ( J NO [x. ] ;; ': IF YES, EXPLAIN. � 10. ESTIMATED TOTAL NUMBER OF ACRES OF WATERS OF THE U.S., INCLUDING ,; WETLANDS, LOCATED ON PROJECT SITE: Unable to det�rmine at pr �Pnt -. : . . 7/8/92 . ,' � �� 11. NUMBER OF ACRES OF WATERS OF THE U.S., THE PROPOSED PROJECT: . INCLUDING WETLANDS, FILLED: DRAINED: FLOODED: EXC�tIATED : TOTAL'IMPACTED: -�- IMPACTED BY 12. DESCRIPTION OF PROPOSED WORK (ATTACH PLANS): Bridqe replacement �.,zi t-h nnP 1 i nP nf 1 �f�" X fi�" "'n�t �c� arc-h 13. PURPOSE OF PROPOSED WORK: Replacemexit Of structurally deficient bridge. 14. STATE REASaNS WHY THE AP?LICANT BELIEVES THAT THIS ACTIVITY MUST BE CARRIED OUT IN WETL�.NDS. ALSO, NOTE MEASURES TAKEN TO MINIMZZE WETLAND IMPACTS. Unable to determine if wetlands are present, all efforts will be provided to minimize off-site erosion. 15. YOU P.RE REQUIRED TO CONTACT THE U.S. FISH AND WILDLIFE SERVICE (USFWS) AND/OR NATZONAL MARINE FISHERZES SERVICE (NMFS} REGaRDZNG TFiE PRESENCE OR ANY FEDERALLY LISTED OR PROPOSED FOR LISTING ENDANGERED OR THREATENED SPECIES OR CRITICAL HABITAT IN THE PERMIT AREA THAT MAY BE AFFEC:�.'D BY.THE PROPOSED PROJECT. HAVE YOU DONE SO? YES [Xj NO [] RESPaNScS FROM THE USFWS AND/OR NMFS SHOULD BE FORWARDED TO CORPS. 16. YOU ARE REQUIRED TO CONTACT THE STATE FEISTORIC PRESERVATION OFFICER � (SHPO) REGP,RDING THE PRESENCE OF HISTORIC PROP:RTIES IN THE PERMIT AREA WHIC:i MAY BE AFFECTED BY THE PRaPOSED PROJECT? HAVE YOU DONE SO? YES [}{] NO ( j RESPONSE FROM THE SHPO SHOULD BE FORWARDED TO CORPS. 17. ADDITIONAL INFORMATION REQUIRED BY DEM: - A. WETLAND DELINEATION MAP SHaWING ALL WET.T.ANDS, ST�AMS,:AND LAKES ON THE PROPERTY. B. IF AVAILABLE, REPFtESENTATIVE PF:OTOGRAPT.i OF WETLANDS TO' HE IMPACTED BY - PROJECT. C. IF DELINEATION WAS P�'RFORMED BY A CONSULTANT, INCLUDE ALL DATA SHEETS _. .. RELEVANT TO THE PLACEMENT OF THE DELINEATION LINE. - D. ZF A STORMWATER MANAGEMENT PLAN IS REQUZRED FOR THZS PROJECT, ATTACH �, COPY . � .. E. WHAT IS LAND USE OF SURROUNDING PROPERTY? ReGiden-ia rt�ral farmlanc3 F. IF APPLICABLE, WHAT IS PROPOSED METHaD OF SEWAGE DISPOSAL? . NA � � \ �-I�-q9 OWNER'S SI ATURE DATE ? ws a � '.� . 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