20050234 Ver 1_Application_20050207

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STATE OF NORTH CAROLINA
DEPARTMENT OF TRANSPORTATION
MICHAEL F. EASLEY
GOVERNOR
February 3, 2005
U.S. Army Corps of Engineers
Raleigh Regulatory Field Office
6508 Falls of the Neuse Road, Suite 120
Raleigh, NC 27609
LYNDO TIPPETT
SECRETARY
Q~c~~oe~~
FEB 7 - 2005
DENR -WATER QUALITY
WETLANDS AND STORMyyATER BRANCH
Attention: Mr. Eric Alsmeyer
NCDOT Coordinator
Subject: Secondary road improvements to SR 1506 (Currin Road) from SR 1507
(Brookston Road) to dead end in Vance County. WBS element 5.209111.
The North Carolina Department of Transportation (NCDOT) proposes to upgrade and pave
SR 1506 (Currin Road) from SR 1507 (Brookston Road) to dead end in Vance County
(Figures 1-3). Total project length is 0.5 miles. Transportation and highway laws of North
Carolina (G.S. 136-44.6, 136-44.7, 136-44.7A, 136-44.8, and 136-44.9) require the NCDOT
to develop annual work programs for construction and maintenance of secondary roads.
These general statutes specifically set forth requirements for annual construction and paving
of existing unpaved roads. Paving of these roads is performed in priority order as established
by the NCDOT for each unpaved road within a given county. This number is based on
characteristics of each road, including number of homes, schools, churches, businesses,
industries, recreational facilities, traffic counts, presence of school bus routes, and value as a
thoroughfare. SR 1506 is scheduled to be paved in the 2004-2005 Secondary Roads
Construction Program.
Impacts to Waters of the United States
Site 1 -Waters of US
Construction at this site will impact an unnamed intermittent tributary to Fishing Creek
(NCDENR-DWQ Index No. 28-79-(1), Best Usage Classification C NSW; HUC 03020102)
(Figure 3) in the Tar-Pamlico River Basin. The existing structure that conveys the creek is a
24-inch reinforced concrete pipe (rcp) that is 40 feet long (see Photographs 1 and 2). This
pipe will be replaced with a 48-inch rcp that is 60 feet long. Permanent impacts at the site
associated with the longer pipe and minimal amounts of rip rap to protect the new structure
include 36 linear feet existing channel impacted. The Site 1 work zone will be temporarily
dewatered for approximately 5 days. This will involve the temporary placement of
impervious dikes in the creek at the upstream and downstream limits of construction. Either
Division 5, 2612 N. Duke Street, Durham, NC 27704
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sand bags or sheet piling will be used as an impervious dike. Once the stream has been
dewatered, the replacement pipe will be installed. To maintain water flow during
construction, water upstream of the impervious dike will be temporarily pumped out and
conveyed around downstream of the impervious dike. Temporary concurrent impacts to the
stream from this activity will result in dewatering 36 linear feet of stream. All materials used
for the impervious dikes will be removed after construction.
Riparian Buffer Impacts
Site 1 -Buffers
The construction at this site involves a road crossing of a stream that is subject to the
Tar-Pamlico Riparian Buffer Rule. The unnamed intermittent tributary to Fishing Creek at
Site 1 is depicted on the most recent version of the Middleburg (197011982) topographic
quadrangle (Figure 1) as well as on the Soil Survey of Vance County (USDA-SCS, 1977)
(Figure 2). The NCDOT proposes to install temporary erosion and sediment control
devices in Zone 1 and Zone 2 of the riparian buffer. Specifically, temporary silt basins,
temporary rock silt checks, rock pipe inlet sediment traps, and temporary silt fences will
be used. The temporary structures will be removed once the vegetation has been
established and then seeded with a seed mixture of fescue and Bahia grass Please note
that the placement of these structures are within the 60 right-of--way width and their
associated impacts are included within the project total of 1,611 ftl in Zone 1 and 842 ft2
in Zone 2 (totaling 36 linear feet of riparian buffer impacts outside the Existing
Transportation Facility). Based on the impacts to the riparian buffer at this site, this
crossing is EXEMPT.
Waters of the U.S./Riparian Buffer Mitigation
Avoidance: All wetlands and surface waters not affected by the project will be protected from
unnecessary encroachment. No staging of construction equipment or storage of construction
supplies will be allowed in wetlands or near surface waters.
Minimization: The side slopes have been steepened to the extent possible at jurisdictional
sites. Strict enforcement of sedimentation and erosion control Best Management Practices for
the protection of wetlands and surface waters will be enforced during project construction.
Continued coordination will occur with maintenance forces and the Environmental Officer
during construction to minimize impacts to these sites.
Compensatory Miti ag tion: Unavoidable impacts to 20 linear feet of stream (surface
water fill) associated with this project will be mitigated (at a 2:1 ratio) by providing 40
linear feet of stream restoration equivalent in the Tar Pamlico River Basin (Hydrologic
Cataloging Unit 03020102). All compensatory mitigation requirements will be
assimilated on a quarterly basis and provided to the Ecosystem Enhancement Program
(EEP) for their acceptance with a copy provided to the USACE for verification and
accounting purposes.

