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Home My WebLink About20071470 Ver 1_Application_2007082707N70 APPLICATION FOR DEPARTMENT OF THE ARMY PERMIT I OMB APPROVAL NO. 0710-003 (33 CFR 325) Expires December 31, 2004 Public reporting burden for this collection of information is estimated to average 10 hours per response, although the majority of applications should require 5 hours or less. This includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Service Directorate of Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202.4302; and to the Office of Management and Budget, Paperwork Reduction Project (0710-0003), Washington, DC 20503. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please DO NOT RETURN your form to either of those addresses. Completed applications must be submitted to the District Engineer having jurisdiction over the location of the proposed activity. PRIVACY ACT STATEMENT Authority: Rivers and Harbors Act, Section 10, 33 USC 403: Clean Water Act, Section 404, 33 USC 1344; Marine Protection, Research and Sanctuaries Act, 33 USC 1413, Section 103. Principal Purpose: Information provided on this form will be used in evaluating the application for a permit. Routine Uses: This information may be shared with the Department of Justice and other federal, state, and local government agencies. Submission of requested information is voluntary, however, if information is not provided the permit application cannot be evaluated nor can a permit be Issued. One set of original drawings or good reproducible copies which show the location and character of the proposed activity must be attached to this application (see sample drawings and instructions) and be submitted to the District Engineer having jurisdiction over the location of the proposed activity. An application that is not completed in full will be returned. ITEMS 1 THRU 4 TO BE ILLED BY THE CORPS) I 1. APPLICATION NO. 2. FIELD OFFICE CODE 3. DATE RECEIVED 4. DATE APPLICATION COMPLETED ITEMS BELOW TO BE F LLED BYAPPLICAN 5. APPLICANTS NAME 8. AUTHORIZED AGENTS NAME AND TITLE (an agent is not required) North Carolina Turnpike Authority 6. APPLICANT'S ADDRESS 5400 Glenwood Ave, Suite 400 Raleigh, NC 27612 9. AGENT'S ADDRESS 7. APPLICANT'S PHONE NOs. W/AREA CODE 10. AGENTS PHONE NOs. W/AREA CODE a. Residence a. Residence b. Business 919-571-3000 b. Business 11. STATEMENT OF AUTHORIZATION I he eby authorize, to act in my behalf as my agent in the processing of this application and to furnish, upon request, sup emental Into tion i sup ort of this permit application. APPLICANTS IGNA RE DATE $ . 2 7 , -yam -r I NAME, LOCATION, AND DESCRIPTION OR PROJECT OR ACTIVITY 12. PROJ?CT NAME OR TITLE (see instructions Western Wake Freeway, NCDOT TIP No. R-2635, Wake County NC 13. NAME OF WATERBODY, IF KNOWN (if applicable) Little Branch and its UTs, 14. PROJECT STREET ADDRESS (i/ applicable) Big Branch and Its UTs, UTs to Beaver Creek, White Oak Creek, UTs to Reedy Branch, Clark Branch and Its UTs, Bachelor Branch and Its UTs, UTs to Panther Creek, Moms Branch and its UTs, and Nancy Branch and Its UTs, Jack Branch 15. LOCATION OF PROJECT Wake NC COUNTY STATE 16. OTHER LOCATION DESCRIPTIONS, IF KNOWN (see Instructions) Section, Township, Range, Lat/Lon, and/or Accessors's Parcel Number, for example. 17. DIRECTIONS TO THE SITE Near Apex, NC from NC 55 at SR 1172 (Old Smithfield Road) to NC 55 near SR 1630 (Alston Avenue) ENG FORM 4345, Jul 97 EDITION OF FEB 94 IS OBSOLETE (Proponent: CECW-OR) 'b ?M .» 1 r• .•?. #'??? ` M 18. Nature of Activity (Description of project, Include all features) Construct a 12.6-mile long, new location roadway (Western Wake Freeway) on the western side of Wake County. The proposed Western Wake Freeway is a component of the Raleigh Outer Loop. It is planned as a six-lane, fully controlled-access, toll facility with a 78-foot wide median. 19. Project Purpose (Describe the reason or purpose of the project, see instructions) Provide a high speed, multi-lane, and controlled-access facility to accommodate the increasing transportation demand in the western Wake County area. USE BLOCKS 20-22 IF DREDGED AND/OR FILL MATERIAL IS TO BE DISCHARGED 20. Reason(s) for Discharge Needed in order to provide a new location roadway. 21. Type(s) of Material Being Discharged and the Amount of Each Type in Cubic Yards See attached permit drawings. 22. Surface Area in Acres of Wetlands or Other Waters Filled (see instructions) 14,467 linear feet of stream channel, 20.14 acres of wetlands, and 11.23 acres of ponds 23. Is Any Portion of the Work Already Complete? Yes _ No X IF YES, DESCRIBE THE COMPLETED WORK 24. Addresses of Adjoining Property Owners, Lessees, Etc., Whose Property Adjoins the Waterbody (If more than can be entered here, please attach a supplemental list). See Attached List 25. List of Other Certifications or Approvals/Denials Received from other Federal, State, or Local Agencies for Work Described In This Application. AGENCY TYPE APPROVAL IDENTIFICATION NUMBER DATE APPLIED DATE APPROVED DATE DENIED Would include but is not restricted to zonipg, building, and flood plain permits 26. Application is hereby made for a pe it or permits to authorize the work described in this application. I certify that the information in this application is complet and accu e. I fu er ce fy that I possess the authority to undertake the work described herein or am acting as the duly authorized agent of the a lic nt. SI ATURE OF PPLI N DATE 8.,z-7.c3-7 SIGNATURE OF AGENT DATE The plication must be signed by the person who desires to undertake the proposed activity (applicant) or it may be signed by a duly authorized agen if the statement in block 11 has been filled out and signed. 18 U. C. Section 1001 provides that: Whoever, in any manner within the jurisdiction of any department or agency of the United States knowingly and will Ily falsifies, conceals, or covers up any trick, scheme, or disguises a material fact or makes any false, fictitious or fraudulent statements or representations or makes or uses any false writing or document knowing same to contain any false, fictitious or fraudulent statements or entry, shall be fined not more than $10,000 or imprisoned not more than five years or both. ENG FORM 4345, Jul 97 EDITION OF FEB 94 IS OBSOLETE (Proponent: CECW-OR)