3
Protected Species
Plants and animals with federal classifications of Endangered, Threatened, Proposed
Endangered and Proposed Threatened are protected under provisions of Section 7 and
Section 9 of the Endangered Species Act. As of January 29, 2003, the dwarf wedgemussel
(Alasmidonta heterodon) and bald eagle (Haliaeetus lecicocephalus) are listed as federally
protected species in Vance County. The UT to Fishing Creek at this site is intermittent and
does not provide suitable habitat for mussel fauna. Cumin Road is not adjacent to nor is it
surrounded by open water suitable of supporting foraging habitat for the bald eagle.
Therefore, based on the lack of suitable habitat observed during the 06/22/04 and 11 /29/04
site visit, biological conclusions of No Effect have been rendered for each species.
Historical Compliance
This project has been screened by all pertinent parties to ensure historic compliance.
Summary
NCDOT proposes to upgrade and pave SR 1506 (Cumin Road) in Vance County. Impacts
are proposed to Waters of the United States (surface water fill). Unavoidable impacts to
20 linear feet of stream associated with this project will be mitigated (at a 2:1 ratio) by
providing 40 linear feet of stream restoration equivalent in the Tar Pamlico River Basin
(Hydrologic Cataloging Unit 03020102). All compensatory mitigation requirements will
be assimilated on a quarterly basis and provided to the Ecosystem Enhancement Program
(EEP) for their acceptance with a copy provided to the USACE for verification and
accounting purposes. In addition impacts to the riparian buffers within the Tar-Pamlico
River Basin are proposed. However, based on the impacts to the riparian buffer at this
site, this crossing is EXEMPT.
Application is hereby made for a Department of the Army Section 404 Nationwide
Permit (NWP) 14, NWP 33, and NCDENR-DWQ Section 401 Water Quality
Certification (WQC) No. 3404 and WQC No. 3366 for above-described activities. An
automated payment procedure has recently been implemented between the NCDOT and
NCDWQ. This procedure will enable the Division to apply for the 401 WQC without
submitting a check for this permit application. This new procedure will provide payment
to the NCDWQ by charging the permit application fee of $200.00 directly to the
appropriate NCDOT WBS element 5.209111. Apre-construction notification is attached
with this request. If you have any questions or need additional information, please contact
Ms. Heather Montague at [phone].
cerely,
C,.~
on G. Nance, P.E.
Division Engineer
cc: Ms. Nicole Thomson, NCDWQ Mr. Clarence Thompson
Mr. Steve Winstead, NCDOT Ms. Katie Simmons

SR 1506 (Cumin Road) - Vance County
Photograph 1. View upstream of inlet at Site 1.
Photograph 2. View downstream from outlet at Site 1.

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Project Study- Area
SR 1 X06 Currin Road
~ Vance County
USDA-SCS (1977)
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Begin Project
End Project

Note:
Placement of impervious dike
for dewatering _ _ _: PrOpOSed rip rap
~, ® Fill In Surface Waters
I ETF Existing Transporation Facility
EE EC EC Erosion Control Devices
N N I N N
0 0 ~ o 0
N -
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_____________________ ___'C EC EC____~f
ETF _ ~ __.
- T - - - - - - - - - -
20ft paved
SR 1506
roadway width
- - - - - - - - - - - - - - - - - - - -
N
8 ft
rip rap
_____C _EC __E C_____ ___________ _______________ ____ ____ _ _
~10 f0 iii _ __ _ _
18fit gravel
roadway width
_4- -_ _ C i.~ r r i n- R d-= ----_ _ --_ _ -- - - - - - - - - propose d
~ 60ft ROW
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..........
ETF __ _ __ _ __ __ __
10 ft SW fill
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________________ ~___________\_____ C__EC_ EC____~ __________________________ ___________ ________________________________.
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Plac ement of impervious dike
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Site 1 -Construction Plan
SR 1506 Currin Road
Vance County
Figure 3
1 "=3U'
01 /25/05

Office Use Only: Form Version May 2002
O~fl23~4
USACE Action ID No. DWQ No.
(If any particular item is not applicable to this project, please enter "Not Applicable" or "N/A".)
I. Processing
Check all of the approval(s) requested for this project:
® Section 404 Permit ® Riparian or Watershed Buffer Rules
^ Section 10 Permit ^ Isolated Wetland Permit from DWQ
® 401 Water Quality Certification
2. Nationwide, Regional or General Permit Number(s) Requested: NWP 14 and NWP 33
3. If this notification is solely a courtesy copy because written approval for the 401 Certification
is not required, check here: ^
4. If payment into the North Carolina Wetlands Restoration Program (NCWRP) is proposed for
mitigation of impacts (verify availability with NCWRP prior to submittal of PCN), complete
section VIII and check here: ^
5. If your project is located in any of North Carolina's twenty coastal counties (listed on page
4), and the project is within a North Carolina Division of Coastal Management Area of
Environmental Concern (see the top of page 2 for further details), check here: ^
II. Applicant Information
1. Owner/Applicant Information
Name: NCDOT Division 5. Jon G. Nance. P
Mailing Address: 2612 N. Duke St. Durham NC 27704
Telephone Number: [phone] Fax Number: [phone]
E-mail Address: JNance(r.~,dot.state.nc.us
2. Agent/Consultant Information (A signed and dated copy of the Agent Authorization letter
must be attached if the Agent has signatory authority for the owner/applicant.)
Name:
Company Affiliation:
Mailing Address:_
Telephone Number:_
E-mail Address:
Fax Number:
Page 1 of 8

III. Project Information
Attach a vicinity map clearly showing the location of the property with respect to local
landmarks such as towns, rivers, and roads. Also provide a detailed site plan showing property
boundaries and development plans in relation to surrounding properties. Both the vicinity map
and site plan must include a scale and north arrow. The specific footprints of all buildings,
impervious surfaces, or other facilities must be included. If possible, the maps and plans should
include the appropriate USGS Topographic Quad Map and NRCS Soil Survey with the property
boundaries outlined. Plan drawings, or other maps may be included at the applicant's discretion,
so long as the property is clearly defined. For administrative and distribution purposes, the
USACE requires information to be submitted on sheets no larger than 11 by 17-inch format;
however, DWQ may accept paperwork of any size. DWQ prefers full-size construction
drawings rather than a sequential sheet version of the full-size plans. If full-size plans are
reduced to a small scale such that the final version is illegible, the applicant will be informed that
the project has been placed on hold until decipherable maps are provided.
1. Name of project: Proposed pipe replacement of a structure conveying unnamed tributary to
Fishing Creek in association with upgrading_and paving SR 1506 (Curtin Road) in Vance
County
2. T.I.P. Project Number or State Project Number (NCDOT Only): Non-TIP and Non-Work
Order Number
3. Property Identification Number (Tax PIN)
N/A
4. Location
County: Vance Nearest Town: Henderson
Subdivision name (include phase/lot number): N/A
Directions to site (include road numbers, landmarks, etc.): From Henderson take Hwy 158
northeast to SR 1507 (Brookston Road). Make a right onto Brookston Road then left onto
SR 1506 (Curtin RoadZ
5. Site coordinates, if available (UTM or Lat/Long): Site 1:36.3754°N, 78.3384°W
_(Note - If project is linear, such as a road or utility line, attach a sheet that separately lists the
coordinates for each crossing of a distinct waterbody.)
6. Property size (acres): 3.6 acre (Project is 0.5 mi long)
7. Nearest body of water (stream/river/sound/ocean/lake): UT to Fishing Creek
8. River Basin: Tar Pamlico
(Note -this must be one of North Carolina's seventeen designated major river basins. The
River Basin map is available at http://h2o.enr.state.nc.us/admin/maps/.)
9. Describe the existing conditions on the site and general land use in the vicinity of the project
at the time of this application: Site is surrounded by agriculture land and residences.
Page 2 of 8

10. Describe the overall project in detail, including the type of equipment to be used: Grade,
drain, pave, and erosion control at SR 1506 (Currin Rd). The. NCDOT will also dewater the
work zone during construction at the pipe replacement site. Equipment may include
excavator, backhoe, bulldozer, grader, and crane.
11. Explain the purpose of the proposed work: The project is part of the secondary road paving
program. The existing_~ravel roadway will be paved with asphalt.
IV. Prior Project History
If jurisdictional determinations and/or permits have been requested and/or obtained for this
project (including all prior phases of the same subdivision) in the past, please explain. Include
the USACE Action ID Number, DWQ Project Number, application date, and date permits and
certifications were issued or withdrawn. Provide photocopies of previously issued permits,
certifications or other useful information. Describe previously approved wetland, stream and
buffer impacts, along with associated mitigation (where applicable). If this is a NCDOT project,
list and describe permits issued for prior segments of the same T.I.P. project, along with
construction schedules.
None that are known for NCDOT activities.
V. Future Project Plans
Are any future permit requests anticipated for this project? If so, describe the anticipated work,
and provide justification for the exclusion of this work from the current application.
No
VI. Proposed Impacts to Waters of the United States/Waters of the State
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
wetlands, open water, and stream channels associated with the project. The applicant must also
provide justification for these impacts in Section VII below. All proposed impacts, permanent
and temporary, must be listed herein, and must be clearly identifiable on an accompanying site
plan. All wetlands and waters, and all streams (intermittent and perennial) must be shown on a
delineation map, whether or not impacts are proposed to these systems. Wetland and stream
evaluation and delineation forms should be included as appropriate. Photographs may be
included at the applicant's discretion. If this proposed impact is strictly for wetland or stream
mitigation, list and describe the impact in Section VIII below. If additional space is needed for
listing or description, please attach a separate sheet.
1. Provide a written description of the proposed impacts The project proposes to replace the
existing structure Site 1. The NCDOT will also dewater the work zone during construction.
2. Individually list wetland impacts below:
Wetland Impact Area of Located within Distance to
Site Number Type of Impact* Impact 100-year Floodplain** Nearest Stream Type of Wetland***
(indicate on ma) (acres) (es/no) (linear feet)
N/A
Page 3 of 8

* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: mechanized cleating, grading, till,
excavation, tlooding, ditching/drainage, etc. For dams, separately list impacts due [o both structure and tlooding.
** 100-Year tloodplains are identified through [he Federal Emergency Management Agency's (FEMA) Flood Insurance Rate Maps
(FIRM), or FEMA-approved local floodplain maps. Maps are available through the FEMA Map Service Center at 1-800-358-9616, or
online at http:-%'w~~~w.fcma;,gov.
*** List a wetland type that best describes wetland to be impacted (e.g., freshwater/saltwater marsh, forested wetland, beaver pond,
Carolina Bay, bog, etc.) Indicate if wetland is isolated (determination of isolation to be made by USAGE only).
List the total acreage (estimated) of all existing wetlands on the property: NONE
Total area of wetland impact proposed: NONE
3. Individually list all intermittent and perennial stream impacts below:
Stream Impact
Length of Impact Average Width Perennial or
Site Number Type of Impact*
(linear feet) Stream Name** of Stream Intermittent?
(indicate on map) Before Im act (please specify)
Pipe replacement 20 ft
Rip rap along
iJT
1 streambank for 16 ft 2.5 ft intermittent
Fishing Creek
stabilization only
Temporary 36 ft (concurrent)
Dewatering
* List each impact separately and identify temporary impacts. Impacts include, but are not limited to: culverts and associated rip-rap,
dams (separately list impacts due to both structure and flooding), relocation (include linear feet before and after, and net loss/gain),
stabilization activities (cement wall, rip-rap, crib wall, gabions, etc.), excavation, ditching/straightening, etc. If stream relocation is
proposed, plans and profiles showing the linear footprint for both the original and relocated streams must be included.
** Stream names can be found on USGS topographic maps. If a stream has no name, list as UT (unnamed tributary) to the nearest
downstream named stream into which it flows. USGS maps are available through the USGS at 1-800-358-9616, or online at
www.us~s.~ov. Several Internet sites also allow direct download and printing of USGS maps (e.g., www.topozune.com,
www.mapqucst.com, etc.).
Cumulative impacts (linear distance in feet) to all streams on site:
Site 1:36 feet existing channel impacted (concurrent 36 feet temp impact from dewaterint;).
4. Individually list all open water impacts (including lakes, ponds, estuaries, sounds, Atlantic
Ocean and any other water of the U.S.) below:
Open Water Impact Area of
Name of Waterbod
y Type of Waterbody
Site Number Type of Impact* Impact (if applicable) (lake, pond, estuary, sound,
(indicate on ma) (acres) ba ,ocean, etc.)
N/A

List each impact separately and identify temporary impacts. Impacts include, but are not limited to: fill, excavation, dredging,
tlooding, drainage, bulkheads, etc.
5. Pond Creation
If construction of a pond is proposed, associated wetland and stream impacts should be
included above in the wetland and stream impact sections. Also, the proposed pond should
be described here and illustrated on any maps included with this application.
Pond to be created in (check all that apply): ^ uplands ^ stream ^ wetlands
Describe the method of construction (e.g., dam/embankment, excavation, installation of
draw-down valve or spillway, etc.): N/A
Page 4 of 8

Proposed use or purpose of pond (e.g., livestock watering, irrigation, aesthetic, trout pond,
local stormwater requirement, etc.): N/A
Size of watershed draining to pond: N/A Expected pond surface area: N/A
VII. Impact Justification (Avoidance and Minimization)
Specifically describe measures taken to avoid the proposed impacts. It maybe useful to provide
information related to site constraints such as topography, building ordinances, accessibility, and
financial viability of the project. The applicant may attach drawings of alternative, lower-impact
site layouts, and explain why these design options were not feasible. Also discuss how impacts
were minimized once the desired site plan was developed. If applicable, discuss construction
techniques to be followed during construction to reduce impacts.
All surface waters not affected by construction will be~rotected from unnecessary encroachment
during construction. Strict enforcement of Best Management Practices for the protection of
surface waters will be enforced during construction. On1Y the smallest amount of fill necessary
to complete the project will be placed in waters of the United States or protected riparian buffers.
VIII. Mitigation
DWQ - In accordance with 15A NCAC 2H .0500, mitigation may be required by the NC
Division of Water Quality for projects involving greater than or equal to one acre of impacts to
freshwater wetlands or greater than or equal to 150 linear feet of total impacts to perennial
streams.
USAGE - In accordance with the Final Notice of Issuance and Modification of Nationwide
Permits, published in the Federal Register on March 9, 2000, mitigation will be required when
necessary to ensure that adverse effects to the aquatic environment are minimal. Factors
including size and type of proposed impact and function and relative value of the impacted
aquatic resource will be considered in determining acceptability of appropriate and practicable
mitigation as proposed. Examples of mitigation that may be appropriate and practicable include,
but are not limited to: reducing the size of the project; establishing and maintaining wetland
and/or upland vegetated buffers to protect open waters such as streams; and replacing losses of
aquatic resource functions and values by creating, restoring, enhancing, or preserving similar
functions and values, preferable in the same watershed.
If mitigation is required for this project, a copy of the mitigation plan must be attached in order
for USAGE or DWQ to consider the application complete for processing. Any application
lacking a required mitigation plan or NCWRP concurrence shall be placed on hold as
incomplete. An applicant may also choose to review the current guidelines for stream restoration
in DWQ's Draft Technical Guide for Stream Work in North Carolina, available at
http: //h2o. enr.state.nc.us/ncwetlands/stnn~ide.httnl.
1. Provide a brief description of the proposed mitigation plan. The description should provide
as much information as possible, including, but not limited to: site location (attach directions
and/or map, if offsite), affected stream and river basin, type and amount (acreage/linear feet)
of mitigation proposed (restoration, enhancement, creation, or preservation), a plan view,
Page 5 of 8

preservation mechanism (e.g., deed restrictions, conservation easement, etc.), and a
description of the current site conditions and proposed method of construction. Please attach
a separate sheet if more space is needed.
40 ft of stream restoration by payment in the Ecosystem Enhancement Program
2. Mitigation may also be made by payment into the North Carolina Wetlands Restoration
Program (NCWRP). Please note it is the applicant's responsibility to contact the NCWRP at
[phone] to determine availability and to request written approval of mitigation prior
to submittal of a PCN. For additional information regarding the application process for the
NCWRP, check the NCWRP website at http://h2o.enr.state.nc.us/wrp/index.htm. If use of
the NCWRP is proposed, please check the appropriate box on page three and provide the
following information:
Amount of stream mitigation requested (linear feet): N/A
Amount of buffer mitigation requested (square feet): N/A
Amount of Riparian wetland mitigation requested (acres): N/A
Amount ofNon-riparian wetland mitigation requested (acres): N/A
Amount of Coastal wetland mitigation requested (acres): N/A
IX. Environmental Documentation (required by DWQ)
Does the project involve an expenditure of public (federal/state) funds or the use of public
(federal/state) land?
Yes ® No ^
If yes, does the project require preparation of an environmental document pursuant to the
requirements of the National or North Carolina Environmental Policy Act (NEPA/SEPA)?
Note: If you are not sure whether aNEPA/SEPA document is required, call the SEPA
coordinator at [phone] to review current thresholds for environmental documentation.
Yes ^ No
If yes, has the document review been finalized by the State Clearinghouse? If so, please attach a
copy of the NEPA or SEPA final approval letter.
Yes ^ No ^
X. Proposed Impacts on Riparian and Watershed Buffers (required by DWQ)
It is the applicant's (or agent's) responsibility to determine, delineate and map all impacts to
required state and local buffers associated with the project. The applicant must also provide
justification for these impacts in Section VII above. All proposed impacts must be listed herein,
and must be clearly identifiable on the accompanying site plan. All buffers must be shown on a
map, whether or not impacts are proposed to the buffers. Correspondence from the DWQ
Regional Office may be included as appropriate. Photographs may also be included at the
applicant's discretion.
Will the project impact protected riparian buffers identified within 15A NCAC 2B .0233
(Neuse), 15A NCAC 2B .0259 (Tar-Pamlico), 15A NCAC 2B .0250 (Randleman Rules and
Water Supply Buffer Requirements), or other (please identify )?
Yes ® No ^ If you answered "yes", provide the following information:
Page 6 of 8

Identify the square feet and acreage of impact to each zone of the riparian buffers. If buffer
mitigation is required calculate the required amount of mitigation by applying the buffer
multipliers.
Site 1
Zone* Impact Multiplier Required
s uare feet) Miti ation
1 1611 3 N/A
2 842 1.5 N/A
Total 2453 N/A
* Zone I extends out 30 feet perpendicular from near bank of channel; Zone 2 extends an
additional 20 feet from the edge of Zone 1.
If buffer mitigation is required, please discuss what type of mitigation is proposed (i.e., Donation
of Property, Conservation Easement, Riparian Buffer Restoration /Enhancement, Preservation or
Payment into the Riparian Buffer Restoration Fund). Please attach all appropriate information as
identified within 15A NCAC 2B .0242 or .0260.
XI. Stormwater (required by DWQ)
Describe impervious acreage (both existing and proposed) versus total acreage on the site.
Discuss stormwater controls proposed in order to protect surface waters and wetlands
downstream from the property.
Existing: 1.1 acre impervious surface (18 foot wide gravel road) of 3.6 acre total project size.
Proposed: 1.2 acre impervious surface (proposed 20 foot wide asphalt paved road) of 3.6 acre total
project size. The erosion control plan for this project is designed for 900 cubic feet of storage per acre.
Erosion and sediment control devices along the protect are comprised of temporary silt basins,
temporary rock silt checks, rock wipe inlet sediment traps, and temporary silt fences.
XII. Sewage Disposal (required by DWQ)
Clearly detail the ultimate treatment methods and disposition (non-discharge or discharge) of
wastewater generated from the proposed project, or available capacity of the subject facility.
The project will not s;enerate wastewater.
XIII. Violations (required by DWQ)
Is this site in violation of DWQ Wetland Rules (1 SA NCAC 2H .0500) or any Buffer Rules?
Yes ^ No
Is this an after-the-fact permit application?
Yes ^ No
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XIV. Other Circumstances (Optional):
It is the applicant's responsibility to submit the application sufficiently in advance of desired
construction dates to allow processing time for these permits. However, an applicant may
choose to list constraints associated with construction or sequencing that may impose limits on
work schedules (e.g., draw-down schedules for lakes, dates associated with Endangered and
Threatened Species, accessibility problems, or other issues outside of the applicant's control).
l~T/A
Applicant/A
(Agent's signature is

/ I
only if an authorization letter from the applicant is provided.)
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